Patterns of alcohol consumption vary across racial/ethnic groups as shown in Table 4.4 and Table 4.5. The NIAAA suggests that low alcoholism rates occur in certain groups because the drinking customs and sanctions (permissions) are well established and consistent with the rest of the culture. Conversely, multicultural populations have mixed feelings about alcohol and no common rules; they tend to have higher alcoholism rates. A population's alcohol norms (how one should behave in relation to alcohol) and attitudes (general beliefs about drinking) have been found to be strong predictors of drinking (Galvan et al., "Alcohol Use and Related Problems among Ethnic Minorities in the United States," Alcohol Research and Health, vol. 27, no. 1, 2003).

In addition, certain populations may be at higher or lower risk because of the way their bodies metabolize (chemically process) alcohol. For example, many Asians have an inherited deficiency of aldehyde dehydrogenase, a chemical that breaks down ethyl alcohol in the body. Without it, toxic substances build up after drinking alcohol and rapidly lead to flushing, dizziness, and nausea. Therefore, many Asians experience warning signals very early on and are less likely to continue drinking. Conversely, research suggests that Native Americans may lack these warning signals. Therefore, they are less sensitive to the intoxicating effects of alcohol and are more likely to develop alcoholism.