ࡱ> %` UYbjbj"x"x .t@@1O%&&&<PPPd8, <dok2T" V)"d"4jjjjjjj$lh oXkP) ))kPP)k...)HPPj.)j..^fPPjH 0Zj+Bh6j?k0okxh.ao,BaoljaoPj,"$N.% &"""kk-"""ok))))dddDddddddPPPPPP Evil Water  By Subodh K. Singh, Ph.D. Scene 1 Location: College cafeteria, Sinte Gleska University (a tribal college) on the Rosebud Indian reservation in South Dakota. Five students are at a table enjoying a coffee break before their chemistry class. They are gossiping about nothing more important than how cold it has recently been. Erik, who is looking at a local newspaper, suddenly makes a loud exclamation. He has found an article in the newspaper about a current debate going on in the Tribal Council on whether or not the Tribe should allow a bar to open on the reservation. Liquor sales are currently prohibited on this reservation because of the misuse of drugs and alcohol by community members. People now have to drive 30-40 miles off of the reservation to get a bottle of liquor, wine, or beer. Erik is clearly disturbed as he finishes reading this article. Maria Sanchez: Whats up Erik? Why are you upset? Erik: I cant believe that someone is actually trying to get permission to open a bar on the reservation. (He is clearly angry) Everyone in the group is interested and worried about Erik being so upset. Maria is new to the reservation; this is her first year in the United States as a transfer student from Mexico. She does not want to offend Erik, but wants to know why he is upset about a bar opening on the reservation. Maria: Erik, what is special about opening a bar? There are bars on every street corner throughout the USA. Erik recognizes Marias genuine interest, so he controls his anger so he can explain why he is upset. Erik: You know Maria, alcohol has destroyed the lives of many people on the reservation. It isnt called evil water for nothing. I blame alcohol for many of the problems we have on our reservation today. So to prevent tribal members from consuming alcohol, the tribal council banned alcohol from the reservation. This ban has existed for a long time. We dont need easy access to alcohol and tribally sanctioned social settings where drinking is encouraged. I think I read an article in my sociology class about this. It recommended development of dry social contexts supported by high ranking role models and counselors like Elders. I dont think the ban should be lifted now. Maria: Well I can see that but driving 40 miles to a bar outside the reservation isnt good either. Theres too many accidents and deaths on the highway. I read in the paper last week that the military was going to start allowing some bars on military reservations for that reason. Finding the conversation interesting, Lane Pablo, whose mother is from the Navajo Nation, joins the discussion Lane: You know Maria, what strikes me is how resistant we Indians were to the inducements of alcohol in the beginning, when the Euro-Americans first came to our lands; refusing to drink to intoxication, loosing respect for the white men who did, and becoming angry when a chiefs son (an adolescent) was encouraged to get drunk and make a fool himself. A mere 20 years after this, with 9 out of 10 of our people dead from war, starvation, and the ravages of disease, and our culture and native economy in total ruin, the survivors were well on the way to becoming the people that we think we know today. I believe, that as a people, we are completely unable to handle alcohol. I know that there is probably more than one explanation for our susceptibility to alcohol, but I believe that it has been tragic for our life and culture. Erik: I dont know about our susceptibility. You hear that all time but are Indians really more susceptible? Why would that be? Drinking isnt just an Indian problem. Its just well hidden in the middle class. But I do think the factors that promote alcoholism and substance abuse here are different. The problem goes back a long way in Native communities. Didnt that psychology instructor we had last semester call it post colonization stress? You cant try to systematically annihilate a culture, take their lands, forcibly relocate people, and break up their families by sending their children to boarding schools without long-term consequences. And it isnt just the past. Theres no jobs here. What can anyone do ? You just about have to leave the community to find good work and adequate housing. People without hope drink. Maria: I can see why you and Erik feel so strongly about this. It is awful when unscrupulous individuals use alcohol to undermine your culture and economy. I have learned since Ive been here at Sinte Gleska, how equally dishonest people cheated Indians out of their land allotments after the Dawes (Allotment) Act of 1887. Lane feels Maria wants to know more, so he adds: Lane: You know Maria, there is a history of the introduction of foreign intoxicants by dominant or conquering cultures, and the results are uniformly bad ones. Perhaps the most often noted example, in addition to the Native American one, is the impact of opium on the Chinese. Opium was brought into China by the British from India, where it had been used ceremoniously for centuries without harmful