Native American cultures, which encompass American Indian, Alaska Native and Native

Hawaiian tribes, are rich with history, tradition, spirituality, and art. There are 562

Federally recognized tribes across the United States,1 each with its own distinctive identity.

However, one thing many tribes share is alcohol problems and other health disparities.

Native American populations experience significant health issues compared with the

general population. They have higher death rates from alcoholism, tuberculosis,

diabetes, accidents, suicide, homicide, and other causes. Their life expectancy is 6

years lower than the U.S. average.2

WHAT YOU NEED TO KNOW

WHAT IS THE SCOPE OF FASD AMONG

NATIVE AMERICAN POPULATIONS?

Native Americans have some of the highest rates of fetal

alcohol syndrome in the Nation. Among some tribes, the

rates are as high as 1.5 to 2.5 per 1,000 live births.3 Among

others, the rates are comparable to that of the general

population in the United States and range between 0.2

to 1.0.3,4

Alcoholism is one of the most significant public health

problems for Native Americans. They are five times more

likely than whites to die of alcohol-related causes, including

liver disease. They also have higher rates of drunk driving

and related deaths than the general population.5

Some tribes are leading the way toward preventing and

treating alcohol problems in Indian Country through

education, training, and other strategies.

WHAT ARE FETAL ALCOHOL SPECTRUM

DISORDERS?

“Fetal alcohol spectrum disorders” (FASD) is an umbrella

term describing the range of effects that can occur in an

individual whose mother drank alcohol during pregnancy.

These effects may include physical, mental, behavioral,

and/or learning disabilities with possible lifelong

implications. The term FASD is not used as a clinical

diagnosis. It refers to conditions such as fetal alcohol

syndrome (FAS), alcohol-related neurodevelopmental

disorder (ARND), and alcohol-related birth defects

(ARBD). Each year, at least 40,000 babies are born with

an FASD, costing the Nation up to $6 billion. The average

lifetime cost for one individual with FAS is approximately

$1.4 million.6

WHY IS FASD A PROBLEM AMONG NATIVE

AMERICANS?

The underlying causes of health disparities are complex.

The history of Native Americans is filled with violence,

oppression, displacement, and loss of self-determination.

This legacy of trauma is believed to be a factor in many

problems, including alcohol abuse.7

Poverty and inadequate access to health care also play a

role. About 32 percent of Native Americans live below

the poverty level, compared with 13 percent of all

Americans.2 In addition, Native American communities

are very young, with a median age of 24. This is almost

10 years younger than the overall population.2 This

difference tends to magnify the impact of binge drinking

and risky behaviors, which are more common among

youth.8

FASD, as well as alcoholism and alcohol abuse, are serious

problems in some Native communities. However, the

stereotype of the drunken Indian is misleading. In some

tribes, alcohol use is similar to or lower than the general

U.S. population. On a typical day, abstinence is

common.9,10

WHAT IS BEING DONE TO ADDRESS FASD

AMONG NATIVE AMERICANS?

Services are greatly needed to address FASD in Native

American communities, including prevention efforts and

interventions for children and adults with an FASD.

The prevalence of FAS in Alaska is 5.6 per 1,000 live

births for American Indians/Alaska Natives, compared

with 1.5 per 1,000 in the State overall.5

FETAL ALCOHOL SPECTRUM DISORDERS AMONG

NATIVE AMERICANS
Pregnancy is Sacred

For more information, visit fasdcenter.samhsa.gov or call 866-STOPFAS.

www.stopalcoholabuse.gov

DHHS Publication No. (SMA) 07–4264

Printed 2007

An assessment of 10 tribal reservations and five urban Indian

Community Health Centers showed that such services were

limited or nonexistent.11

Interventions should:

• Incorporate tribal practices, combining mainstream,

evidence-based strategies with traditional elements such

as talking circles and ceremonies

• Address alcohol issues in families to break the cycle of

alcohol abuse, since FASD is often a multigenerational

problem

• Incorporate collaborative, holistic approaches both at

home and school for people with an FASD, such as training

in effective parenting and teaching strategies

The Substance Abuse and Mental Health Services

Administration’s FASD Center for Excellence is working

with tribal leaders to develop culturally appropriate resources,

provide training on prevention and intervention, and identify

best practices. Building on the cultural strengths of Native

American communities can support positive outcomes at

all stages, from early intervention for infants to adult

support services.

