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Human Services, 1998). Furthermore, unemployment is generally higher among AI/ANs (16.2 percent versus 6.4 percent nationally). Not surprisingly, poverty is often quite severe in AI/AN communities. In 2000, the median family income was $33,144 compared to $49,628 for the general population (U.S. Census Bureau, 2002). Thus, the AI/AN population is younger, is less educated, and has fewer economic resources than the rest of the U.S. population (U.S. Department of Health and Human Services, 1998). However, it is important to recognize that there is considerable variability across tribes and regions of the country (U.S. Department of Health and Human Services and Indian Health Service, 1997).

History

Although there was some exposure to alcohol among AI/ANs prior to European contact, it was confined mostly to agricultural peoples of the Southwest (Waddell, 1980). The majority of tribes gained their first experience with alcohol from frontiersmen, trappers, and traders—often under exploitative circumstances. Given the relatively rapid nature of this introduction and a lack of indigenous mechanisms to control alcohol use, problems with alcohol developed in many, but by no means all, AI/AN cultures (Abbott, 1998; Levy and Kunitz, 1974; MacAndrew and Edgerton, 1969; Mancall, 1995). Stereotypes of the “drunken Indian” soon abounded and tribal leaders—and then the federal government—attempted to control the use of alcohol (Mancall, 1995). Although AIs became U.S. citizens in 1924, federal laws prohibiting their use of alcohol remained in effect until 1953. Interestingly, up to 50 percent of tribes still limit access to alcohol within their reservation borders (Abbott, 1998).

Institutions

Educational, human, and health services in AI/AN communities have undergone radical changes in recent years. These are largely the result of the Indian Self-Determination and Educational Assistance Act (Public Law 93-638), which has given AI/AN tribes greater flexibility and autonomy to restructure human services. These changes are well illustrated by changes in health services delivery for AI/ANs. Since 1965, IHS has developed a system of ambulatory mental health services for Indian communities at no cost to those eligible. Hospitals and clinics are operated either by IHS or by tribes. Three distinct funding and provider models have evolved in AI/AN communities. In the first and original model, commonly referred to as direct service, federal agencies such as IHS function as both funders and providers of services. In the second model, federal agencies provide funding and tribes are the contracted providers (i.e., the federal agencies oversee the types and



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