effects. In China, however, this foreign substance quickly became a pernicious and addictive drug, a symbol of subjugation and escape. We now know what opium did to the Chinese people in the 19th century. Erik finds these facts interesting so he quickly adds: Erik: Indians have had their revenge by introducing tobacco smoking, which was not traditionally addictive for Indians, to white people. David Whiting has been listening very intently, but silently. Now he looks at his watch. David: O.K. guys, it is 10:03, we are almost late for class, so lets go. Professor Singh is never late for his class. The group leaves for their chemistry class. Scene 2 The chemistry classroom. Dr. Singh begins his lecture by starting to explain molecular orbital theory. Soon, however, he realizes that his students seem distracted. He interrupts his lecture to see if he can find out why the students are not as attentive as they usually are. Dr. Singh: David, is there something going on? You and your friends seem preoccupied. David: Yes, professor, before class we were discussing alcohol consumption and the reservation community. The conversation got pretty serious. The tribe is considering lifting the ban on bars on the reservation. But, I am little confused about this. For example, I know that about a month ago approximately 145 people died from drinking fake vodka in Russia and that here on the reservation people use and misuse alcohol. On the other hand, I know that most Americans drink alcohol on a regular basis, so, I would really like to know more about alcohol and its effects. If you dont mind, and the class agrees, could you please tell us something about alcohol and what you think about this issue ? Dr. Sing: O.K., lets change the lecture topic for today. I think this is a subject worth discussing. Lets talk about some of the basic science and well brainstorm other issues that seem important. Our class could follow this with the community discussion and actually testify at the tribal council. In 2005, Americans drank an average of 2 gallons (7.57 liters) of alcohol per person. This translates roughly into one six-pack of beer, two glasses of wine, and three or four mixed drinks per week. About 35 percent of adults do not consume alcohol, so the numbers are actually higher for those who do! Alcohol is an amazingly popular social phenomenon. While we notice it on the streets among the poor, its widespread in the middle class as well. Its just more hidden. Of course the level of consumption varies, but the problem is severe among American Indians and conventional treatments programs arent necessarily very effective. Indian communities are struggling with ways to deal with the problem. Its really an essential part of nation-building and some interesting programs rely on cultural reintegration as a key element of treating alcoholism. If you have ever seen a person who has had too much to drink, you know that alcohol is a drug that has widespread effects on the body, and that the effects vary from person to person. People who drink might become the life of the party or they might become sad and depressed. Their speech may slur and they may have trouble walking. It all depends on the amount of alcohol consumed, a persons history with alcohol, and a persons personality. Lets start by first briefly discussing the basic chemistry of alcohol. Although a great number of alcohols are known, the term alcohol is normally applied to ethyl alcohol, or ethanol. The name grain alcohol is often applied to this compound because it was formerly made exclusively from grains such as corn, barley, and rye. Alcohol is produced by the fermentation process, in which yeast breaks down sugars in the absence of oxygen. This alcohol (ethanol) in alcoholic drinks interferes with the transmission of nerve cells in the brains. This causes the buzz that people get from drinking alcoholic beverages, as well as the hangovers and other health problems. In part, it enhances the effect of a neurotransmitter called GABA (gamma amino butyric acid). GABA acts as an inhibitory neurotransmitter on the central nervous system. It has a sedative effect and causes sleepiness. Ethanol is a GABA-A agonist. This means that when ethanol attaches to signaling molecules known as GABA-A receptors, it causes the release of GABA-A. There are several different subtypes of GABA-A receptors, each of which triggers a different reaction to alcohol, from the sedative effect to memory loss to nausea. Ethanol also acts as an antagonist at the NMDA receptor. NMDA is a receptor for glutamines, a neurotransmitter responsible for passing messages from one nerve cell to another. Ethanol blocks its action. When the NMDA receptor is activated, it enhances stimulation of the nervous system. However, when an antagonist blocks the receptor, it suppresses the nervous system response and enhances the sedative effect of alcohol. Many of the positive effects that people feel when drinking alcohol are related to how it affects the cerebral cortex - the highest portion of your brain. There alcohol depresses the behavioral inhibitory centers. In other words, when we drink, we often become more social and confident. Alcohol