Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2023 May 1.
Published in final edited form as: Alcohol Clin Exp Res. 2022 Apr 7;46(5):815–824. doi: 10.1111/acer.14819

Assaultive trauma, alcohol use, and alcohol-related consequences among American Indian adolescents

Nichea S Spillane 1, Tessa Nalven 1, Silvi C Goldstein 1, Melissa R Schick 1, Katelyn T Kirk-Provencher 1, Aayma Jamil 1, Nicole H Weiss 1
PMCID: PMC9117488  NIHMSID: NIHMS1793229  PMID: 35342962

Abstract

Background:

American Indian (AI) adolescents report disproportionate rates of alcohol use and alcohol-related consequences compared to adolescents from other racial/ethnic groups. Trauma exposure is reported at high rates among AI individuals and likely confers risk for alcohol use. The purpose of the present study was to examine the effects of assaultive trauma experiences (e.g., physical and sexual assault) on alcohol use and alcohol-related consequences in AI adolescents.

Methods:

AI 7th-12th graders residing on or near a reservation (n = 3,498, Mage = 14.8; 49.5% female) completed self-report measures regarding trauma exposure, alcohol consumption, and lifetime alcohol-related consequences. Institutional IRBs, tribal authorities, and school boards approved the study protocols prior to beginning data collection.

Results:

Nearly half (49.3%, n = 1,498) of AI adolescents reported having experienced at least one assaultive trauma in their lifetime. Those who had experienced assaultive trauma in their lifetime were more likely to report lifetime alcohol use (χ2 = 111.84, p < .001) and experienced greater alcohol-related consequences (t(1746) =12.21, p<.001) compared to those with no assaultive trauma exposure. Multilevel regression analyses indicated that a greater number of assaultive traumatic events was significantly associated with greater odds of lifetime alcohol use (p < .001, OR = 1.81, 95%CI [1.65, 2.00]) and having experienced a greater number of alcohol-related consequences (b = .36, SE = .04, t = 16.95, p < .001, 95% CI [.31, .46]).

Conclusions:

Findings of the present study highlight the relevance of exposure to assaultive trauma in AI adolescents’ use of alcohol and experiences of alcohol-related consequences. These findings implicate the need for trauma-informed interventions in addressing AI adolescent alcohol use.

Keywords: American Indian, adolescent, trauma, alcohol use, alcohol-related consequences

Introduction

American Indian (AI) adolescent alcohol use is a significant public health concern. Though there is a great variability among AI communities in alcohol use rates, AI individuals experience disproportionate harm related to alcohol use compared to individuals from other racial/ethnic groups (Stanley et al., 2014, Swaim and Stanley, 2018). Compared with a nationally representative sample of U.S. adolescents from Monitoring the Future, AI adolescents in one study reported higher rates of lifetime alcohol use in 8th, 10th, and 12th grade (e.g., 72.5% of AI 12th graders versus 61.2% of 12th graders in the general U.S. population; Swaim and Stanley, 2018). AI adolescents also initiate drinking alcohol at younger ages compared to their non-AI counterparts (Stanley and Swaim, 2015, Henry et al., 2011, Stanley et al., 2014), which is of great concern given that early initiation of alcohol use is associated with experiencing more alcohol-related consequences and higher likelihood of being diagnosed with an alcohol use disorder later in life (Henry et al., 2011). AI adolescents have been found to be more likely to experience various alcohol-related consequences compared to their White counterparts, including driving accidents and social consequences such as fights with parents and peers (Beauvais, 1992). AI adolescents are also at increased risk for a number of alcohol-related health inequities in adulthood; for example, rates of alcohol-related mortality are 6.6 times higher for AIs than for the general population (Indian Health Service, 2019). Given high rates of consequences and deleterious long-term outcomes, it is imperative to understand specific risk factors for alcohol use and associated consequences among AI adolescents.

