Much remains to be done.

Dr. Philip May presents a highly competent discussion of the major considerations attending morbidity and mortality associated with alcoholism on Indian reservations in the United States. Unfortunately, his article in this publication is mostly applicable to the period prior to 1985. Since 1985, the profile of chemical dependency in Indian country has been dramatically altered. A proliferation of substances ranging from black tar heroin to designer drugs, often used intravenously, have taken hold on reservations across the United States. In addition, consequences of chemical dependency have altered. Instead of risking a bad hangover and the occasional multifatality automobile accident, today's drug abuser faces the risk of AIDS. The sexual promiscuity associated with alcohol abuse intersects with the long-standing risks associated with needle sharing to place both drinkers and druggers in a risk pool the dimension of which is significantly expanded since the early 1980$. The year 1986 was a watershed in terms of chemical dependency in Indian country for a variety of reasons. The film, "For the Honor of AIL" which detailed the triumph of sobriety at Alkali Lake, was released. The Anti-Drug Act of 1988, Public Law 99-570, was enacted, providing for the first time resources and direction to the Indian Health Service (INS) and Bureau of Indian Affairs to coordinate their efforts and make a priority of the problem of alcohol and drug abuse among Indian tribes and their members. The year 1986 was also a turning point in the epidemiology of chemical dependency on many reservations. Historically, Indian populations have suffered from a diabetes pandemic. Needles and injections were a painful daily ordeal for many. Intravenous drugs, especially Asian heroin, were too costly for most Indians to consider. In 1986, the prevalence of black tar heroin became impossible to ignore.This addiction soon became as cheap as alcohol and almost as available. An epidemic of injectable methamphetamenes, manufactured in rural laboratories across the South and West, occurred at approximately the same time. These low-cost, highly addictive drugs changed the face of chemical dependency in Indian country in a very fundamental way. Forty ounces