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Abstract
Frank et al. provided a useful synthesis of the cultural and historical roots of drinking problems among American Indians. We agree with the authors that further research into the origins of modern indigenous people’s problems with alcohol would benefit from an interdisciplinary "determinants of health" approach in which biological influences on alcohol problems are investigated in the context of the cultural, social, and economic forces that have shaped individual and group drinking patterns. However, we were dismayed by the contrast of that statement with the authors’ actual conclusions, specifically that "this article supports an argument that has been stated by others—that cultural dimensions of Native American drinking must be considered far more important than the notion that Native American’s propensity for heavy and dependent drinking is primarily genetic." This statement creates polarities, it is premature and oversimplified, and it will prove unhelpful in encouraging integrative research. The relative importance of causal factors is an empirical question. There are studies in the field, such as the Ten Tribes Study that we are pursuing, that have assessed genetic as well as cultural and historical factors. These endeavors may permit a quantitative answer to the questions of whether a model of cultural, historical, and genetic factors fits the data, and the relative proportion of the variance in drinking problems that is accounted for by each set of predictors. Until such data are available, speculation is premature.
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