RESEARCH

Assessing the Impacts of Legalization of Alcohol Sales on a Dry Reservation

Supplement Directors: Roland Moore, Ph.D. and Juliet Lee, Ph.D.

Introduction

Like states and many counties in the US, sovereign Indian nations may decide whether and how to legalize alcohol on their lands.  Of the 567 federally-recognized tribes, approximately 1/3 maintain complete prohibition of alcohol, while many more maintain partial restrictions on possession, consumption, and/or sales of alcoholic beverages.  In a number of American Indian and Alaska native communities where alcohol is prohibited, residents of those communities, including the majority who do not drink at all, wonder why their reservations experience severe physical and psychological damage from alcohol-related injuries, intimate partner violence, and other kinds of harm, even when sales and/or possession of alcohol is forbidden. 

It is difficult to assess how communities currently restricting all alcohol sales might improve or worsen the physical and psychological health of the individuals, families, and tribes who live there.  This study investigates the range of objectives as well as locally-defined measures of current and potential harms and benefits that reservation residents believe would occur if they decide to change the alcohol control policy or leave it alone. 

So why do alcohol-related problems occur in places where alcohol is prohibited?  Working with community and scientific partners on and near a reservation which was considering legalizing alcohol sales, we assessed the personal, social and economic impacts of alcohol availability on the reservation, and considered the potential impacts of legalization, using typical public health outcomes (such as alcohol-involved assaults and traffic collisions) as well as novel health indicators identified through qualitative inquiry with tribal members and other reservation residents.

 

Research Goals and Activities

Our overall goal is to understand how it is possible that less formal availability of alcohol might be related to more problems on Native American lands which prohibit sales and use of alcohol.  This is an important theoretical step for refining a presently underdeveloped yet widely used alcohol availability theory that is based primarily upon urban research. 

To achieve this goal, we formed a research group comprising alcohol researchers, a tribal non-profit development company located on a Great Plains reservation, and a non-profit owned and operated by American Indian health researchers in the region.  We sought and obtained the guidance and approval of the tribe's research review board before we began the study.

Collaboratively, we conducted a mixed-method study collecting different kinds of information about how alcohol is and might be sold and consumed under past, present and future policy constraints. 

We also observed, asked about, and analyzed data about the costs and benefits of each of these policy systems in and around the reservation:  

  • We interviewed community leaders and local experts about the effects of potential alcohol policy change from their perspective.
  • We conducted observations of goods and prices at stores, restaurants, and bars located on or near the reservation to understand how pricing varied with increasing distance from border cities, and which locations might sell alcohol if the tribe decides to change its alcohol control policy.
  • We looked for patterns in anonymous patient data from the local Service Unit of the Indian Health Service (IHS) to document alcohol involvement in illnesses and injuries within the current alcohol policy environment.
  • We analyzed publically-available hospitalization records for non-IHS facilities in the area (which are also used by reservation residents) in order to sort out the effects of living on- or off-reservation and extent of rural effects in the widely dispersed population living in and around the reservation.
We compiled these diverse data in order to shed light on the complex impacts of alcohol sales, use, and problems both on and off reservations in vast rural areas in the Great Plains.

Discoveries (Findings)

What we have learned so far is that there is little published information on tribal alcohol control policies and their influence on alcohol-related problems.  In the course of our collective study, we have:

  • Compared alcohol problems across large rural areas of two states (154,590 square miles) with those in urban areas, and assessed associations to American Indian populations and tribal lands; we found more alcohol- and drug-related hospitalizations (for example, from car crashes or alcohol abuse) in geographic areas with more American Indian residents, even after considering other community characteristics.  High rates of alcohol problems do exist among persons living on reservation lands despite prohibition.
  • Identified specific processes by which legalization could lead to greater or fewer alcohol problems in American Indian communities.  We have learned that alcohol problems may arise within a prohibition system when private individuals purchase alcohol to resell on reservation lands; they may sell to anyone, anytime, and are not responsible for what happens afterwards.  In addition, persons who legally sell alcohol just off the reservation may not responsibly manage beverage sales; they may sell to people at risk of drunken driving, those who spend limited family income on alcohol or buy alcohol when they are already intoxicated. 
  • Examined sales and marketing of alcohol around reservation boundaries to assess the relationship between alcohol marketing, American Indian populations, and local problems; we found evidence that the price of beer was marked up 44% when compared to city prices, single cans of beers could be marked up as much as 200%, and bootleggers were reported to sell alcohol at even greater markups.  These markups reflect greater distribution costs in rural areas, markups for ‘single sales' and legal risks entailed by bootleg sales.

What are the most helpful recommendations for policy makers?

At this point it appears that it is not possible to recommend prohibition as an unalloyed good for all American Indian tribes.  When tribal areas are surrounded by readily available alcohol, when bootlegging is a profitable activity, and when tribal members may easily access alcohol just off reservation lands for consumption at home, risks for alcohol problems may increase. 

More importantly, the very limited amount of research on this topic leads us to two critical recommendations.  Researchers must:

  • Specify the extent of alcohol-related problems found under different policy conditions across American Indian tribes in the U.S.; this will help us make well-informed decisions about elements of tribal alcohol control policies that they might choose to change.
  • Identify associated health risks in areas with particularly high rates of alcohol-related trauma in order to direct limited prevention and treatment services to critical populations.