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Native Americans in the United States have historically had extreme difficulty with the use of alcohol. Problems continue among contemporary Indians with 12% of the deaths among American Indians and Alaska Natives being alcohol-related. Use of alcohol varies by age, gender and tribe with women, and older women in particular, being least likely to be regular drinkers. Indians, particularly women, are more likely to abstain entirely from alcohol than the general US population. Frequency of use among American Indians is generally less than the general population, but the quantity consumed when it is consumed is generally greater.
A survey of death certificates over a four-year period showed that deaths among Indians due to alcohol are about four times as common as in the general US population and are often due to traffic collisions and liver disease with homicide, suicide, and falls also contributing. Deaths due to alcohol among American Indians are more common in men and among Northern Plains Indians. Alaska Natives showed the least incidence of death. Alcohol abuse by Native Americans has been shown to be associated with development of disease, including sprains and muscle strains, hearing and vision problems, kidney and bladder problems, head injuries, pneumonia, tuberculosis, dental problems, liver problems, and pancreatitis. In some tribes, the rate of fetal alcohol spectrum disorder is as high as 1.5 to 2.5 per 1000 live births, more than seven times the national average, while among Alaska natives, the rate of fetal alcohol spectrum disorder is 5.6 per 1000 live births, more than 70 times the state average.
Native American youth are far more likely to experiment with alcohol than other youth with 80% alcohol use reported. Low self-esteem is thought to be one cause. Active efforts are underway to build self-esteem among youth and to combat alcoholism among American Indians.
It has been found that the incidence of alcohol abuse vary with gender, age, and tribal culture and history. While little detailed genetic research has been done, it has been shown that alcoholism tends to run in families with possible involvement of differences in alcohol metabolism and the genotype of alcohol-metabolizing enzymes.
Anastasia M. Shkilnyk who conducted an observational study of the Asubpeeschoseewagong First Nation of Northwestern Ontario in the late 1970s when they were demoralized by Ontario Minamata disease has observed that heavy Native American drinkers may not be physiologically dependent on alcohol, but abuse it by engaging in binge drinking, a practice associated with child neglect, violence, and impoverishment. 
|This section possibly contains original research. (June 2013)|
A lot of folklore has grown up around the concept of the various forms of liquor traded in the west with the First Nations peoples. The recipes of those liquors exist mainly in the realm of folk tales, and still require some research and interpretation to bring rationality to the Fort Whoop-Up story, but the naming of the drinks has a little more scholarship.
"Whoop-Up wallop" is a name relating to the immediate sensations caused by the alcohol. "Fire water" refers to a testing of the proof of the alcohol – literally whether the product could be lit on fire. Another appellation is "forty rod", said to have derived by the distance the drinker could be expected to walk (40 rods, or 220 yards) before the intoxicating effects began to impair mobility. One of the names is "bug juice" – a term that appears on the surface to just as ribald as any other, but the name is a contraction of Beelzebub, the Lord of the Flies. The term's usage has a background with roots in 19th century religious, colonial and racial divisions.
In 1863, an expedition from Fort Benton, Montana, funded by John J. Healy visited Fort Edmonton with the intention of mining for gold in the North Saskatchewan River. Healy's party was not welcome in the Hudson's Bay territory, and taken as rival traders. But one of the Bay men, carpenter William Gladstone, seemed to enjoy the company of the Americans, who helped him build a cabin. Gladstone had no objection to a return of the favor to his new neighbors: "I got into my new house some time in December. The miners brought over some Montana bug juice with them and we had a gay time at the house-warming." Gladstone remarked about "another big blow-out at New Year's (1864) ... exciting enough while it lasted, I can tell you." When the Americans left for home in the spring, Gladstone came with them, and eventually was the chief architect and carpenter in charge of Fort Whoop-Up.
When Alf Hamilton and J.J. Healy arrived to establish their trade in 1869, they were allowed by the US government to cross the Blackfeet Reservation in northern Montana, and to "take with them a party of from 20 to 30 men and six wagons loaded with supplies provided there is no spirituous liquors in the wagons except a small quantity which may be taken safely for medicinal purposes". Fort Benton historian Joel Overholser wrote that the "medicinal liquor was probably sufficient to provide alcohol rubdowns for all of the men of the expedition." Healy said that the liquor on that first trip was not designed so much to trade as an item of barter, than as a "lubricant" of the trade – gifts to tribal leaders to ensure their business. "We took up 50 gallons of alcohol, not so much for the value of the goods it would bring in, as thereby to secure the Indian trade."
Liquor was a commodity of trade between Whoop-Up and the Blackfoot people, as they had long been introduced to the substances by the Hudson's Bay and the American Fur Companies. The Bloods and Piegan were familiar with whisky.
The earth spirituality of the Blackfoot was not something that newcomers raised in the Catholic and Protestant traditions of the church would immediately understand, nor want to. As such, the world of Nappi, was lumped into the world of the pagan or the godless, which to the newcomers might just as well mean the world of the devil, or Beelzebub – Bug. According to Bernard DeVoto, in Across the Wide Missouri, trappers often referred to the Blackfoot as "Bugs Boys". DeVoto confirmed that the term derived from the trapper Joe Meek who called them "Beelzebub Boys" or "sons of the Devil." That soon devolved into "Bub's Boys" and finally corrupted to merely "Bugs' Boys", in derision of their spirituality.
In Jack London's White Fang, an American Indian trader is tricked into alcoholism by another tradesman, who eventually takes him for everything he has, including his skins (the tools of the Indian's trading) and his "dog", the main character of the book.
The 2002 movie Skins explores the degrees of alcoholism in American Indians.