Social perceptions about the pattern of use of cachaça among indigenous peoples of the

This study shows how it was possible to engage in intersubjective dialogue regarding the replacement of models and uses of Maxakali traditional drinks with a distilled beverage introduced through inter-ethnic contact. A comprehensive phenomenological approach was employed to understand and describe the social perceptions about the use of this distillate. Through thematic analysis, symbols and meanings of alcohol use were interpreted through their daily life histories, recorded by 21 leaders in three focus groups. It could amplify ‘subjugated voices’ and embarks on a similar venture of researching their villages' leaders from two disenfranchised groups. The findings highlighted that, with the use of sugar cane liquor, some adaptations have occurred in Maxakali alcohol use, with negative consequences for the communities. They revealed how the native drinks have disappeared and the liquor has been inserted into Maxakali cultural system. Considering the subjectivity of the leaders in the process of data collection and analysis, functions regarding the liquor as a social lubricant, facilitator of shamanic trances, knowledge producer, and factor in the relations of gender and age were identified. Those functions were enmeshed in their symbols and meanings regarding their drinking pattern and contexts,


Introduction
The colonization and Western expansionism in Brazil dissolved and eliminated models and uses of native fermented beverages (NFB). These kinds of beverages come from a fermentation technique based on insalivation, which persisted only in the mestizo population in the Amazon/Brazil (Fernandes, 2004;Fernandes, 2013). During these periods in South America, studies (Fernandes, 2004;Fernandes, 2013) show that, from the clash between cultures and ethnic groups of the Brazilian indigenous peoples (BIP) with 'the others', an ethylic regime emerged that was built up around a distilled beverage, not the NFB.
The emergence of this regime focused on distilled alcoholic beverages (Fernandes, 2004), which have a higher alcoholic gradation than NFB (Brasil, 2009;Oliveira et al., 2019), is a phenomenon that needs to be better studied in Brazil (Pena, 2005).
With the introduction of this distilled drink, in particular sugar cane liquor (SCL), Brazilian researchers in this field (Fernandes, 2004;Fernandes, 2013;Souza et al., 2003;Souza, 2013;Ferreira, 2004;Pena, 2005;Quiles & Barros, 2001;Pereira & Ott, 2012;Ghiggi & Langdon, 2014) seek to understand the conceptions regarding these cultural practices. Those practices involve the apprehension of and the symbolic values towards the consumption of these strong distillates, which results in diseases and the marginalization of indigenous peoples.
Anthropological studies (Fernandes, 2004;Fernandes, 2013;Souza et al., 2003;Ferreira, 2004; Ghiggi & Langdon, 2014) show that, with the substitution of regimes, BIP have experimented with and continue to experience distilled beverages, which have a disproportionate impact on their health and socio-cultural living. The consequences of these problems have caused serious suffering in the daily life of BIP (Fernandes, 2004;Oliveira et al., 2019;Souza, 2013;Ferreira, 2004;Pena, 2005). What aggravates this situation, even more, is the early use of alcohol by adolescents and the pattern of abusive use (Fernandes, 2004;Fernandes, 2013;Oliveira et al., 2019;Souza, 2013;Pereira & Ott, 2012), although these patterns vary among ethnicities and within the same community (Souza, 2013).
The first recording of the use of these distillates among Maxakali indigenous peoples (MIP) was in 1918. It has been recognized that SCL facilitates a change in euphoria, and this change is experienced quicker and is more intense than the effect of the consumption of NFB. SCL consumption also puts the Maxakali in contact with spirits during their rituals. Moreover, in their state of alcoholic trance, they resurrect historical animosities (Ribeiro, 2008). The outcome is signaled by fights and murder among their kinsmen and community members (Popovich, 1980;Álvares, 1992;Rubinger, 1980). More recently, the consequences of Maxakali alcohol use have been described (Oliveira et al., 2019). It is noted that, with the complete replacement of the NFB by cachaça (SCL), cultural adaptations have been shaped by inter-ethnic contact, related to negative issues for the drinkers and their environment (families, villages, and communities). In daily life (Schutz, 1979), the consequences have manifested through an ethnic and biopsychosocial triad (Schutz, 1979;Geertz, 1989) in the form of accidents, insults, marital disharmony, neglect, violent behaviors, illness, and death (Oliveira et al., 2019).
