Attitudes toward substance use, patterns of use, and physiologic differences to substances vary in different cultures. Muslims do not drink alcohol, but wine is an integral part of Jewish religious rites. Some Native American tribes use peyote, a hallucinogen, in religious ceremonies. It is important to be aware of such beliefs when assessing for a substance abuse problem.
Certain ethnic groups have genetic traits that either predispose them to or protect them from developing alco-holism. For instance, flushing, a reddening of the face and neck as a result of increased blood flow, has been linked to variants of genes for enzymes involved in alcohol metabo-lism. Even small amounts of alcohol can produce flushing, which may be accompanied by headaches and nausea. The flushing reaction is highest among people of Asian ances-try (Wakabayashi & Masuda, 2006).
Another genetic difference between ethnic groups is found in other enzymes involved in metabolizing alcohol in the liver. Variations have been found in the structure and activity levels of the enzymes among Asians, African Americans, and whites. One enzyme found in people of Japanese descent has been associated with faster elimina-tion of alcohol from the body. Other enzyme variations are being studied to determine their effects on the metabolism of alcohol among various ethnic groups (National Insti-tute on Alcohol Abuse and Alcoholism, 2007b).
Statistics for individual tribes vary, but alcohol abuse overall plays a part in the five leading causes of death for Native Americans and Alaska Natives (motor vehicle crashes, alcoholism, cirrhosis, suicide, and homicide). Among tribes with high rates of alcoholism, an estimated 75% of all accidents are alcohol-related (National Institute on Alcohol Abuse and Alcoholism, 2007b). Alaska Natives are seven times more likely than the general population to die of alcohol-related problems (Malcolm, Hesselbrock, & Segal, 2006).
In Japan, alcohol consumption has quadrupled since 1960. The Japanese do not regard alcohol as a drug, and there are no religious prohibitions against drinking. Exces-sive alcohol consumption is widely condoned at parties, business functions, and at home, and very few Japanese people go to alcohol treatment. Japan is sixth on the list of highest beer consuming countries in the world—behind China, the United States, Germany, Brazil, and Russia (Kitanaka, 2007). In Russia, high rates of alcohol abuse, suicide, cigarette smoking, accidents, violence, and car-diovascular disease are found in the male population. Life expectancy for Russian males is 60.5 years, whereas it is 74 years for females. This is a trend mirrored across the entire former Soviet Union (Grogan, 2006).