Book Review

Drinking Careers: A twenty-five-year study of three Navajo populations

N Engl J Med 1995; 333:199July 20, 1995

Article

Drinking Careers: A twenty-five-year study of three Navajo populations
By Stephen J. Kunitz and Jerrold E. Levy, with Tracy Andrews, Chena DuPuy, K. Ruben Gabriel, and Scott Russell. New Haven, Conn., Yale University Press, 1995. $28.50. ISBN: 0-300-06000-9

When one thinks of the scholars studying alcohol use among Native Americans, the team of Stephen J. Kunitz and Jerrold E. Levy may come to mind. A physician and an anthropologist, they have provided scholars with expertise and perspectives on the topic for the past 25 years. This book is a welcome addition to that tradition.

Kunitz and Levy refer to this book as a longitudinal study of Navajo drinking. It is that, but it is more than that. It also offers a retrospective view of their collaboration, an analysis of their current thoughts on alcohol use by Native Americans, and a call for prospective studies. Finally, it is a history, in that it considers Navajo alcohol use and alcohol-treatment programs in their historical contexts. (The authors even discuss the impact the New Age has had on treatment programs.)

Kunitz and Levy combine the natural-history tradition of clinical medicine with the concept of career, which has its origins in the social sciences. Their study of the cause of Native American alcohol use combines biologic (although not genetic), sociological, and psychological perspectives. Equally important, they present their findings in terms that both novices and experienced practitioners can understand. Thus, there is something for readers from virtually any background and persuasion.

In 1966, these authors studied 122 people from three groups of Navajo — a traditional, rural, stock-raising extended kindred; an urban sample; and a group of patients at the Public Health Service hospital. These community samples “were chosen to represent the range of socioeconomic and cultural variations on the reservation.” This book is a follow-up study of 112 (92 percent) of those they initially interviewed. They obtained complete life histories of 32 people who had died since 1966 and the current life histories (through 1990, when the study ended) of the rest. The findings are thought-provoking.

The authors describe different drinking patterns for males and females. They relate that “eighty percent of male social drinkers were abstinent in 1990, regardless of study group, and only 6 percent, all in the Hospital group, had died of causes that were probably alcohol-related.” It is equally interesting that a “high portion of high-risk men . . . were able to become abstinent over a period of twenty-five years.” They also describe the existence of many drinking patterns, a finding that “should help put to rest the idea that the high rate of alcohol abuse among certain Indian populations is biologically based.” Furthermore, in a case study of alcohol use in a single family over four generations, they conclude that the community environment, not alcohol abuse by the parents, is an important cause of abusive drinking.

Just as informatively, they found that few of the treatment programs use traditional therapies. They also suggest that “The belief that aboriginal religion and values are superior to those of modern medicine . . . may be counterproductive. . . . Such notions may serve only to accentuate the already existing division separating Indians from surrounding populations. It may, indeed, work to deprive Navajos and other Indian peoples of whatever theoretical and practical advances in treatment are made in the future.”

The book should be in the library of anyone interested in alcohol use by Native Americans, either as a retrospective study or as a wake-up call for the future. Among the concluding comments is the following: “Despite encouraging developments, however, it is also clear that there has been little progress in assessing the magnitude or even the nature of the problem.” The authors are to be commended for a job well done.

Walter Randolph Adams, Ph.D.
Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912