Although ethnographic studies have recognized that the use of SCL and its consequences among Maxakali (Ribeiro, 2008;Popovich, 1980;Álvares, 1992;Rubinger, 1980) is damaging, the issue still needs to be explored (Oliveira et al., 2019;Pena, 2005) considering the breadth and depth of the theme and the socio-cultural diversity among 305 BIP (Fernandes, 2004;Fernandes, 2013;Souza, 2013;Langdon, 2005). This gap raises three questions: (1) How do the MIP perceive SCL experimentation in their socio-cultural contexts? (2) What are the social perceptions regarding the use of this distillate, which was introduced and perpetuated by inter-ethnic contact? (3) How can the information gathered in answering questions 1 and 2 be integrated into an intercultural sensitive prevention program for alcohol use among MIP?

Sociohistorical contexts, study population, and theoretical references
Ethnographic studies conducted with the MIP point out that Tikmũ'ũn is the native term used for self-designation of Makoni, Monoxó, Kapoxó, Malali, Maxakali, Cumanaxó, and Panhame indigenous peoples who all speak Maxakali (Ribeiro, 2008;Popovich, 1980), as well as how they are recognized by the Brazilian State through the Maxakali ethos. Before colonization and Western expansionism, these indigenous peoples occupied six valleys located in Northeast Minas Gerais, Southern Bahia, and Northern Espírito Santo States (Ribeiro, 2008;Rubinger, 1980). Data on the contact among the remnants of these groups and the regional population are much more detailed as of 1960 (Pena, 2005;Ribeiro, 2008;Rubinger, 1980). However, it was in the Mucuri Valley, Minas Gerais State, during the first decades of the 20th century, that these groups met to resist the attacks against their traditional enemies and non-Indians at the headwaters of the Umburanas river (Pena, 2005;Rubinger, 1980).
Although not all members of each group knew each other, to resist the attacks of non-Indians, studies show that this coexistence was achieved only because of the movement of people and goods. Besides this coexistence, these studies also explain that the formation of these alliances was represented by inter-group marriage (Ribeiro, 2008;Álvares, 1992). Besides kinship interchanged through marriage, the BIP also exchanged ritual songs, which were used to give greater stability to their alliances and to strengthen the coexistence among the representatives of these groups (Ribeiro, 2008;Álvares, 1992;Álvares, 2004).
From six valleys and three states, the Tikmũ'ũn nowadays live on just over 6,000 hectares. They comprise one land and two indigenous reserves, located around four municipalities, in the extreme northeast of Minas Gerais, on the border with the State of Bahia (Pena, 2005). In 2017, for the four communities, the Indigenous Health Care Information System (SIASI) recorded a total of 1,873 Maxakali. Their geo-political-social organization is represented in Figure 1. In this study, we sought to broaden the spectrum of theorists who contributed to a theoretical framework on a social action benchmark. In Schutz (Schutz, 1979), we identified concepts that contribute to the understanding of the principles of a comprehensive approach regarding social action. The current relevance of these theoretical notions lies in their ability to understand and (re)interpret reality based on the action and subjectivity of the social actor (Schutz, 1979). Schutz's exposure to basic methods of Husserl's phenomenology and Weber's comprehensive sociology was crucial in defining the theoretical framework as the focus of this study while collecting and analyzing interview records.
According to Schutz (Schutz, 1979), actions are previously planned human conduct whose meanings are produced mentally. It is also understood that only a small part of a person's world knowledge originates from his or her own experience; most of someone's world knowledge is transmitted to him or her by others through their socio-cultural life (Schutz, 1979) who share the same spatial and temporal perceptions (Shkilnyk, 1985).