Trauma exposure may be one risk factor that places AI adolescents at increased risk for alcohol use. The self-medication hypothesis suggests that harmful alcohol use among AI adolescents may develop in response to emotional distress stemming from trauma exposure (Khantzian, 1997). Specifically, alcohol use may reduce, eliminate, or allow the individual to avoid emotional distress associated with post-trauma symptoms, thus negatively reinforcing the alcohol use. In turn, this may lead to alcohol use becoming an automatic escape response, increasing the likelihood of developing an alcohol use disorder (Chilcoat and Breslau, 1998, Khantzian, 1997, Garland et al., 2013). Recent research has found empirical support for trauma-related self-medication (Thege et al., 2017, Hawn et al., 2020), such that “drinking to cope” with trauma may serve as a mechanism through which traumatic symptoms influence alcohol-related consequences (Hawn et al., 2020).

AI individuals are at high risk for trauma exposure broadly (Kirk-Provencher et al., 2020, Easton et al., 2019, Futures Without Violence, 2012) as well as posttraumatic stress disorder (PTSD) specifically compared to the general population (Robin et al., 1997). In particular, AI individuals are at disproportionate risk for experiencing assaultive traumas (e.g. physical and sexual assault; Bachman et al., 2010, Yuan et al., 2006). Among AI adolescents, experiencing assaultive traumas has been found to be associated with adverse alcohol-related consequences, including heavy alcohol use and alcohol use disorder, as well as risk for future trauma exposure, such as sexual victimization (Kirk-Provencher et al., 2020, Koss et al., 2003). Trauma during childhood or adolescence may be particularly relevant to the development of problematic patterns of alcohol (i.e., those which might confer increased risk for experiencing alcohol-related consequences; Libby et al., 2004, Whitesell et al., 2009). For example, among trauma-exposed AIs, trauma exposure during childhood is more strongly associated with the development of substance use problems than trauma exposure later in life (Libby et al., 2004). Further, adverse childhood experiences (ACEs; physical, sexual, or emotional abuse and/or neglect) are more frequently reported among AI youth (compared to non-AI youth) and to be linked to alcohol use and heavy drinking among AI individuals (Loving, 2014, Warne et al., 2017). AI adolescents may experience adverse symptoms stemming from experiencing assaultive trauma, including persistent feelings of shame, self-blame, anger, and depression (Easton et al., 2019), which may lead to drinking alcohol as a means to self-medicate (Khantzian, 1997). Taken together, these studies suggest that alcohol use and alcohol-related consequences may represent an important trauma sequela for AI adolescents.

To avoid over-pathologizing AI communities, it is important to note the context in which trauma and alcohol use occur and to highlight the resilience of AI people. AI people have experienced widespread genocide, legally sanctioned ethnic cleansing, and forced acculturation through the criminalization of important cultural practices since first contact with colonizers. The effects of colonization continue to this day. In May and June 2021 alone, hundreds of Indigenous children’s remains were found in unmarked mass graves at two residential schools in Canada (Coletta, 2021). Historical trauma refers to the emotional and psychological wounding associated with the cumulative and widespread losses of people, land, family, and culture that is transmitted intergenerationally among AI individuals, rather than direct, individual exposure to trauma (Brave Heart and DeBruyn, 1998). Historical trauma has been highlighted as an important contributing factor to numerous mental and physical health disparities observed among AI people, including ongoing experiences of trauma and alcohol use (Skewes and Blume, 2019, Gone et al., 2019). Further, AI communities are disproportionately affected by social determinants of health, including lack of access to healthcare services (Marrone, 2007), which have been linked to disparities in trauma exposure (Mikhail et al., 2018) and alcohol use (McKenzie et al., 2016).

While previous work has linked trauma exposure to alcohol use and alcohol-related consequences, there is a need to understand how assaultive trauma specifically confers risk for AI adolescents. Further, it is possible that there is a dose-response relationship between trauma exposure and alcohol use and alcohol-related consequences. Thus, beyond simply examining the presence of trauma exposure (i.e., yes versus no), it is important to test whether the number of assaultive traumatic events AI adolescents experience may increase the risk for alcohol use and alcohol-related consequences. Indeed, such a relationship exists between trauma exposure and physical health conditions in a national U.S. study (Husarewycz et al., 2014). Thus, the goal of the present study was to examine the associations between exposure to assaultive trauma and both alcohol use and alcohol-related consequences among AI adolescents, including examining the number of assaultive traumas experienced. Based on previous literature in these areas, we hypothesized the following:

  1. Adolescents who reported any assaultive trauma exposure (versus no assaultive trauma exposure) would report higher levels of alcohol use and more alcohol-related consequences.

