Dispelling the Myths: Native Communities

0:00:11 Andrew Williams
Welcome to Let's Talk Recovery Equity. A series of conversations about how we can reach and help more find freedom from addition. This series offers us a space to reflect on some of the complexities of substance use and mental health conditions. And to consider pathways to hope, recovery, and healing. I'm your host, Andrew Williams, Director of Diversity, Equity, and Inclusion for the Hazelden Betty Ford Foundation. Today, I appreciate the opportunity to speak with our special guest, Ted Alcorn. Who's an independent journalist raised in Albuquerque, New Mexico. And who's reporting on health and justice has appeared in various local and national publications such as the New York Times, the Atlantic, the Washington Post magazine, just to name a few. Ted has recently written a seven-part series for the New Mexico in-depth. Focused on the rising trend of alcohol use disorders in New Mexico. And promising solutions to addressing alcohol use disorders and health equity. Ted, welcome to our show and thank you for joining us today.

0:01:19 Ted Alcorn
Thanks for having me. [smiles]

0:01:23 Andrew Williams
All right. Well I'm gonna move straight ahead into our first question and ask you to help our viewers to understand what was the inspiration behind your recent seven-part series? And especially that segment called Poisonous Myths focused on Native American communities.

0:01:40 Ted Alcorn
Well the starting point for the series was really a single data point. An editor at New Mexican Death asked me to look into alcohol and its impact on the state. And I quickly came to understand that the state has a far higher rate of alcohol-related deaths than anywhere else in the country. Not just by a little bit but by a lot. And that those deaths have been growing a lot over time. And frankly, it's a little bit of a mystery why. The state has higher rates of alcohol-related deaths than states that are poorer, and states where there are more drinkers, and than in states where the drinkers drink more. So as I sort of went in unraveling this mystery, I started to understand a little bit more the crisis that the state is facing, but also some of the blindspots that have kept the state from tackling it. And one of the blindspots in New Mexico and I think that we probably routinely encounter elsewhere is that when people hear about alcohol-related deaths, they often say well is that a probably related to racial disparities? And particularly in New Mexico, is that related to the Native population? And whether well-meaning or not well-meaning, I think they're basing that on the assumption that there are higher rates of alcohol-related disease among Native people, and that that might be explanatory for the state's overall high rate of alcohol-related deaths. It could also be a way of sort of shunting away responsibility, of saying isn't this somebody else's problem, isn't this a different group's problem and not the state's? So, I felt like it was really important to tackle this and to look at the facts and one of the things that come across immediately is that there are huge inequalities, huge disparities, in alcohol-related harms within New Mexico. And Native peoples do have much higher rates than other demographic groups. But—and it's a big but—they don't account for the state's high rate of alcohol-related deaths. And in fact every demographic group and gender in New Mexico experiences higher rates of alcohol-related harms than their peers elsewhere. So for me, I think it was both important to look at the inequalities that afflict the state, but also to recognize there is a shared responsibility to address them and you know the state's problems aren't attributable to any single group.

0:03:58 Andrew Williams
Well thank you, Ted, for that response and helping us to kind of more fully understand why you chose New Mexico. Now as you brought your sort of analysis to looking at alcohol use disorder in New Mexico—and I really appreciate the ways in which you highlight what an outlier it is in terms of the levels of alcohol use disorder—and why did you choose to focus on the town of Gallup in particular and the surrounding county of McKinley?