According to Schutz (Schutz, 1979), the social action of the interviewed Tikmũ'ũn is a result of their interactions in different multicultural contexts, where those involved mobilize most of the knowledge previously acquired by their ancestors, and, at the same time, the knowledge produces meanings for action in a reflexive process (Schutz, 1979). To understand this reality and to describe the characteristics of those who experience the SCL experimentation, we added some cultural issues to the comprehensive phenomenology. Maxakali cosmological values were included in the ethnic and biopsychosocial characteristics described by Schutz (Schutz, 1979;Minayo, 2010).
The belief about culture as a fluid system, which is open to reinterpretation, guides the idea that the meanings attributed to alcohol use can be apprehended only by using the understanding of the historical and contemporary conditions of the Maxakali's life, as well as their changes produced by subjects sharing the same web of meanings (Geertz, 1989) in time and space (Shkilnyk, 1985). In addition to assuming culture as a system opened to reinterpretation (Geertz, 1989), it is also assumed that culture determines how people will think, act, and imagine (Shkilnyk, 1985) in this intergenerational web of meanings (Geertz, 1989).
In the meantime, SCL experimentation ceases to be perceived as a set of immutable physical and biological symptoms observed in the empirical world. It is better understood as a subjective process (Oliveira et al., 2019; built up through interactions of sets of symbols and meanings (Schutz, 1979) brought from the Makoni, Monoxo, Kapoxo, Malali, Maxakali, Cumanaxó, and Panhame and experienced intersubjectively by Tikmũ'ũn in their socio-cultural contexts (Schutz, 1979) by the contemporary Maxakali (Oliveira et al., 2019;Pena, 2005;Ribeiro, 2008;Popovich, 1980;Álvares, 1992).

Qualitative Data collection
We began by understanding the Maxakali lived realities discussed in three focus groups, herein called story wheels about alcohol (SWA), a methodology already described in another study (Oliveira et al., 2019). From the SWA, we gathered significant descriptions of Maxakali leaders regarding their experiences with SCL, which could be understood and unveiled in their essence.
Purposeful selection of participants obtained community representation (Turato, 2003). Seven leaders did not attend SWA on account of their social agendas. The SWA were conducted with 21 leaders who live on the reservations. Some held one or more positions, such as teacher (7), village leader (4), indigenous health provider (4), or sanitation officer (3); there were also two shamans and a councilwoman. They were divided into three SWA. We worked with five women (26 to 40 years old) and 16 men (24 to 51 years old). Overall, they represent the two largest communities and nine villages of MIP.
Data collection began after all participants provided written informed consent. The SWAs were carried out and coordinated by the first and last authors of this study with the help of an observer, using an interview script.
Following the SWA phases, we read the story "The Kaxmuk (SCL) in my village" (Figure 2).

Source: Authors.
Subsequently, we asked the following: 'What did you feel when you heard the story?'; 'How was it to listen to this story?'; 'I want to hear you tell me the Kaxmuk story from your village.' When the groups finished their stories, a debate began to clarify any doubts about the issues discussed. The interviews were conducted in Portuguese and/or the Maxakali language, and they were recorded in audio format and later used for analysis.
Following the assumptions of the thematic analysis of Boyatzis (Boyatzis, 1998), two researchers began analyzing narratives through floating reading. Through the fragmentation of the contents of the stories and debates, they developed a coding system, which was later discussed and refined in consensus. This method served as a basis for the following analyses, and it was reformulated whenever the analysis and emergence of new themes occurred. The coding and grouping of the data, including the identification of categories, which developed into themes, evolved until reaching the theoretical saturation of the data.

Sugar cane liquor consumption: Ceremonial use, gender, age, and social knowledge acquisition
Regarding the historical consumption, the female leader said: I grew up in Maxakali culture. Formerly, we had potato and green corn beverages that were made to use in the rituals. We also had a cajá drink (a fruit from the tropical forest) blended in coconut water. We also used to make garapa (sugar cane water) and mixed it with some palm coconuts. These were the drinks we used to drink during the religious rituals, although they were drunk as a food. The women used to make a pot, from that height (in order to show the height of the pot, she put her hand at the height of her head).
