The historical context of why Maxakali uses cachaça
Alcohol is a psychoactive substance with addictive properties that has been widely used in many cultures for centuries. The use of alcoholic beverages has been an integral part of many symbols and meanings of Brazilian indigenous peoples [27-30]. Before the modern era, fermented alcoholic beverages, such as corn, cassava, sweet potatoes, head of morotó, coconut palms, trampled in coconut water, among others, were known in many indigenous communities, or Brazilian mining villages [6,8,27].
In indigenous communities, including the Maxakali peoples, where alcohol was traditionally consumed, the production of their alcoholic and non-alcoholic fermented beverages generally took place on a small scale, as a domestic or collective activity, generally, the responsibility of the female gender [27] who used their fermentation techniques. This is when and where surpluses from their hunting, gathering, and small plantations were seasonally available [29]. Therefore, alcohol consumption was often an occasional and community activity, associated with the ceremonial use of rituals or community festivals [27,31].
Overlapping, and often replacing the traditional patterns of production and consumption mentioned above [6,32,33], are the production and consumption patterns of distilled beverages that developed in European empires and during the industrialization of the early modern era [1,27]. In 2018, there is the first report of the use of Kaxmuk (cachaça) among the Maxakali [8], a drink with potentially higher alcohol content than their traditional drinks described [6].
Today, cachaça has made it available, and transportation has improved. It became a market product that is available in all seasons of the year and at any time during the week [8-11]. This increase in the supply and availability of spirits, often involved in the frontier of interethnic relations, and the resignification of traditional use [28], contributed to the establishment of harmful use of alcohol for the Maxakali [6-8,32-34,].
The historical and cultural analysis presented here has practical implications for overcoming the problems of harmful alcohol use by the Maxakali [30]. Since any attempt to develop a viable intervention program needs to consider the historical sources of Kaxmuk consumption problems in addition to risk factors in contemporary life [12,35,36]. Knowledge of the formation of the Tikmũ'ũn [11,10,8,9] and the intense social and economic forces that helped to shape the first native experiences with Kaxmuk (Rubinger, 1980), help to provide a more balanced perspective on the roots of contemporary consumption pattern problems [1].
Who: gender, age, and life stages of cachaça consumption
Among the Maxakali indigenous people ≥ 9 years of age, the prevalence of 12 months of alcohol use was 39.1%. Although surveyed among different age groups, the prevalence of alcohol consumption in Maxakali was higher than that found by the Kaingang of Paraná (29.9%) and very close to the rate found in the first survey of alcohol use among Brazilian indigenous peoples of 38 .4% [3]. In contrast, 60.9% of Maxakali are abstainers, practically double the rate of 30.7% for the Brazilian population [1].
The usage rate for women (17.3%) was 3.6 times lower than the usage rate for men (61.6%) and lower than the 24.4% rate found for the indigenous female population in Brazil ≥ 18 years old (Brasil, 2007).
In addition to gender, age is also an important factor in the initiation of alcohol consumption, which has implications for the establishment of interventions for prevention and control [31,36]. In Maxakali men, use began in the age group 9 to 14 years (5.7%), increasing to 62.9% in adolescence. On the other hand, among women, the onset occurred later at 20 to 24 years of age (8.8%), increasing to 25.3% at 25 to 45 years of age, reaching 74.2% above 45 years of age.
In some indigenous groups, such as the Teréna, Gavião, Xavante, Karajá, Tikuna, Kayapó, Kaiwá, Xakriabá, Makuxi, the consumption of distilled beverages begins between 10 and 12 years of age, and sometimes even at seven years of age. This pattern is also observed among the Maxakali. According to studies, the fact that they start drinking at this age seems to mark male initiation ceremonies [29,31].
Although there are no studies on alcohol use in Maxakali male initiation ceremonies (Oliveira et al., 2018), which occurs around 5 to 9 years of age [11] or up to 12 years of age (Popovich, 1980). For boys, it involves receiving a song from one of their parents or relatives (grandparents, older brother, or uncle). This song they should learn and know how to sing without hesitation during the ceremony. This ceremonial is not related to the acquisition of physical maturity, but to your ability to assume religious responsibilities [10].
