Thursday, 20 December 2012

White Man's Water, Alcoholics Anonymous & the 12-steps in First Nations

For the past half century, Alcoholics Anonymous and its 12-step recovery program has been the dominant method for treating alcohol abuse in the United States. Reservation communities have been no exception. Erica Prussing describes in her research White Man’s Water: The Politics of Sobriety in a Native American Community (University of Arizona Press, 2011), a one-size-fits-all approach to treatment does not, in fact, fit all. We discuss how communities try to make sense of the changes that have been forced upon them and the differening choices made by different generations. There is also a sexual difference in the way alcohol is used and the repercussions it has on people, families and the meaning behind who controls sex and the implication that drinking has upon social norms within a nation.

Prussing lived for three years on the Northern Cheyenne Reservation in Montana, working with community organizations, building long-lasting relationships, and gathering testimonies of alcohol’s often disruptive impacts on the lives of many Northern Cheyenne. While many young women have embraced the 12-step program, others – particularly of the older generation – find its moral assumptions foreign and unhelpful. What emerges from Prussing’s account is not a reductive and totalizing “Cheyenne culture” but rather a complex negotiation of tradition, community, and recovery in the face of persistent colonial challenges.  This nuance and attention to detail makes Prussing’s call for indigenous self-determination in health care all the more powerful.

Erica Prussing is a medical and psychological anthropologist with special interests in the cultural politics that surround health and health care for indigenous peoples.  She is currently Associate Professor of Anthropology and Community & Behavioral Health, and serving as Academic Coordinator for the American Indian & Native Studies Program, at the University of Iowa.  She earned a Ph.D. in anthropology from the University of California at San Diego in 1999, and an M.P.H. specializing in epidemiology from the University of California at Berkeley in 2000.  She completed postdoctoral training in mental health services and health outcomes research at Children’s Hospital and Health Center in San Diego.  Her recent publications about sobriety on the Northern Cheyenne Reservation appear in journals such as Ethos, Culture, Medicine and Psychiatry, and Alcoholism Treatment Quarterly, as well as in the monograph White Man’s Water: The Politics of Sobriety in a Native American Community (published in the First Peoples: New Directions in Indigenous Studies series at  University of Arizona Press, 2011).  Her current research examines how anthropology can shed critical light on the concepts and reasoning used in epidemiology, and provides an international comparison of how indigenous peoples are increasingly using community-based epidemiological research to achieve greater local control over how their health needs are defined and addressed.

To Learn More (podcast & Interview)


Ouellette, Robert-Falcon. (Director) (2012, Dec 20). At the Edge of Canada: Indigenous Research. White Man's Water, Alcoholics Anonymous & 12-steps in First Nations with Erica Prussing. [Audio podcast]. Retrieved from  
Ouellette, Robert-Falcon, dir. "White Man's Water, Alcoholics Anonymous & 12-steps in First Nations with Erica Prussing." At the Edge of Canada: Indigenous Research.. N.p., 05 2012. web. 20 Dec 2012. < ›


  1. Prussing makes some good points about differing attitudes towards alcoholism and “recovery” from it. She states that even our western psychiatric terminology can have a negative impact because of inconsistencies with Aboriginal cultural frameworks. She mentioned that western medicine refers to depression and alcoholism as mental illnesses, whereas in some Aboriginal communities these are not considered mental illnesses, but a negative mindset that can be changed. Nevertheless, in a recent survey (Jiwa et. al, 2008) more than three quarters of Aboriginal people thought that alcohol abuse and drug addiction are serious issues within their community. Jiwa, Kelly & St Pierre-Hansen (2008) emphasize the importance of community-based prevention, treatment, and follow-up, which is consistent with what Prussing says about meeting local needs and incorporating the community members into the process.
    Interestingly, even though the “drunken Indian” stereotype is prevalent in the media and in society, a higher percentage of Aboriginal people abstain from drinking alcohol than does the general population (CBC, 2013). I think this is indicative of a culture that has been subdued and forced to change because of circumstances beyond their control. As demonstrated by the older Cheyenne women who believe that getting through alcoholism is just returning to the way of life they were taught as young children and had fallen away from. One article on CBC news calls for a shift in energy towards supporting healing rather than promoting stereotypes.
    After listening to this podcast and reading these articles, I think that even though alcoholism is certainly a serious issue in Aboriginal communities, it is not something that we should consider as part of their culture. Many Aboriginal people abstain from drinking alcohol because they know the detrimental effects it has on their families and their culture. In reality, alcoholism is just as relevant to the general population, but it must be dealt with differently in Aboriginal communities, incorporating local teachings and healing.

    Websites Referenced

  2. Author Robert Ouellette identifies the century long impact alcoholism has had on first nation communities. He discusses the work of Anthropologist Erica Pressing, who identifies that the most commonly used form of alcoholism treatment is the Alcoholics Anonymous' 12-step program. Pressing further explores this issue by suggesting that this program of treatment is not effective for all types of aboriginal peoples. She identifies that though young women may have found success in this form of treatment, many Aboriginal people from the previous generations continue to struggle with their alcoholism. Ouellette also identifies that Pressing's research into this field of study not only includes alcoholism, but also mental illness, due to her background education in mental health. Pressing correctly correlates these two major issues effecting Aboriginal people across the United States and Canada. The Mood Disorders Society of Canada notes that 30% of all diagnosed mental health patients also struggle with substance abuse (2009).