Although studies have reported the use of SCL within the house of chants (Ribeiro, 2008;Tugny, 2007), these findings have highlighted the divergence among villages as to their use during rituals, as one leader reported: 'In our culture, there is no cachaça during the rituals. I teach religion, but during the rituals I do not want anyone to drink it, because it disturbs the ritual'.
One point supported by other studies has to do with the possible existence of a controlled type of SCL use during rituals.
As one leader described, 'If you have rituals, there is no drink. When I was a kid, we did not see anything, because the shamans would not let us see. Nowadays, when there is a drink, the mothers and shamans tell and explain the ritual stories. Then they calm down. If you have a drink, the ritual stops and only starts another day'.
It is noticed in the quote above that during an interruption of the ritual activities, the mother and the shaman are responsible to calm down the participant who made use of SCL and is not behaving according to the ritual. Therefore, in some other villages, SCL use is accepted: 'When there are rituals in our village, we take cachaça to the house of chants to make us more cheerful, but there is no disagreement. We were all happy in the house of chants until the sunrise'.
After discussions about the first alcohol use in SWA, the leaders did not directly link it to ceremonial use regarding male initiation, but they pointed out differences between age and gender for initiation and consumption: 'Teenagers at the age of seven do not drink it. Some families offer cachaça at the age of seven years, and if he drinks, he cannot handle it and falls. Now there is a nine-year-old teenager who already starts getting used to drinking'.
While telling stories of their villages, the female leaders described the use of SCL among women with reservations: In my life, since I was very young, my parents did never sad that female child would drink sugar cane liquor. The mothers would not let a child drink. They said, 'You cannot even see the smell.' And today in my village, I will not talk about women, because they do not drink. The girls, my granddaughters, none of them drinks.
Regarding sex, a leader pointed out some differences: 'In my brother-in-law's village, there is a Maxakali monk who has a good ritual. There, young girls do not drink cachaça; women drink a little; young boys drink a lot'.
However, the female pattern of drinking is different among villages, as one leader reported: 'There is a village where some women drink, but they drink just a little. But some drink a lot: 'Besides my brother, another who drinks is my sister. When she drinks, she drinks for a whole week. Just on Saturday when she stops drinking. After that, she goes a month without drinking.
As reported by a male leader: 'When I was five years old, I was learning about our culture. I had never tried sugar cane liquor. I only saw my father drinking because he was older. My father, while drinking sugar cane liquor, taught me the ritual songs and told stories of our ancestors.
One leader reported as follows: 'I got married, and my wife had a little baby. We were under postpartum care, and my father went out to the town and bought sugar cane liquor, and came to visit us. He gave me cachaça to teach me some songs of the Bat and the Hawk rituals'.
In the domestic context, SCL seems to be used to transfer and produce cultural knowledge: 'My father came to visit us.
He gave me cachaça to teach me more ritual songs.'

The Maxakali pattern of drinking
Although respecting rules concerning age and gender, since large amounts are ingested during parties and drinkers stop only when all SCL is gone or they become unconscious, the pattern is similar to the one narrated in the Maxakali stories: I've noticed the white man; he drinks a little bit. And then he says: 'Where is the lemon?' We Maxakali drink sugar cane liquor, but we do not have control. Maxakali takes the big pipe (disposable bottle) and drink until it is finished or falls to the ground. And the next day, if I wake up with a hangover, I go back and search for more. In my village, my brother drinks a lot! He and his children. When they want to drink, they drink Monday, Tuesday, Wednesday, Thursday, and Friday; on Saturday, they finish and cure their hangover. Then they go 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. On the second day of drinking, there are some Maxakali whose hands start to bend; they see snakes; they see a lot of things. When they have this kind of vision, they cannot sleep. So, I go there and cover them with a blanket, because they say it's getting cold. They still talk to you like this: 'I have a hangover. I drank five days in a row.' I say: 'That's all right; we'll stop drinking.' Everyone stays quiet for the whole week, up to a month; everyone is still.