  2. Experiencing a greater number of assaultive traumas would be associated with greater odds of alcohol use and experiencing alcohol-related consequences.

Materials and Methods

Participants

The participants for this study consisted of 3,498 AI students, drawn from a larger sample of 5,744 students living on or near AI reservations. Participants included in the present study were between the ages of 10 and 21 years old (M = 14.8, SD = 1.7) and 49.5% were female. Thirty-three schools were selected from 11 states by stratifying the country into six geographic regions (Northwest, Northern Plains, Northeast, Southeast, Southern Great Plains, and Southwest); schools were chosen to match the percentage of AIs per geographic region reflected in the 2000 U.S. Census data (Snipp, 2000). Therefore, this sample is considered representative of AI adolescents nationally. The reservations and tribes who participated in the study are not identified to protect confidentiality. Schools who elected to participate in the research were compensated $500 and were given a report following study completion summarizing aggregate findings.

Procedures

The present study consisted of a secondary data analysis utilizing a dataset collected by the Tri-Ethnic Center for Prevention Research at Colorado State University. This dataset is also publicly available through National Addiction and HIV Data Archive Program. In brief, data were collected between 2009 and 2013 as a part of an ongoing epidemiologic study of substance use trends among AI adolescents (Stanley et al., 2014). All study materials and procedures were approved by appropriate school boards, tribal authorities, and Institutional Review Boards (IRBs) prior to beginning data collection. Parents were sent a form giving them the opportunity to opt children out of the study and students provided assent; however, less than 1% of the students were opted out by their parents or declined to participate.

Measures

Participants completed The American Drug and Alcohol Survey™ (ADAS), a self-report, pencil-and-paper survey assessing substance use and potentially related variables. The ADAS was listed in the 2007 Substance Abuse and Mental Health Services’ Measures and Instruments Resource guide, and it is continually updated to reflect current substances used by adolescents. It has also demonstrated good reliability and validity within AI adolescent populations (Oetting and Beauvais, 1990, Stanley et al., 2014, Goldstein et al., under review)

Experiences of Assaultive Trauma

Number of assaultive traumas experienced.

Six questions assessed the frequency of ever experiencing different types of assaultive traumas: being beaten up by a peer or by someone else, scared or hurt with a weapon, sexually assaulted, or robbed. Four response options ranged from 0 (“never”) to 3 (“six or more times”). Item-level scores were summed, with higher scores indicating experiencing a higher number of experiences of assaultive trauma.

Lifetime assaultive traumatic experience.

The above item, assessing for number of experiences of assaultive trauma was collapsed into a separate variable and coded as 0 = “no” and 1 = “yes,” such that a rating of 1 indicated a history of ever having any traumatic experience of being beaten up, scared/hurt with a weapon, sexually assaulted, or robbed.

Alcohol Use

Lifetime alcohol use.

One question assessed if adolescents had ever had a drink of alcohol. Response options were coded as 0 = “no” and 1 = “yes,” with a rating of 1 indicating a history of lifetime use of alcohol.

Past month alcohol use.

One question assessed frequency of alcohol use in the past month. Five response options ranged from “none” to “20 or more times.” Because of the zero-inflated nature of the variable, frequency variables were collapsed and coded as 0 = “no” and 1 = “yes,” such that a rating of 1 indicated drinking alcohol one or more times in the past month.

Binge drinking.

Two questions assessed frequency of binge alcohol use in the past two weeks. For males, an item assessed how often they had five or more drinks of alcohol within a two-hour period, and for females, and item assessed how often they had four or more drinks within a two-hour period. Eleven response options for both items ranged from “0” to “10 or more.” Because of the zero-inflated nature of the variable, frequency variables were collapsed and coded as 0 = “no” and 1 = “yes,” and the two items for males and females were combined, such that a rating of 1 indicated binge drinking one or more times in the past two weeks for either males or females.

Alcohol-related consequences.