0:04:24 Ted Alcorn
So for folks who don't know the geography of New Mexico too well, Gallup is just a small town of about 20,000 people in the western part of the state. Even people in New Mexico might only know it as a town that they drive through on the Interstate going west or east or a transit hub for the trains that run through. But because of its unique geography, it's sandwiched between the Navajo nation, Zuni and Hopi reservations are also nearby. It's a trading post. It draws a lot of out-of-town residents to buy groceries, to shop, to do all the things that serve urban life requires or offers. And for generations, it's been known as a place where you could also buy alcohol. And there's reservations and the Navajo nation have long-standing prohibitions on the possession of and consumption of and sale of alcohol. So, it's sort of a little bit of artifact of its geography. But Gallup has been a place where a lot of people come to drink and where a lot of the harms of alcohol are really visible. On the streets and the roadways. And so it has had for a generation within New Mexico and maybe beyond its borders, a reputation as a place that was really afflicted by alcohol. Thirty years ago, the Mayor, Edward Munoz at that time, he was trying to tackle the issue head-on. He declared the town 'Drunk Town, USA.' He was trying to make the public aware of and face this alcohol-related problem, but it also brought a lot of stigma on the place. And that stigma is really woven in with the stigma around alcohol use in Native peoples. Because most of the people who are observed inebriated on the streets were Native.

0:06:14 Ted Alcorn
So, I felt like it was important to focus on it because it is a place that has much higher rates of alcohol-related deaths than other parts of our state, in New Mexico. But also that it's sort of this physical embodiment of some of the stigma and the harms that have been assigned. And when I went there to report I both wanted to understand, you know, the sort of this stark—the starkness of the problem and how it was affecting the place, but also to look honestly at how the place is addressing it. Because Gallup, going back to that mayor thirty years ago, has been more open, I think, and more proactive about addressing alcohol use and alcohol environment than anywhere else in the state. So that—that spotlight in a sense that has been stigmatizing in some way, has also I think goaded the community into action.

0:07:03 Andrew Williams
All right, thank you, Ted, you've given us a nice kind of entry point into beginning to talk about solutions. But I wanna circle back just before we move into that conversation around solutions. I think what you shared in your earlier response and what we find in your series, especially that piece on Poisonous Myths, right, is that one of your key arguments is that it's really mistaken, you know, to attribute the high levels of alcohol use disorder and deaths associated with alcohol use disorder, to the Native American communities in that region. That it's a much more widespread problem. But with that, it's sort of an important context. Do we see disparities between Native American alcohol consumption and deaths associated with alcohol consumption in the rest of the population. You know, here in Minnesota where I'm from, we have huge disparities. Where African-Americans are almost five times more likely to die from overdose. And I think for Native Americans in Minnesota, the rate is almost seven times as high. So are there similar disparities there and how would you begin to explain those?

0:08:06 Ted Alcorn
So, there's a lot of different kinds of data we can look at I suppose. And I have a background in Public Health so I'm a big fan of sort of going to the basic and most indisputable kind of data we have. And so when we look at, for example, alcohol-related deaths or deaths that are entirely attributable to alcohol I should say, we see these big disparities. You know, the Native population in New Mexico has death rates that are many-fold greater than Hispanic population, we're told experience higher rates of death than the Anglo population in New Mexico, there's the biggest demographic groups. So, as somebody who cares about health and equity, that's intrinsically a problem. You know, the high preventable nature of these deaths, the catastrophic consequences of them, is something that should concern all New Mexicans. But the fact that different New Mexicans are bearing the risk unequally is unjust as well. But then how we explain those disparities is really important. And historically I think, and maybe even commonly, people have bought into a mythology that perhaps alcohol use disorder or the severity of alcohol-related disease, are attributable to Native people having different genetics. And without a doubt, genetics plays a role in addiction. You know, the scientists tell me about 50 percent of a person's risk of developing an addiction is heritable. It's not in their control, it's a part of their genetic makeup. People who have a lot of history of addiction in their family need to be aware of that, right, and concerned about that. But, that's very different from saying that Native people as a whole have higher rates of—or a higher propensity—for addiction or severe alcohol-related disease. And that, despite the fact that for years people have searched for such evidence, there's just no—there's no scientific evidence that genetics explains that disparity. And researchers told me, you know, that myth is important and problematic, because it creates the sense that for Native people that addiction and alcohol use disorder are their destiny, you know? That it's built in, there's nothing they can do about it.