Pregnancy is a sacred time for many Native Americans. Many

tribes share the belief that individuals must consider the

impact of their decisions on the next seven generations.

Preventing alcohol abuse during pregnancy is a powerful

way to protect future generations and ensure that all

children have a healthy start, free of FASD.

RESOURCES

Washington State Department of Social and Health

Services. Journey Through the Healing Circle series.

To order, contact the Washington State Alcohol/Drug

Clearinghouse at 206-725-9696 or visit www1.dshs.wa.gov.

National Indian Child Welfare Association. Beyond the

Gloom and Doom: Tools for Help and Hope With Native

People Affected by Fetal Alcohol Syndrome and Related

Neuro-Developmental Disorders. To order, call 503-222-

4044 or visit www.nicwa.org.

Center for Substance Abuse Prevention. Drinking and Your

Pregnancy. To order call 800-729-6686 or visit

http://ncadistore.samhsa.gov/catalog/productDetails.aspx?

ProductID=17174

REFERENCES

1. 68 Federal Register 68179-68184. December 5, 2003. Part III. Department

of the Interior. Bureau of Indian Affairs. Indian Entities Recognized

and Eligible To Receive Services From the United States Bureau of

Indian Affairs. Notice.

http://homer.ornl.gov/oepa/rules/68/68fr68179.pdf

2. Indian Health Service. Trends in Indian Health, 2000-2001. Rockville,

MD: U.S. Department of Health and Human Services.

www.ihs.gov/NonMedicalPrograms/IHS_Stats/Trends00.asp

3. Centers for Disease Control and Prevention. 2002. Fetal alcohol

syndrome—Alaska, Arizona, Colorado, and New York, 1995–1997.

MMWR 51(20):433-435.

www.cdc.gov/mmwr/preview/mmwrhtml/mm5120a2.htm

4. May, P.A., and Gossage, J.P. 2001. Estimating the prevalence of fetal

alcohol syndrome: A summary. Alcohol Research & Health 25(3):159-

167. www.niaaa.nih.gov/publications/arh25-3/159-167.htm

5. Office on Women’s Health. National Women’s Health Information

Center. No date. Health Problems in American Indian/Alaska Native

Women. Washington, DC: U.S. Department of Health and Human

Services. www.4woman.gov/faq/american_indian.htm

6. Lupton, C.; Burd, L.; and Harwood R. 2004. Cost of fetal alcohol spectrum

disorders. American Journal of Medical Genetics 127C (671):42-50.

7. Center for Substance Abuse Prevention. 1994. Gathering of Native

Americans. Rockville, MD: Substance Abuse and Mental Health Services

Administration. p2001.health.org/CTI05/Cti05ttl.htm

8. May, P.A. 1995. The epidemiology of alcohol abuse among American

Indians: The mythical and real properties. American Indian Culture

and Research Journal 18(2):121-143. www.ihs.gov/publicinfo/

publications/healthprovider/issues/IHSProMar2.asp

9. May, P.A., and Gossage, P. 2001. New data on the epidemiology of

adult drinking and substance use among American Indians of the

northern states: Male and female data on prevalence, patterns, and

consequences. American Indian and Alaska Native Mental Health

Research 10(2):1-26.

10. Spicer, P.; Beals, J.; Croy, C.; et al. 2003. The prevalence of

DSM-III-R alcohol dependence in two American Indian populations.

Alcoholism: Clinical and Experimental Research 27(11):1785-1797.

11. SAMHSA FASD Center for Excellence. FASD in Indian Country Site

Visit: Final Report Executive Summary. March 2004. 

http://fasdcenter.samhsa.gov/documents/

FASDNASiteVisitExSum0404.pdf