Alcohol-related consequences were assessed by nine different items that inquire whether drinking alcohol has ever caused different problems such as getting in trouble in school or causing a fight with others (Goldstein et al., under review). Four response options ranged from “no” to “10 or more times,” and based on the zero-inflated nature of the variable, frequency variables were collapsed and coded as 0 = “no” and 1 = “yes,” such that a rating of 1 indicated a problem occurring one or more times. The items were added to obtain a total scale score reflecting the number of alcohol-related consequences (range: 0–9), with higher scores indicating having reported a higher number of different alcohol-related consequences. Reliability in the present sample was good, Cronbach’s α = 0.84.

Statistical analyses

All study analyses were conducted using SPSS v26.0 and all variables of interest were assessed for adherence to GLM assumptions, as recommended by Tabachnik & Fidell (2019). First, descriptive analyses were conducted to report on the total number of AI adolescents who had reported assaultive trauma, how many of each type of assaultive trauma, and total number of assaultive traumas. Chi-square analyses were utilized for binary variables to assess for differences between those reporting a history of lifetime assaultive trauma exposure (or not) and past month alcohol use, lifetime alcohol use, and binge drinking (binary variables). Next, an independent sample t-test analysis was utilized to assess, among those who endorsed lifetime alcohol use, whether there were group differences on number of alcohol-related consequences for those who had experienced at least one assaultive trauma and those who had not. Then, bivariate correlations (i.e., Pearson product-moment correlations among continuous variables and point-biserial correlations among dichotomous and continuous variables) were conducted to explore bivariate associations among assaultive trauma exposure, alcohol use, age, and sex. Finally, two multilevel regression analyses were conducted to evaluate the associations between number of assaultive trauma experiences as it relates to lifetime alcohol use and number of alcohol-related consequences (level one), while accounting for the nesting of the data within the 33 schools (level two). A multilevel binary logistic regression model was utilized to test for the effects of number of assaultive traumas, while controlling for sex and age, on lifetime alcohol use. Finally, the sample was selected for only those who endorsed lifetime alcohol use (n = 2,082), and a multilevel Poisson regression was utilized to account for the count-type outcome variable and test for the effects of number of assaultive traumas, while controlling for sex, age, and past-year alcohol use, on alcohol-related consequences. For the multilevel Poisson regression model, predictor variables were Z-standardized, and the model was re-run with this standardized variable to obtain standardized regression estimates to serve as a measure of effect size and allow for comparison of the magnitude of effects. In the present study, we focused on level one variables only because we aimed to better understand individual differences in assaultive trauma experiences and their relation to alcohol use and alcohol-related consequences.

Results

Descriptive, Chi-Square, and t-test Analyses

Based on established guidelines that absolute values of skewness > 2 and kurtosis > 4 indicate non-normality (West et al., 1995, Kim, 2013), number of alcohol-related consequences was approximately normally distributed (skewness = 1.63, kurtosis = 1.78), but number of assaultive trauma experiences was not (skewness = 2.82, kurtosis = 12.16). A square-root transformation normalized the number of assaultive trauma experiences (skewness = 0.80, kurtosis = −0.15), and this transformed variable was used in all further analyses. Descriptive, chi-square, and t-test results are presented in Table 1. Of the total sample, 42.8% (n = 1,498) reported having experienced at least one of the four categories of assaultive trauma experiences in their lifetime, and of this group, the average number of different assaultive trauma experiences was 1.61 (SD = 0.82). In total, 34.7% (n = 1,064) indicated they had been beaten up, 18.7% (n = 572) indicated they had been scared/hurt with a weapon, 12.1% (n = 370) indicated they had been sexually assaulted, and 16.0% (n = 490) indicated they had been robbed in their lifetime. Of the subsample who had experienced at least one assaultive trauma, 69.8% (n = 1,044) reported lifetime alcohol use, while 51.0% (n = 785) of those who had not experienced assaultive trauma reported lifetime alcohol use. Of the total sample, participants also reported an average of 1.34 alcohol-related consequences (SD = 2.1), and among those who endorsed lifetime alcohol use, participants reported an average of 2.1 alcohol-related consequences (SD = 2.34).

Table 1.

Descriptive, chi-square, and t-test analyses for the total sample and by trauma exposure.

