Native American Alcoholism
Alcoholism is a substantial problem for Native Americans (May, 1994). Native American alcohol consumption rates are not higher than those of the general population, but there are higher rates of alcoholism and alcohol-related problems. This higher incidence of alcohol-related problems among Native Americans has been attributed to the social disintegration and breakdown that resulted from their domination and subjugation on reservations. Alcoholism became a rampant problem on many reservations as lifestyles were altered without meaningful replacement, and the enforced reservation restrictions increased tensions and frustrations. Problems with alcoholism became particularly acute among groups previously accustomed to the hunter-gatherer lifestyle and the freedom of movement it had entailed. Alcohol consumption has served not only as a means of reducing stress but, paradoxically, also as a means of asserting Native American identity. The Euro-American culture developed the stereotype of the Native American as an uncontrollable drunk, a perception strengthened by the increased alcohol use by Native Americans as a response to cultural and personal disintegration. Congressional action outlawed alcohol on reservations to protect them. These stereotypes reinforced for Native Americans the equating of drunkenness with "Indianness" and thereby served as a means of public assertion of Native American identity. For many Native Americans, drinking served as protests against Euro-American culture, especially during the prohibition movements outlawing alcohol in the early twentieth century.
Alcohol consumption among Native Americans is a means of establishing camaraderie; such use is particularly prevalent among young men. The population bulge of young Native Americans makes the incidences of alcohol consumption appear higher when not age adjusted. Most young male Native American drinking is not true alcoholism but instead the approximate normative patterns for other Americans. Their drinking behavior is an important part of life-cycle development: dealing with prohibited opportunities, peer group relations, and male solidarity (also see Kunitz, 2006).
Native Americans' drinking patterns and problems largely reflect the consequences of U.S. laws restricting alcohol possession on reservations. This forces alcohol consumption to be a public rather than a private affair. Because drinking is an off-reservation activity, it presents problems not encountered when people have the option of home consumption. Alcohol-related problems reflect consequences of the broader social systems. The federal governments' prohibition of alcohol on reservations results in off-reservation binge drinking, which presents additional problems when they are returning home on often poor two-lane highways filled with other drunks. The remoteness of reservations means access to ambulances and medical facilities for alcohol-related accidents can take hours, increasing mortality. Thus, for Native Americans, the problems of alcohol reflect macrolevel factors rather than strictly personal or cultural dynamics.
constitution or the approved amendments. Many have asserted that the federal government lacks the constitutional authority to regulate what we put into our bodies, including medicines and drugs.
So after Timothy Leary's successful Supreme Court challenge to the federal restrictions on marijuana, Congress enacted administrative control over marijuana and other political drugs such as LSD, psilocybin, and peyote by regulating them as medicines under public health provisions. No constitutional amendment was passed to regulate marijuana; instead, regulation was achieved by political maneuvering directed by the Richard Nixon White House staff. Legislation classifying these substances as medicines made them subject to regulatory control through the channels of the government's administrative law bureaucracy, rather than on the basis of the evidence regarding their medical effectiveness. The federal government has used this control to not only prohibit use but also to systematically block research into marijuana's therapeutic potential and to carry out a war against its citizens who assert what they view as their constitutional rights.
The federal government's administrative classification of marijuana and other ethno-medicines (e.g., psychedelics) as illegal drugs reflects an effort at ideological control over forms of consciousness permitted in society. Our society condones the production and distribution of drugs such as alcohol and nicotine that were at the foundation of American culture (see Winkelman, 2006a, Chapter Four), but other forms of drug-induced alterations of consciousness have been long criminalized in the West (Winkelman and Bletzer, 2005). The classification of medicines as substances with a potential for abuse is done in political terms and through political processes, rather than in terms of medically defined criteria regarding harm. Clearly, tobacco and alcohol have an enormous potential for abuse and are contributory factors in the major causes of mortality for Americans. Tobacco and alcohol are not classified as substances with a potential for abuse, however, and their use is not prohibited by the federal government. The right to kill ourselves with these drugs is part of our individual liberties guaranteed under the constitution!