Where sugar cane liquor use is learned by Maxakali and with whom they drink
According to leaders' reports, women are more likely not to drink because of their responsibilities to their family members, as reported: The married women do not drink and do not like to see their husbands drink. There are some wives who do not let their husbands drink. They worry about their husbands; they do not want them to get hurt or get into trouble. They and their husbands have to take care of the children, tend crops, participate in rituals, and help the community, and the cachaça does not allow that. The sugar cane only brings problems into the house.
Studies suggest that the low prevalence of alcohol use among women may be related to day-to-day responsibilities and the duties of the roles assigned to indigenous women (Pereira & Ott, 2012;Kunitiz, 2006). These responsibilities are reinforced by a female leader: 'My father used to drink cachaça. But he never said anything like, "Come on over and have a drink with me." He would say, "You are a woman; you will take care of your children because your brothers will not take care of your children".
Two leaders pointed out two examples, the first regarding the use of SCL by a mother: 'There is a mother who drinks and thinks like this: "I will offer it to my children so they will not be against my drinking or against us. They'll take it, and they'll be fine with us." But the matter is, she is teaching her son to drink sugar cane liquor.' The second example regards SCL use by both parents: 'The father speaks like this: "I am drinking; your mother is drinking; why do you not want to drink with us?" Then, the child goes and drinks'. According to the interviewees, when parents drink, they expose behavioral models that are socialized with their children. As one leader reported: 'If the mother drinks with her husband, her sons and daughters will drink.'

Sugar cane liquor consumption: Ceremonial use, gender, age, and social knowledge acquisition
Studies regarding the age at which alcohol use begins among BIP have taken into account the trials associated with their ceremonies (Fernandes, 2004;Souza et al., 2003;, as well as gender and age roles (Edwards et al., 2005;Whitesell et al., 2012). Souza and Garnelo (S2007), studying when, how, and what is drunk among the Rio Negros/AM Indians, highlighted the types of drinks, their alcoholic gradation, and the contexts in which they are drunk. Two types of traditional drinks were recognized. The first is related to the native food infrastructure. It is formed by low-fermentation drinks, which are beverages with a low alcohol gradation. According to the authors, these kinds of drinks are presented as 'food drinks', which are consumed from early childhood in their rituals . The second type is constituted by the same fermented beverages, although with a high alcohol gradation. Its use begins at about 12 to 15 years of age in rituals or recreational situations.
The use in this age group is linked to male initiation ceremonies   (Figure 3). For the Maxakali, consumption of traditional fermented drinks, considered a type of food, has disappeared. The use of these beverages in the rituals was described as like a mythical past, as when Álvares (1992) describes the myth of the Parrot or as a historical consumption, as described by a female leader with more than 40-year interviewed. According to the myth, when the Maxakali gathers in the Parrot ritual, the women make clay pots in which they cook their food and make their fermented beverages. Before the ritual, the parrot spirits bring the corn to the women, who chew it and throw it into a large pot of clay. The next day, the spirits of the Parrot take the corn kettle to the house of chants.
This story goes back to the past to a time when the Maxakali were not used to drinking white beverages. They had their drink, which was made of corn, and the caterpillar head of bamboo. These beverages were drunk to release ritual chants (Maxakali et al., 2008).
There are no studies regarding the use of fermented drinks (low alcohol gradation) in the Maxakali male initiation ceremonies. The use of cauim-a fermented drink prepared with chewed manioc or corn, sometimes mixed with various fruits or honey-is reported briefly by Pena (Pena, 2005), but without reference to ceremonial use.
The findings of this study diverge from reports by Pena (Pena, 2005). In his study, regarding access to SCL, he highlighted that there is no distinction between sex, as well as the age of access for 12-year-old girls (Pena, 2005).