As highlighted in the findings of qualitative research (Oliveira et al., 2018; 2019), it is suggested to link the role of alcohol consumption with the roles of parents and grandparents in the transmission of this knowledge to their children: “my father, while drinking, taught me the religion chant” and even to their grandchildren: “I got married and my wife had a baby. We were under postpartum care and my father came to visit us. He gave me Kaxmuk to teach me some songs of the Bat and the Hawk rituals’. In these cases, what leads the person to drink is is a sensation experienced by the drinker, whereby he or she demonstrates knowledge: ‘My father while drinking, taught me the religious song and told me the story of our [6].
The Maxakali pattern of drinking (quantity)
The teenager, after starting to drink Kaxmuk, takes a glass and then another glass, with 10 minutes, another half a glass later; he gets dizzy with two and a half glasses. Then it falls, it can't take it anymore [32,33]. (...) In my village, my brother drinks a lot! When he wants to drink, he drinks Monday, Tuesday, Wednesday, Thursday, Friday; on Saturday, he finishes and cures his hangover. Then he goes for a month without drinking. Today, I drink a full glass, and right afterward I drink it again. My brother-in-law drinks three glasses, and then he loses control of his head, up to a month; everyone is still [7].
Considering the definition of abusive consumption of 5 doses (225 mL or 70g of pure alcohol) of alcoholic beverage on one occasion for men and 4 (180mL or 56g) doses for women [2], it is observed that the consumption of 2 and a half glasses of cachaça (450ml or 144g of pure alcohol) among teenagers Maxakali is double the five doses defined for heavy consumption for men. When you drink three glasses, you consume seven doses more than the five, considered as the cutoff point for abusive consumption.
Compared to adults, children and adolescents tend to have higher blood alcohol concentrations after drinking similar amounts of alcohol [14]. Extrapolating from what is known about alcohol metabolism in adults, excessive alcohol consumption for young people should be defined as follows: 3 doses for ages 9-13; 4 doses (14 to 15 years) and 5 for ≥ 16 years of age) [14,34]. This implies that when Maxakali teenagers drink 2 and a half glasses of cachaça, they are taking 7, 6, 5 doses in addition to the doses defined for abusive consumption for their respective age groups.
These results represent a warning condition already highlighted in studies on the trajectories of alcohol consumption among American Indian adolescents. These studies indicate that the younger the age of onset of consumption, the greater the chance of developing harmful use symptoms and alcohol use disorders in adulthood in these adolescents [12, 35-37].
Sociodemographic and cultural characteristics of cachaça consumption and harmful consequences to health
When a Maxakali consumes cachaça and crosses the boundaries (of thinking, acting, imagining, and judging) of his people's culture, both the person who drinks and the others in his sociocultural environment can be affected by harmful consequences of this use [6,8,9,38]. In the world of life, the consequences related to the harmful use of cachaça were presented in the form of accidents, marital disharmonies, negligence [6], in addition to violent behavior, illnesses, and deaths [5,6], in addition to the individual who drinks, families and villages are also affected by these consequences [6].
About families, there are cultural differences in their definition and, therefore, in the role of the family in primary socialization [15]. For example, in the Gê tribes, the elders have specific roles and are generally highly regarded. The grandparents and fathers of extended families exert great influence through their opinions, as do the Maxakali [10]. Therefore, the main source of socialization responsible for the task of raising children is more likely to involve a relative other than the biological parents [15].
However, these differences do not violate the general principle that, in virtually all cultures, the family is one of the main sources of primary socialization, and the effect of the family on socialization depends on the bond and the transmission of norms of behavior patterns between its members [15].
The results of the present study show that in Maxakali extended families, 95.2% of the fathers drink and it was in these families that the highest proportion (80.4%) of use of Kaxmuk by mothers was observed. Thus, while it is possible that grandparents can serve as vital and supportive cultural role models, it is also possible that their previous life experiences similarly encourage substance use among younger generations [15,39].
This is a potentially important condition, given the central role that grandfathers and grandmothers, father and mother of an extended family play in many indigenous families [37,39]. For example, for the Maxakali, the mother is always close to her baby as long as the baby is not weaned, when other older members of the family or the younger members of the father's family begin to provide the help and protection that the child received from the biological mother. The real discipline, by the way very severe, is given by these relatives [10]. This holistic and combined family effort in early childhood education is a cultural force that can play a key role in the social ecology of substance use [37].