Total sample (n=3,498) Assaultive trauma exposed (n=1,498) Not assaultive trauma exposed (n=1,542)
n (%)
Age (x¯, SD) 14.8 (1.7) 14.8 (1.7) 14.8 (1.7)
Sex
 Male 1,708 (50.5%) 749 (51.4%) 684 (46.2%)
 Female 1,672 (49.5%) 709 (48.6%) 797 (53.8%)
Past month alcohol use*
 No 2,526 (73.7%) 982 (66.8%) 1,242 (81.5%)
 Yes 901 (26.3%) 489 (33.2%) 281 (18.5%)
Lifetime alcohol use*
 No 1,407 (40.3%) 451 (30.2%) 753 (49.0%)
 Yes 2,082 (59.7%) 1,044 (69.8%) 785 (51.0%)
Binge Drinking*
 No 2,787 (83.0%) 1,132 (78.1%) 1,311 (88.8%)
 Yes 571 (17.0%) 318 (21.9%) 166 (11.2%)
Alcohol-related consequences**, 2 (x¯, SD) 1.3 (2.1) 1.9 (2.4) 0.76 (1.5)
Open in a new tab

Note:

*

Denotes significant group differences by assaultive trauma expereince history from Pearson’s chi-square analyses at p<.05;

**

Denotes significant group differences by assaultive trauma experience history from independent samples t-test at p<.05;

1

Past year alcohol use is a measure of frequency with the range: 0–5;

2

Alcohol-related consequences is a count variable with the range: 0–9.

This t-test was conducted among a subset of the total sample, only among those who endorsed lifetime alcohol use (n = 2,082).

Results from chi-square analyses suggest that there was a significant group difference for those who had experienced at least one assaultive trauma (versus had not) on reporting a history of drinking alcohol in the past month (χ2 = 85.71; p < .001, Cramer’s V = .17) and in their lifetime (χ2 = 111.84; p < .001, Cramer’s V = .19), as well as past two-week binge drinking (χ2 = 60.61; p < .001, Cramer’s V = .14). Those who had experienced at least one assaultive trauma were more likely to report a history of past month, lifetime, and binge alcohol use than those who had not experienced an assaultive trauma.

An independent samples t-test was conducted to compare differences in number of alcohol-related consequences experienced among those who endorsed lifetime use of alcohol between participants who had (versus had not) experienced at least one lifetime assaultive trauma. Results revealed that those who had experienced at least one assaultive trauma (M = 3.62; SD = 2.47) as compared to those who had not (M = 1.37; SD = 1.84) reported significantly more alcohol-related consequences, t(1746) = 12.21; p < .001, d = 1.03.

Bivariate Correlations

Pearson product-moment and point-biserial correlations (see Table 2) revealed that all alcohol use outcomes (i.e., past month alcohol use, lifetime alcohol use, and binge drinking) were significantly associated with each other and with all assaultive trauma variables (i.e., having experienced at least one assaultive trauma and number of assaultive trauma experiences). See Supplemental Table 1 for bivariate correlations between assaultive trauma types and alcohol use outcomes.

Table 2.

Bivariate correlations among alcohol use and assaultive trauma variables, along with age and sex (n = 3,498).

Measure 1 2 3 4 5 6 7 8
1. Age —
2. Sex (female) .002 —
3. Lifetime assaultive trauma experience −.02 −.05* —
4. Number of assaultive trauma experiences .002 −.09** .89** —
5. Past month alcohol use .15** .08** .17** .19** —
6. Lifetime alcohol use .26** .11** .19** .21** .46** —
7. Binge drinking .12** .06* .14** .18** .65** .35** —
8. Alcohol-related consequences .12** .13** .28** .33** .46** .45** .47** —
Open in a new tab

Note.

*

p < .01,

**

p < .001.

Multilevel Regression Analyses1

Alcohol use.

In the first model, multilevel binary logistic regression analysis was used for lifetime alcohol use; the overall model was significant, F(3, 2985) = 128.25, p < .001 (see Table 3). The intraclass correlation for alcohol was .049, suggesting that only about 4.9% of the variance in log odds of endorsing lifetime alcohol use was explained by school-level differences. The variance estimate for the school-level intercepts was statistically significant (b = .20, SE = .09, z = 2.30, p = .02, 95%CI [.09, .48]), indicating that the log odds of endorsing lifetime alcohol use varied significantly across schools. While controlling for age and sex, number of assaultive traumas experienced was significantly associated with likelihood of endorsing lifetime alcohol use (p < .001, OR = 1.81, 95%CI [1.65, 2.00]), such that each one-unit increase in number of assaultive traumas experienced was associated with an 81% increase in likelihood of lifetime alcohol use, controlling for age and sex.