Despite the differences between the use of alcohol and the secrets of the house of chants, in accordance with the findings, the use seems to occur in a controlled fashion. In this way, norms and attitudes are expected according to what the culture determines in each group (Geertz, 1989) regarding its way of thinking, acting, and imagining (Geertz, 1989;Shkilnyk, 1985).
Therefore, not allowing clutter or fights during the Maxakali ritual is behavioral etiquette of humans and spirits.
Anthropological studies (Ribeiro, 2008;Popovich, 1980;Álvares, 1992;Álvares, 2004) emphasize that in the Maxakali cosmological life cycle, the child receives his spirit at birth. In possession of his spirit, this child will prepare for the male initiation ceremony. This entails receiving a song from one of his parents or relatives (grandparents, older brother, or uncle). The child should remember it and know how to sing it without hesitation during the initiation ceremony (Ribeiro, 2008;Popovich, 1980;Álvares, 1992;Álvares, 2004).
The possession of a chant can occur only through knowledge as part of a long learning process that begins in childhood, even before the initiation ritual (Ribeiro, 2008;Popovich, 1980;Álvares, 1992;Álvares, 2004). This special learning, which is usually taught by a father or grandfather, is kept within the kinship group as part of its heritage (Fernandes, 2013;Popovich, 1980;Álvares, 1992).
After the male initiation ceremony, it is incumbent upon adult and elderly men in the house of chants to teach the boys the knowledge and secrets of the rituals, the entities that sing in their rituals, and the groups of singer spirits who visit the house of chants (Álvares, 1992; Álvares, 2004). The girls do not go through initiation (Popovich, 1980;Álvares, 2004), since only the Maxakali men, all of them, are xammans (Álvares, 2004); however, marriage for some girls begins at age (Pereira & Ott, 2012).
The findings of this study highlight that the social function of alcohol use regarding the roles of parents and grandfathers in the transmission of knowledge is an important aspect of the shamanic life of their children and grandchildren. It is expected from the son to listen to what his father says and also to learn and value the cultural beliefs told by his dad (Popovich, 1980). Thereby, the son will maintain the knowledge through an intergenerational web of meanings, which determines his way of thinking, acting, and imagining (Shkilnyk, 1985) as a true Maxakali (Álvares, 1992; Álvares, 2004).
From the reports of the SWA analysis, it is apparent that, in the context of the rituals, the SCL can be seen as a vehicle that 'we take the cachaça to the house of chants', it (SCL) is a substitute for traditional drinks that 'women used to make such a bottle', and nowadays it acts as a reinforcement of the social relations of families and allies for rituals (Ribeiro, 2008;Álvares, 1992;Álvares, 2004).
As with the Maxakali described here, Ferreira (Ferreira, 2004) reveals a similar use of cachaça among the Mbyá indigenous people. She pointed out that what leads a person to drink 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 ancestors.
The consumption of the cachaça, to drink until to the end, as described to Kaxiri consumption by Rionegrino/AM  or to kiki consumption to the Kaingáng (Souza et al., 2003) seems to have also been assumed by the Maxakali: 'Maxakali pick up the pipe and drink until it is finished or falls to the ground'. This pattern of consumption, 'heavy drinking', is described as an unhealthy or dangerous way to drink. The alcoholic does things that he or she would not normally do if he or she were not drinking, such as driving a car or riding a motorcycle at high speed, attempting suicide due to mood swings, behaving violently, and exhibiting long-term emotional problems (DSM-V, 2013;OMS, 1993).
Assuming that the traditional drink has been replaced by the distilled drink, the transposed logic must also be analyzed in an interdisciplinary way in terms of the amount of pure alcohol ingested and the respective effects on the body. Therefore, we compared the amount of pure alcohol from SCL to the traditional fermented beverage. For this comparison, we used Pilsen beer, a non-NFB whose alcoholic gradation value is within the limits of the gradations of fermented beverages (Brasil, 2009).