The results of this study corroborate the findings of a qualitative research with the Maxakali, where the role of alcohol consumption is linked with the roles of parents and grandparents in the transmission of cultural norms: “My wife and I were on guard. My father came to visit us and gave me cachaça to teach me singing (rituals)” [6]. That is, while the father or grandfather or both drink to sing religious songs, they can, in addition to transmitting social norms through learning the songs of religion and stories of ancestors, also determine patterns of AU behavior, while culture is transmitted through each generation [15].
In contrast, where 100% of individuals aged 9 to 14 years do not drink, come from the Maxakali nuclear families. The results showed a protective association with the use of alcohol; in this family structure, the lowest proportions of alcohol use among parents were observed, reaching 97.9% of mothers and 21.4% of fathers who do not drink. Differences in alcohol consumption are also related to the parental transmission of substance use behavior norms. The high abstinence rates of mothers from nuclear families corroborate the findings of other studies that associate the low prevalence of alcohol use among women with family organization and the exercise of roles assigned to indigenous women [40,41]. Within the domain of family roles, maternity emerges as a particular protective factor for alcohol consumption [6,12].
It is noteworthy that, while the proportion of teenagers who drink have harmful consequences related to the consumption of cachaça is 4.5% in the ARP2 Conglomerate, where Nuclear Families are predominant, in the ARP3 Conglomerate, where there is 97.9 % of Extended Families this proportion increases more than five times for adolescents, young adults and elderly in these families. It is also observed that this conglomerate was the one with the highest proportions of alcohol use by the mother (71.5%) and by the fathers (98.8%) of these extended families.
In the ARP1 cluster, the highest proportion of negative consequences related to the use of cachaça was identified (38.4%). In this conglomerate, consisting exclusively of individuals aged 25 to 45 years, the results of this study show association of harmful use of cachaça with damage to health and social problems in this age group, regardless of gender and family structure.
Results of research that analyzed the relationships of family structure with alcohol use highlight that living in families with separated parents is a risk factor for the development of early use in adolescence and disorders related to alcohol use in adulthood [35,37,39]. In the present study, no relationship was observed between single-parent families and other types of families regarding the use of cachaça and its related consequences.
Alcohol is typically a consumer good for the Maxakali [9,38], which means that drinking normally uses resources that would otherwise be available for other purposes [6]. Where earnings are low, excessive alcohol consumption can further impoverish the drinker, the drinker's family, or the entire community, thus increasing health damage and social problems [1]. Regarding monthly per capita family income, research results show that children living in low-income families are more likely to report substance use, including alcohol [1]. In the present study, family income did not show significant associations with either AU or ARP among the Maxakali. Corroborating the evidence that socioeconomic status permeates the effect of family structure on substance abuse, it has been weak or inconsistent [18,39] and is not responsible for the increased problems of alcohol use.
Limitations
One of the strengths of this study is that it is pioneering and the only one to include the entire Maxakali population over eight years of age. However, there are several limitations. The results of this study with the Maxakali cannot be extrapolated to other Brazilian indigenous peoples. The cross-sectional design of the study also prevents causal interpretations of the observed associations. We do not know if cachaça consumption is influenced by the availability of the alcohol source or if the alcohol source influences the drinking behavior. For example, as Maxakali does not produce cachaça, it is not clear whether young people who obtain alcohol from a certain source drink more alcohol or whether consumption behaviors are related to the specific sources where alcohol is sold.
It may be that in interethnic contact relationships young people who drink frequently are more dependent on certain sources or are more likely to access alcohol through various sources in their contact relationships, compared to young people who drink infrequently. On the other hand, it may be that larger amounts of alcohol are obtained from certain sources, which leads to heavier consumption. Longitudinal surveys are needed to better determine the directionality of these relationships.
Given the collectivist orientation of the Maxakali culture, understanding the influence of the roles of other members of the extended family, as well as the transmission of norms of behavior patterns related to the etiquette of the use of cachaça are demands of this agenda. This research may contribute to the expansion of studies on this theme to build knowledge of how the Maxakali will behave in front of an AU & ARP prevention and control program.