N AMERICANS, including Alaskan Natives, have experienced significant problems with alcohol since its introduction into their cultures by the early European settlers. Morbidity and mortality rates attributable to alcohol abuse among the Native American population are at epidemic levels within certain segments of this population. As in the majority population, alcohol abuse substantially contributes to rates of death from all types of accidents, liver disease (including cirrhosis), homicide, suicide, other types of psychiatric illness, and fetal alcohol effects and fetal alcohol syndrome (Young, 1991). With a Native American/Alaskan population of approximately 2 million people representing more than 300 distinct tribal and ethnic groupings, the magnitude of the problem is quite large. The term Alaska Natives often collectively refers to three indigenous and linguistically distinct groups: Eskimos, Indians, and Aleuts (Phillips and Inui, 1986). Eskimos represent approximately 8.5% of the Alaskan population and include the Yupikand Inupiat-speaking groups. Indians represent approximately 5.4% of the Alaskan population and include the Tlingit, Haida and Tsimpshian, and Athabascan tribes. Aleuts comprise approximately 2% of the population and are found in the Aleutian Island chain, as well as in south central Alaska. Although a number of investigations of alcohol problems among Alaska Natives have been undertaken, few have used standardized assessment measures or sampling procedures that permit direct comparisons with studies conducted on the majority population. We have previously provided a comprehensive clinical description of 650 Alaska Natives in residential treatment in Anchorage for alcohol dependence by using a standardized assessment protocol (Hesselbrock et al., 2000; Parks et al., 2001). These Native Alaskan inpatients were typically affected with a very severe form of alcohol dependence. Lifetime comorbid drug problems were also quite prevalent. Major affective disorder due primarily to alcohol abuse and withdrawal was the most frequently reported psychiatric condition; antisocial personality disorder (ASPD) was also quite prevalent among both males and females. Alaska Native alcoholics with comorbid ASPD had a particularly early onset of first intoxication (average, 11.5 years) and onset of regular drinking (average, 14.5 years). Both males and females with ASPD had a rapid development of alcohol problems and entered treatment at an early age (approximately 23 years). Multivariate cluster analysis yielded a two-cluster solution similar to those of Babor et al. (1992): type A (later onset and milder form of alcohol dependence) and type B (adolescent onset, more childhood problem behaviors, adult antisocial traits, and multiple alcoholism treatments). Type B individuals were more likely to be characterized by parental alcohol dependence and antisociality. Female patients reported a poorer overall perceived health status than men, and 49% of the women experienced some form of personal violence; in general, their victimization was related to drinking by themselves and the perpetrators and to their treatment outcomes. However, even with this severe form of alcoholism, general medical health care utilization among hospitalized Alaska Natives with alcohol dependence is quite similar to the health care utilization patterns found among index inpatient alcohol-dependent patients participating in the Collaborative Study on the Genetics of Alcoholism (COGA) study (Hesselbrock et al., 2001; Reich et al., 1998) (Table 1). In general, the number of lifetime overnight stays for medical reasons, outpatient surgeries, emergency room visits, and clinic or doctor visits in the 6 months before the interview did not vary across the different ethnicities, although the rates did vary by gender. It is important to note that, even given the differences in geography and the density of health care availability, Alaska Natives used general health care and hospital care for alcohol or substance abuse problems as frequently as alcohol-dependent patients from the COGA study subjects living in the lower 48 states. When the alcohol-dependent Alaska Native sample was compared with the COGA sample in relation to mental health utilization for all types for problems (see Table 2), including alcohol or substance abuse, some differences were noted. Male Alaska Natives with alcohol dependence were less likely to use the services of all types of mental From the Department of Psychiatry (VMH), University of Connecticut School of Medicine, Farmington, Connecticut; School of Social Work (MNH), University of Connecticut, West Hartford, Connecticut; and University of Alaska (BS), Anchorage, Alaska. Received for publication May 20, 2003; accepted May 21, 2003. Supported by NIH Grant AA10288 and the NIH Office on Minority Health Research (Grants U10AA08403, AA03510, and MO1 RR6192). Reprint requests: Victor M. Hesselbrock, PhD, Department of Psychiatry, MC-2103, University of Connecticut School of Medicine, Farmington, CT 06030-2103; Fax: 860-679-4077; E-mail: hesselb@psychiatry.uchc.edu. Copyright © 2003 by the Research Society on Alcoholism.
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