If 'my brother-in-law drinks three glasses', we have in three glasses 540 ml of cachaça, with 40% alcohol at 20 o C. This amount represents 216 ml of pure alcohol, equivalent to drinking 25.5 glasses of beer with 4.7% alcohol (4.7% represents the average alcoholic gradation from four kinds of Brazilian beers and one imported beer). If we convert 216 ml of pure alcohol into grams, we will have 172.8 g of pure alcohol. Considering 172.8 g of pure alcohol consumed, we have the equivalent of 0.17 g of alcohol per 100 ml of circulating blood in a 70-kg man. The effects of this amount of alcohol are described in Figure 4. intermittently, as they spend short or long periods without drinking: 'Afterwards, they (Maxakali) go for a month without drinking'. This drinking pattern would surely trigger abstinence syndrome in alcoholics of the general population, which is not the case with the Maxakali. This intermittent consumption in the development of disorders related to alcohol use among BIP has been the subject of debate and corroborates the findings of other studies (Souza, 2013;Quiles & Barros, 2001).
Ribeiro (Ribeiro, 2008) asserts that the emergence of conflicts, which are usually evoked by the risk of the disappearance of these people, cannot be interpreted under a purely negative bias. For the most part, the joining of several indigenous peoples who form the Maxakali ethos may be the expression of a style of political action in which collisions are made to expire (Ribeiro, 2008). Researchers point out that if we want to establish programs for the prevention and treatment of disorders related to alcohol use among BIP, it is fundamental to investigate the particular manifestations and contexts of drinking, moving the theme to the collective/social field and considering with whom, how, where, and when one drinks in the native view (Fernandes, 2004;Souza et al., 2003;Souza, 2013;Ferreira, 2004;Pereira & Ott, 2012;Ghiggi & Langdon, 2014), since the act of drinking is conduct that cannot be defined or judged outside its socio-cultural context (Oyacer & Nanco, 1998;Menendez, 1982).

Where sugar cane liquor use is learned by Maxakali and with whom they drink
In the studies of alcohol use among indigenous peoples, Eitlle et al. (Eitlle et al., 2013) emphasize that the family, as a dynamic and unique context for individual development, has been a neglected topic. Among indigenous peoples, there is an enormous diversity of family and kinship systems. Members of these systems help and protect each other; their collective responsibilities for the actions of others regulate individual behavior (Swain et al., 2011). This collective responsibility model the collective behaviors in society.
Popovich (Popovich, 1980), studying marriages and kinship relationships, and Alvares (Álvares, 1992; Álvares, 2004), studying social organization, observed that each level of Maxakali kinship carries a set of definitions, roles, and responsibilities for conduct. Each level has an information depository as well as an instrument that leads to action, bringing with it many expectations and behavioral norms (Popovich, 1980;Álvares, 1992).
According to Swain et al. (Swain et al., 2011), maternity emerges as a particular factor of protection from alcohol consumption, which is reinforced by the report of a leader: 'When the father drinks and the mother do not drink, the mother still cares for the child and does not pay attention to the father. Why then do the wife of my cousin and my sister-in-law not have children with malnutrition? Because they do not drink'.
Studies with American Indians (Swain et al., 2011) have highlighted that in families where one or both parents are heavy drinkers, the risk is increased for their children's alcohol consumption. The disorders related to alcohol use by both parents were associated with the presence of 18-year-old children with alcohol-related problems. In addition, there is an increased risk of these disorders in children whose parents drink around four to nine times for men and two to three times for women (Swain et al., 2011).
Considering possible prevention strategies for and with the Maxakali, the findings of this study present challenges that must be overcome by the therapeutic approaches available to the general population. The relationship between gender and age at the beginning of SCL use, for example, brings to light the cultural complexities that we highlight. First: '…has a family that offers a drink to seven-year-old boys'; second: "Young girls do not drink; young boys drink a lot.'; third: 'Today, in my village, the girls, and my granddaughters, none of them drinks'; and fourth: 'Today, few women drink. And they do not drink too much.' Prussing and Gone (Prussing & Gone, 2011) studied the issues regarding gender and age in a cultural context for the treatment of alcohol use among Canadian and American Indians. They pointed out a process that has become especially visible in recent decades: Indigenous communities around the world are working to decolonize their health services. These communities have seen that the causes of health problems reflect colonial legacies, such as the multigenerational effects caused by the disappearance of their models and uses of native drinks and the introduction of distillates into their daily lives (Prussing & Gone, 2011).