also raises the level of the chemical dopamine in the brains reward center, which creates that buzzed feeling. These effects get more pronounced as the blood alcohol content (BAC) increases. In order to understand alcohols effects on the body, it is helpful to understand the nature of alcohol as a chemical, so lets take a look... Here are several properties of alcohol: Alcohol is a clear liquid at room temperature. Alcohol is less dense and evaporates at a lower temperature than water (this property allows it to be distilledby heating a water and alcohol mixture. the alcohol evaporates first). Alcohol dissolves easily in water and blood. Alcohol is flammable (so flammable that it can be used as a fuel). Alcohol can be made by four different methods: Fermentation of fruit or grain mixtures Distillation of fermented fruit or grain mixtures (Spirits such as whiskey, rum, vodka, and gin are distilled.) Chemical modification of fossil fuels such as oil, natural gas or coal (industrial alcohol) Chemical combination of hydrogen with carbon monoxide (methanol or wood alcohol) The alcohol found in alcoholic beverages is ethyl alcohol (ethanol). The molecular structure of ethanol looks like this: H H3 C - C - O - H H In this structure, C is carbon, H is hydrogen, O is oxygen, and the hyphens are the chemical bonds between the atoms. For purposes of clarity, the bonds between the three hydrogen atoms and the left carbon atom are not shown. The OH (O-H) group on the molecule is what gives it the specific chemical properties of an alcohol. You will not find pure alcohol in most drinks; drinking pure alcohol can be deadly because it only takes a few ounces of pure alcohol to quickly raise the blood alcohol level into the danger zone. For various types of beverages, the ethanol concentration (by volume) is as follows: Beer = 4 to 6 percent (average of about 4.5 percent) Wine = 7 to 15 percent (average of about 11 percent) Champagne = 8 to 14 percent (average of about 12 percent) Distilled spirits (e.g. rum, gin, vodka, whiskey) = 40 to 95 percent Most of the typical spirits purchased in liquor stores are 40 percent alcohol. Some highly concentrated forms of rum and whisky (75 to 90 percent) can be purchased in liquor stores. Some highly concentrated forms of whiskey (i.e. moonshine) can be made and/or purchased illegally. In most U.S. states, you must be 21 years or older to buy alcoholic beverages, and there are penalties for serving or selling alcoholic beverages to minors. Eric: So is that why theres a debate about the percent alcohol levels in products sold in different places? I heard that there are certain zones in some cities where there is a limit on the percentage alcohol in products that can be sold. I think they did that in Pioneer Square in Seattle to control all the alcoholism there. Dr Singh: Yes, thats right, Eric. Thats also a consideration in setting DUI tolerance levels on highways. They also attempt to control this through legislation aimed at risk levels in different age groups. Tolerance levels are much lower for young people, for example, who have much high accident rates. And men and women even have different tolerance levels. If you have seen someone who has had too much to drink, you have probably noticed definite changes in that persons performance and behavior. The body responds to alcohol in stages, which correspond to an increase in blood alcohol content (BAC): Euphoria (BAC = 0.03 to 0.12 percent) They become more self-confident or daring. Their attention span shortens. They may look flushed. Their judgment is not as goodthey may say the first thought that comes to mind, rather than an appropriate comment for the given situation. They have trouble with fine movements, such as writing or signing their name. Excitement (BAC = 0.09 to 0.25 percent) They become sleepy. They have trouble understanding or remembering things (even recent events). They do not react to situations as quickly (if they spill a drink they may just stare at it). Their body movements are uncoordinated. They begin to lose their balance easily. Their vision becomes blurry. They may have trouble sensing things (hearing, tasting, feeling, etc.). Confusion (BAC = 0.18 to 0.30 percent) They are confusedmight not know where they are or what they are doing. They are dizzy and may stagger. They may be highly emotionalaggressive, withdrawn or overly affectionate. They cannot see clearly. They are sleepy. They have slurred speech. They have uncoordinated movements (trouble catching an object thrown to them). They may not feel pain as readily as a sober person. Stupor (BAC = 0.25 to 0.4 percent) They can barely move at all. They cannot respond to stimuli. They cannot stand or walk. They may vomit. They may lapse in and out of consciousness. Coma (BAC = 0.35 to 0.50 percent) They are unconscious. Their reflexes are depressed (i.e. their pupils do not respond appropriately to changes in light). They feel cool (lower-than-normal body temperature). Their breathing is slower and shallower. Their heart rate may slow. They may die. 6. Death (BAC more than 0.50 percent) - The person usually stops breathing and dies. Now lets move to a brainstorm