0:10:21 Ted Alcorn
In fact, when we open our minds to the possibility those disparities can stem from other factors, we start to look at the really unequal treatment of Native people, in New Mexico and nation-wide, since the beginning. Since the beginning of the history of this colonization or this country, and the ongoing unequal treatment of that population. New Mexico, the Indian Health Service gets about a third of the funding for each patient that other federal health programs are able to provide their patients. Native people in New Mexico experience much higher rates of unemployment, violence, poverty. And so those factors we know can contribute to higher rates of social disorder and of addiction. And the researchers tell me that's really what we need to think about as the sources of these disparities.

0:11:12 Andrew Williams
Well thank you, Ted. And I really appreciate the way you're helping us to explode these myths around any sort of genetic basis, right, to alcohol use disorder among Native Americans. And I really appreciate the ways in which you speak to the kind of contemporary political economic policies, social conditions, that actually contribute to this. And, you know, once we move away from the sort of biological explanations, right, I think a more historical, social, kind of systems explanation also often speaks to the role of intergenerational trauma as well. I wonder if you could speak to that because I believe your answer is also partly, you know, validating that as a grounding of the challenges but not an exclusive explanation itself.

0:12:00 Ted Alcorn
Yeah, you know, I found it on the one hand I was reading a lot of the science about this, but then I was just talking to Native clinicians, Native counselors, some of whom were themselves in recovery and who I thought spoke with great legitimacy and expertise and authority about their own experience and that of their community. And without a doubt, historical trauma was something that they sited. And, you know, a counselor who works in the Emergency Room screening people for alcohol use disorder, she said, 'You know, people may need to get tired of hearing about this historical trauma, but it's real.' You know, it really does reverberate down through families. And there's research to show that Native people, you know, think on a daily basis about lost land, about murdered loved ones, New Mexico within this century families disrupted by a boarding school system and fragmented and scattered. So, those consequences are absolutely real.

0:12:58 Ted Alcorn
I did talk with historians and advocates who wanted to also frame it a little bit larger. They said, you know, they acknowledge the importance of trauma but they said that still makes this almost seem like alcohol use among Native people is this coping response to this trauma and Native people implicitly just need to learn how to cope better. And they said, you know, that's a little bit narrow. It makes alcohol use among Native people exclusively an Indian problem, in their words. And they point at the fact that well, the way that the economy, for example, in Gallup is organization, that is very much involving Whites and Hispanics, other groups in New Mexico, continues to propagate that kind of exploitation. In Gallup, to give you an example, you know there's only allowed to be eleven businesses licensed to sell alcohol for a town of that size under New Mexico state law. But there's thirty still in operation. The history of the town also involves a lot of other predatory businesses like predatory lenders who offer loans at sort of usurious rates, the exploitation of Native craftspeople, so, and the historians said this town has a whole is organized around these principles of inequality and theft. And that means, you know, we can't just think about this as coping with historical trauma, we need to be thinking about how our existing society can treat people more equally and not exploit their weaknesses or vulnerabilities.

0:14:27 Andrew Williams
Yeah Ted your last response it reminds me of a quote from your piece that I wanna share really quickly. And it's from State Senator Gerald Ortiz Pino. And he says, you know, it's not that everyone is in agreement around the causes, but what he does zero in on is he says, hey, partly when we're looking for explanations, it's that there's a lot of money to be made on this. And I think that's what your last answer kind of speaks to. And that also then triggers for me one of the really intriguing parts of your analysis when we begin to think about solutions. And the role that taxation and taxing alcohol sales can play in helping address this ongoing crisis.

