Boozing, sniffing, and toking: an overview of the past, present, and future of substance use by American Indians.

This paper provides an overview of Indian peoples, alcohol misuse, and the prevalence of drug and inhalant experience. Early use of alcohol among North American Native peoples may represent early chemical warfare to gain European advantage over an "enemy." The magnitude of the present-day problem of alcohol and substance misuse is described in mortality rates and proportionate use reports. The use of other drugs and substances, such as inhalants, amphetamines, sedatives, and hallucinogens is examined. A brief overview of the history and complex relationships between American Indians and alcohol from the time of initial contact to the present is sketched out before approaches to primary, secondary and tertiary prevention are considered. The issue of potential conflict between tribal statutes and health objectives is noted. Some possible solutions are proposed.