    I spent a term last summer working at the Behavioural Health Foundation (BHF) which is a treatment centre for substance abuse and co-occurring mental illness. The BHF is an excellent resource in Manitoba for treatment in both of these areas. As Pressing identified, substance abuse and mental health often go hand-in-hand; substance abuse triggering mental health issues, or substance abuse as a self-medicated form of relief for the individual suffering from mental health issues. Through my position at the BHF I learned about the program and its philosophies, one of which being; the therapeutic community mode: residents live on site in the facilities and participate in a community which supports its members. This is largely different from the Alcoholics Anonymous treatment plan, in which members participate in weekly sessions. Residents at the BHF are continually monitoring and supporting each other throughout their treatment. I feel that Pressing would agree that the BHF's therapeutic community model of treatment is preferable to the majority of Aboriginal peoples suffering from substance abuse and mental health, especially those from intimate communities, such as those living on reservations. I believe that resources such as BHF should be more easily accessible to Aboriginal peoples in order to promote healthy living for ourselves, and for our future generations.

  3. I think that Robert Falcon-Ouellette worded it beautifully when he said that the Northern Cheyenne people, along with other Aboriginal peoples, are struggling with “a complex negotiation of tradition, community, and recovery in the face of persistent colonial challenges.” The idea that alcohol has different repercussions on men than woman, and that Cheyenne women have a historical and cultural role of regulating sexual attention caught my eye. I tried to be neutral in regards to the topic but, when Erica Prussing explained how “women tend to be the primary victims” of sexual violence attributed to alcohol abuse, I found this difficult to do. Especially when I combined this with the statistics I found form the government of Newfoundland. For example, “Aboriginal women are 3.5 times more likely than non-aboriginal people to experience violence” and 54% of Aboriginal women report, “spousal violence, such as being beaten, choked, threatened with a gun or knife, or sexually assaulted.”
    I won’t argue that the cause of this abuse is Aboriginal women’s role as a sexual regulator, more than likely it has deep roots in loss of identity, colonization, and past abuse, but this role does not seem to work against such abuse. I am of a different culture, but I believe that it is imperative that males be taught that they can, and should, control their sexual actions. I acknowledge that for many this may be difficult due to past abuse and alcoholism, but men must be encouraged take ownership over their actions before they can seek help, be it from elders or whomever.
    I was slightly softened when I Erica Prussing explained how Cheyenne women are able to use their power over sexual regulation to call out other members in the community. For example, they have the power to remind males that they should be providers and protectors, not abusers. However, I still find the whole idea that women hold the power of sexual regulation as problematic. The women that would be able to use this role to call out men would be the more advantaged, respected women. Whereas, disadvantaged, young women who would be more likely to fall to sexual abuse and victim blaming. This is only supported by the Newfoundland government’s statistic that “75% of survivors of sexual assault in Aboriginal communities are young women under 18 years of age,” 50% “are under the age of 14,” and “25% are under the age of 7.”

  4. After listening to Erica Prussing’s interview, I began to question why we, as a society, hold onto the stereotype of the ‘drunken Indian’, or as Erica mentions, the common belief that drinking is a genetically determined problem for Aboriginal peoples. When in reality, Aboriginal peoples are more likely to abstain from alcohol consumption than non-Aboriginal individuals (Reading, 2009). On the other hand, statistics also show that “Aboriginal youth are at two to six times greater risk for every alcohol-related problem than their non-Aboriginal counterparts” (Chansonneuve, 2007) and I do feel as though this is an issue that needs to be addressed.

    Now some may argue this issue is directly related to the cultural discontinuity that Aboriginal peoples are facing. Regardless of the cause, however, I feel as though there will never be one master treatment for alcohol misuse, as every individual has his or her own unique circumstances that need to be dealt with and treated on an personal level. I do, however, feel it is important to incorporate cultural values. For example, following the 12 Steps of Alcohol Anonymous, as Prussing mentions, was traditionally written from a Christian perspective. Those who hold similar values may find that book beneficial for their recovery process. Some healing and recovery programs in Aboriginal communities in Manitoba, however, have found it beneficial to use the Seven Sacred Teachings to guide their programs (Chansonneuve, 2007). As individuals in the program have noted, it is vital to learn how to treat yourself with respect, especially when you have never experienced being treated with respect.

    In addition, I found it interesting that, in many Aboriginal cultures, women were seen as responsible for not only their own sexual behavior but as well for the men and others in their lives. This view concerns me when cases of sexual abuse start to arise. In 2009, “of the Aboriginal women who had a current or former spouse, 15% reported being a victim of spousal violence in the five years preceding the survey” (compared with 6% of non-Aboriginal women) (Statistics Canada). Coming from a different culture myself, I find it terribly hard to understand how an individual could blame himself or herself as the victim. It is in my opinion, all individuals should be held accountable for his or her own actions, sexual or not.

    Chansonneuve, D. (2007). Addictive Behaviours Among Aboriginal People in Canada.
    The Aboriginal Healing Foundation. Retrieved from
    Reading, J. (2009). The Crisis of Chronic Disease among Aboriginal Peoples: A
    Challenge for Public Health, Population Health and Social Policy. Retrieved from
    Violent victimization of Aboriginal women in the Canadian provinces, 2009.
    Statistics Canada. Retrieved on February 26 from