To fully respond to such multifaceted and changing needs requires a more detailed understanding of how socio-cultural contexts can affect an intercultural sensitive prevention program for alcohol use (Fernandes, 2004;Fernandes, 2013;Souza et al., 2003;Ferreira, 2004;Pena, 2005;Quiles & Barros, 2001;Pereira & Ott, 2012; Ghiggi & Langdon, 2014) of the Maxakali. With regard to alcohol, for example, community members can mix drinking and sobriety with local meanings that circulate, interact, and produce social consequences that, in turn, generate new layers of meaning in a continuous process that influences how, why, and for whom particular therapeutic approaches can be culturally planned (5,7,9,10,12,29,30).
Under the Brazilian Indigenous Health System, these meanings can take different forms and shape substance abuse services in up to 305 different ways (Souza et al., 2003;Ferreira, 2004;Quiles & Barros, 2001;Pereira & Ott, 2012;Ghiggi & Langdon, 2014). Greater attention to this ethnic pluricultural requires rethinking the generalized characterization of the sensitive intercultural prevention and treatment needs of children and adolescents. Together with the Maxakali, indigenous health providers must develop a more nuanced understanding of the experiences of young girls, women, and young boys as members of this complex cultural multiplicity of the Maxakali.

Conclusions
It is essential for providers working in the Maxakali health and social protection networks to understand the legacies of colonization and expansionism in Brazil (Oliveira et al., 2019;Pena, 2005;Ribeiro, 2008), especially the ethnonym (Ribeiro, 2008;Popovich, 1980), the history of inter-ethnic contact (Pena, 2005), and the cosmology (Álvares, 1992; Álvares,2004) that have shaped the current Maxakali alcohol regime (Ribeiro, 2008;Rubinger, 1980). Therefore, it is necessary to better address the ways in which the native beverages have disappeared and the distillate has been inserted into the Maxakali cultural systems, as well as to better understand the functions of this distillate drink as a social lubricant, facilitator of shamanic trances, factor in gender and age relations, and regulator of expressions of violence and enmity (Oliveira et al., 2019).
Reflecting on such legacies (Fernandes, 2004;Fernandes, 2013) represents a fundamental step in the management of the Brazilian Indigenous Health System and the psychosocial network (Ghiggi & Langdon, 2014) to understand the ways in which the majority society and the Maxakali had related in this clash of cultures around the ethical experience imposed by interethnic contact (Fernandes, 2004;Fernandes, 2013). It is important to reaffirm that the inter-ethnic contact process does not represent a one-way street: the cultural change suffered by the Maxakali did not have only one side, nor was it commanded solely by the intentions and strategies of colonizers and representatives of the expansion fronts; it has been as an extensive process of resistance (Oliveira et al., 2019;Pena, 2005;Ribeiro, 2008;Rubinger, 1980) of the Maxakali people as well as a mutual discovery process that continues today.
It is necessary to use other theoretical/methodological approaches and alternatives to investigate the interactions between SCL use and its ethnic and biopsychosocial synthesis (Oliveira et al., 2019). Additionally, it is necessary to incorporate the Maxakali way of life (Fernandes, 2013;Schutz, 1979) into these possibilities (Fernandes, 2013) with its living and pulsating multiplicity (Ribeiro, 2008), as its culture is a fluid system that evolves over time (Geertz, 1989) and determines the way a true Maxakali (Álvares, 1992; Álvares, 2004) thinks, acts, and conceptualizes (Geertz, 1989) time and space (Shkilnyk, 1985).