session about this. Lets move into small groups of two or three and I want you to generate questions that you think need to be answered in order to take an informed position before the tribal council about lifting the ban on alcohol sales on the reservation. The class dispersed into small groups. After working on questions for 20 minutes, they re-gathered to present their results on posters. Dr Singh: Ok, lets hear from the groups about what each of you think needs further exploration and then were going to ask to pick a topic to research and present at the next class. Eric, do you want go first here? Eric: Sure, our group had a number of questions about tribal history here. What do most tribes do? Do most ban alcohol? Does this actually make a difference? Are there any studies that show its better to do that? Dr Singh: ok, lots to work with there. Thats great. Lets hear from group 2, Maria? Maria: We were interested in knowing if there were some tribes that had successfully dealt with the problem of alcoholism. And if there were, what did they do? Can they be models for this tribe? Dr Singh: Great suggestion Group 2. Group 3? Dave: Our group wanted to know more about the physical effects of alcohol. Are Native Americans really more susceptible or is that another stereotype? Does alcohol lead to other kinds of physical problems? What about Fetal Alcohol syndrome (FAS)? My Mom works for the Community Services department, and she says there are big problems in terms of child welfare. Dr Singh: Well, thats a big agenda. For the next class each group will bring in a report on their topics. You might find it really useful to go talk with people in the community who are involved with some of these issues. I think theyd be happy to share what they know. See you next Tuesday. [The case can be taught as an interrupted case by stopping at this point and having students locate and read related articles see references - and then present results in a subsequent class answering some of the questions they raised. Alternatively, the case can be done in a single class in which the students are divided into groups at this point and given some or all of the articles below on these subjects to read and discuss and then move into Scene 3 below] Scene 3: The following Tuesday in Dr Singhs class. Dr Singh: All right, lets get going. Today were going to hear from all of you about what youve learned from your research. So lets use the following format: First, tell us what you read and then briefly outline the major points and what you concluded. Be sure to tell us what was surprising and most significant in terms of the debate about lifting the ban on alcohol sales here. Then at the end of the class, well take a straw vote about what we should tell the tribal council about lifting the ban. References Clawson, Roger. Beating Alcohol through Tribal Self-Help. APF Reporter Vol 13, #1 Index, downloaded 3/14/2008 at http:/ HYPERLINK "http://www.aliciapatterson.org/APF1301/Clawson/" /www.aliciapatterson.org/APF1301/clawson/clawson.html (This is the story of Alkali Lake, a First nations community that aggressively conquered alcoholism). Falcon, James. (August 15, 2005) Alcoholism, the Reservation, and the Government downloaded 3/14/2008 at  HYPERLINK "http://www.americanchronicle.com/articles/1878" http://www.americanchronicle.com/articles/1878 FAS in Native American Communities. Downloaded 3/14/2008 at  HYPERLINK "http://www.come-over.to/FAS/NAFAS.htm" http://www.come-over.to/FAS/NAFAS.htm. Gale, Nancy (1991) Fighting alcohol and Substance Abuse among American Indian and Alaska Native Youth. Eric Digest. Downloaded 3/14/2007 at  HYPERLINK "http://www.ericdigests.org/pre-9221/indian.htm" http://www.ericdigests.org/pre-9221/indian.htm Genetic Influences on Alcohol Drinking and Alcoholism downloaded 3/14/2007 at  HYPERLINK "http://www.indiana.edu/~rcapub/v17n3/p18.html" http://www.indiana.edu/~rcapub/v17n3/p18.html MMWR Weekly. August 1, 2003. Injury Mortality among American Indian and Alaska Native Children and Youth-United States, 1989-1998. Downloaded 3/14/2008 at  HYPERLINK "http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5230a2.htm" http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5230a2.htm Office of Applied Studies (2007). Substance Use and Substance Abuse Disorder Among American Indian and Alaska Natives. Downloaded 3/13/2008 from  HYPERLINK "http://oas.samsha.gov/2K7/AmIndians/AmIndians.pdf" http://oas.samsha.gov/2K7/AmIndians/AmIndians.pdf  Copyright held by AV. Please use appropriate attribution when using and quoting this case.  This case is for educational purposes. It is a hypothetical situation. The name of the college and reservation is only to provide context to the case.  American Indians have experienced massive losses of lives, land, and culture from European contact and colonization resulting in a long legacy of chronic trauma and unresolved grief across generations. BraveHeart and DeBruyn (1998).     PAGE  PAGE 1    &'/r P W #*^bbi""$=$)г{ hT_>*\ hT_H*hT_56\] hT_6]hT_6\] hT_6jhT_0JUhT_hT_CJOJQJ^JaJhT_CJOJQJ]^JaJhT_5CJOJQJ^JaJ%jhT_0J5OJQJU\^JhT_CJOJQJ^JaJ. 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