0:15:08 Ted Alcorn
Yeah. You know, when I think one of the biggest blindspots in general when you think about alcohol use disorder is that we tend to put responsibility for it on the person that is suffering this illness. And there's a lot of value judgements that come with that. And, you know, obviously it's a condition that's still very stigmatized and I'd say different from other chronic conditions like diabetes or asthma. Where it would be much more natural to say, 'What in the environment is creating the higher rates of this disease in a particular geography?' You know, New Mexico has three times the rate of alcohol use disorder, what about New Mexico's drinking environment is more dangerous? And the experts that I went to and asked essentially that question and said, well, one of the central problems is the rock bottom prices of alcohol. And like anything, you know a normal good when prices go up, demand falls for any kind of normal good. And that's true for alcohol too. Alcohol historically has been a lot more expensive to buy. But over the years, the price of alcohol compared to our average income in this country has fallen dramatically. Something like 90 percent. So buying booze today in New Mexico, you know, has never been more affordable even for somebody that makes very low income. And the experts say, you know, alcohol taxes have played a pretty important role in keeping the price of alcohol up high enough that you're facing the true social cost of your drinking. Because when you drink a drink in New Mexico, you know, for every drink that is consumed, there's about two dollars seventy cents of social cost. In the healthcare costs that are gonna come later, in the criminal justice costs. And so, policymakers, you know, ought to be thinking about using tax policy to better reflect the true social cost of alcohol. But in New Mexico as in almost everywhere else in the country, legislators flag alcohol taxes to fall dramatically. And those taxes in New Mexico on an inflation-adjusted basis now, are the lowest they've been in a generation. And just last year, you know, the U.S. Senate further reduced the federal excise taxes on alcohol. So we have policymakers that are very much ignoring the scientific evidence and consensus around using those policy tools to address a really spiking problem of alcohol-related deaths all across the country. And, you know, I think the reporting I did suggests that it's because they're really attending more closely to the interests of businesses that sell alcohol for profit, not for the people who are harmed by consuming it.

0:17:47 Andrew Williams
Okay, Ted, well we're just about out of time, and that's very unfortunate as I have a whole series of other questions I'd love to ask you. But I'm gonna ask you one last question that I think taps not only into your journalistic work, but also your background as a public health professional as well. And we ask this question to all of our guests. And do you have a message for those in the Native community or even beyond in the Gallup area who are either themselves struggling with alcohol use disorder or who have someone in their family or community who is, do you have any sort of consultation or words to care to share with them?

0:18:23 Ted Alcorn
Well I came to that community for this reporting as an outsider. And really more as a listener. And I don't think that I ultimately have even in the time I've spent on this developed enough authority to offer great counsel or advice. But I would say the things that I saw in that community that I would reflect back anyway, or, I think there's so much to be admired in the way that the community, both Native people and allies are coming together to address alcohol in the counseling centers, detoxification centers, in the hospitals, and in the mayoral office there. And the policies and the programs that that community experiments with and succeeds with will hopefully bear fruit for the state as a whole. So I would say, you know, both to reinforce those efforts and to keep going, and hopefully to see progress that can be shared with other people in New Mexico.

0:19:24 Andrew Williams
Well Ted, you know as we discussed earlier in preparation for our interview, my background and training is as an Anthropologist. And from that perspective, I'm very appreciative. That culture of humility that you kind of bring or kind of frame that question with, as well as you drawing our attention to the agency of Native American communities, and the work that they're doing, you know, to address this problem and this reminder that within these communities are the leaders, they are the cultural strengths, and the political will to try to address you know this issue in an integrated and systemic way. And again, thank you so much for your generosity of time and spirit today. And for your incisive journalism. I think that really helps us to more fully understand the complexities of alcohol use disorder in New Mexico. I think the nuance and insights that you bring really help us to explode these dominant myths in our society. Whether it be around the genetic basis of alcoholism in Native communities or exclusive focus on intergenerational trauma. And in so doing, you've really helped us advance our intercultural understanding, and also really helped us to kind of illuminate pathways to healing and hope for all, right, who are impacted by addiction in varying forms. So again, Ted, thank you for joining us today.

0:20:39 Ted Alcorn
[nods, smiles] Thanks for having me.

0:20:40 Andrew Williams
To all of you who are listening or watching our show today, I wanna express my deep gratitude for you taking the time to join us for this important conversation. Please let your family, your friends, and colleagues know about these conversations. And please consider coming back often to catch more episodes of Let's Talk Recovery Equity. Together, we can advance health equity and bring quality and loving care to all those in need. Thank you.