The classification of a substance was formally awarded by Congress to the Attorney General of the United States, who delegated the power to the head of the Drug Enforcement Agency (DEA). Boire (2007) points out that this is a position traditionally held by law enforcement officials and people with legal backgrounds, not people with medical backgrounds. DEA appointees generally lack medical backgrounds and, instead, are political appointees and vocal proponents of the drug war that helps politicians look "tough on drugs." Consequently, despite specific requirements set out by federal law for scheduling a substance, the DEA administrator has acted against many substances in blatant disregard of the available medical evidence. Federal restrictions reflect the government's ideological use of political power to oppress medical freedom for patients. This control opposes patients' rights to treat themselves with the best remedies available.
The use of marijuana as an effective remedy for a wide range of conditions is substantiated by many forms of evidence (Ratsch, 2005). In recent years, medical studies have found it most useful for stimulating appetite in patients who have lost the will to eat from cancer, radiation and chemotherapy treatment, and the AIDS-wasting syndrome. One might presume that medical knowledge would determine the availability and applications of marijuana as a treatment for these conditions. Instead, marijuana is precluded from medical use by a federal administrator's regulatory decision, a political act that classifies it as a Schedule I substance, meaning it is considered to be without medical use and considered more dangerous than cocaine and morphine, which have "approved" medical uses.
The political battles over the control of consciousness continue today across America. States across the country have passed ballot measures that allow for the medical use of marijuana for the treatment of medical conditions. The local state's authorizations have been repeatedly challenged by federal officials, who have harassed and prosecuted doctors and medical marijuana centers even when they are legal under state law. The lack of constitutional authority has not precluded the powers of the federal government from contradicting the will of the people and attacking patients who depend on these substances for their health. The federal government's regulatory activities and War on Drugs have come to constitute a major force in compromising civil liberties.
The federal efforts to maintain a criminalized status for medical marijuana use despite enabling state legislation deprive patients of the treatments they need. The actions of the federal regulatory agencies place questionable government prerogative over the rights of individuals to have access to the medicine they need for comfort, health, and even survival. The federal government has criminalized their health behaviors, even driving many to suicide over the despair faced when their health issues are compounded by the stresses and costs of legal defense and incarceration (see the Web site of the Drug Policy Foundation, http://www.dpf.org). Continued federal efforts to criminalize even informing people about the potential beneficial effects of marijuana in treating their diseases reflect an ideological policy taking precedence over good medical advice.
Changing the oppressive federal climate regarding medical marijuana use, as well as the therapeutic application of other ethnomedicines such as those called hallucinogens and psychedelics, requires a broad-based effort involving many existing groups and coalitions. Winkelman and Roberts (2007b) have provided an overview of the multiple levels of society at which we need to act to change the current political climate that regulates these substances. Political pressure on federal regulatory agencies remains a central approach for opening up experimental use of these substances. This pressure involves many forms of coalitional action, including general education, education of the media, activities in public health, and policy organizations. What remains key is applying the cumulative scientific, clinical, ethnographic, and cross-cultural evidence regarding the immense potentials of these substances to public policy development to facilitate professional, media, and popular pressure to effect administrative changes in federal regulation. In Psychedelic Medicine, Winkelman and Roberts (2007b) have laid the groundwork for this public health and harm reduction endeavor. Education, public policy development, and collective political action, rather than additional science, is necessary to change opportunities for the use of psychedelics in the treatment of some of the most ravaging social diseases of our times, such as the addictions to alcohol, tobacco, methamphet-amines, and opiates and their synthetic derivatives. The generally acknowledged success rates of the conventional addiction treatment industry is not much different from the spontaneous remission rate. In contrast, the effectiveness of the use of psychedelics, particularly peyote, ibogaine, ayahuasca (caapi), LSD, and ketamine, appears impressive (see Winkelman and Roberts 2007a, Volume 2).
Physicians have a moral imperative to seek the applications of these more effective treatments for these devastating psychosocial diseases. The complex legal maneuvers in federal, state, and local venues to protect medical marijuana patients, physicians, and dispensaries have relied on a variety of community coalitions that are networked across the country. The Coalition for Medical Marijuana has united medical, legal, and public policy efforts across the United States. Combined educational and legal approaches have been emphasized by the Center for Cognitive Liberty and Ethics (CCLE) (http://www. cognitiveliberty.org) as well. The CCLE is a network of scholars who address issues in the intersection of law and policy issues as they pertain to cognitive freedoms to use psychedelic medicines and other drugs. Their educational and policy approach has addressed policies necessary to preserve the ethics of the freedom of thought regarding these substances. The
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