Table 3.

Multilevel binary logistic regression models for lifetime alcohol use.

B SE t p OR 95% CI
Intercept −5.45 1.62 −3.36 <.001 0.004 [0.00, 0.10]
Age .35 .03 14..00 <.001 1.42 [1.35, 1.49]
Sex (female) .62 .08 7.36 <.001 1.87 [1.58, 2.21]
Number of assaultive trauma experiences .60 .05 12.04 <.001 1.81 [1.65, 2.00]
Open in a new tab

Alcohol-related consequences.

In the second model, multilevel Poisson regression analysis was used among those who endorsed lifetime alcohol use; the overall model was significant, F(4, 1065) = 41.77, p < .001 (see Table 4). The intraclass correlation for alcohol was .060, suggesting that approximately 6.0% of the variance in number of alcohol-related consequences experienced was explained by school-level differences. The variance estimate for the school-level intercepts was statistically significant (b = .23, SE = .08, z = 2.81, p = .01, 95%CI [.11, .46]), indicating that the average expected log count of alcohol-related consequences experienced varied significantly across school. While controlling for age, sex, and past-year alcohol use, the number of assaultive traumas experienced was significantly related to alcohol-related consequences (B = 0.36, SE = 0.04, β = .30, p < .001, 95%CI [0.31, 0.46]).

Table 4.

Multilevel Poisson regression models for alcohol-related consequences.

B SE β t p 95% CI
Intercept 2.00 1.15 1.74 1.75 .08 [−.25, 4.25]
Age −.07 .03 −.12 −2.54 .01 [−.12, −.02]
Sex (female) .27 .09 .13 2.95 .003 [.09, .45]
Past-year alcohol use .38 .04 .50 9.92 <.001 [.31, .46]
Number of assaultive trauma experiences .36 .05 .30 7.03 <.001 [.26, .46]
Open in a new tab

Discussion

The purpose of the present study was to examine the associations between experiencing assaultive trauma and both alcohol use and alcohol-related consequences among AI adolescents. First, we found that nearly half (42.8%) of adolescents in the present sample reported experiencing at least one assaultive trauma in their lifetime, and more than half reported lifetime alcohol use. This is significantly higher than rates observed in the general U.S. population with respect to assaultive trauma (i.e., 5.2% of adolescents reporting physical assault, 3.8% reporting sexual assault, and 7.6% reporting being threatened with a weapon; McLaughlin et al., 2013). Also notable, of the adolescents who reported having experienced one assaultive trauma, nearly 70% had consumed alcohol in their lifetime compared to approximately 50% for those who had not experienced an assaultive trauma. Consistent with previous literature (e.g., Blumenthal et al., 2008, Libby et al., 2004, Sartor et al., 2018), we found that individuals who reported experiencing an assaultive trauma were more likely to report past month drinking, lifetime drinking, and binge drinking compared to those who had not experienced an assaultive trauma in their lifetime. Moreover, experiencing an assaultive trauma was significantly related to endorsing lifetime alcohol use and with the number of alcohol-related consequences adolescents had experienced. Our results suggest that experiencing assaultive trauma may lead to alcohol use and subsequent alcohol-related consequences. This may be explained by the self-medication hypothesis (Khantzian, 1997), and is consistent with evidence that alcohol serves a regulatory function for adolescents, aiding in the management of distress associated with trauma (Tomlinson and Brown, 2012). Alternatively, and consistent with the high-risk hypothesis, alcohol use may increase risk for assaultive trauma, perhaps by putting adolescents in more risky situations (Windle, 1994) or by impairing their ability to detect danger cues in the environment (Davis et al., 2009). Further longitudinal work is needed to understand the temporal associations between assaultive trauma and alcohol use and alcohol-related consequences for AI youth.

Our results suggest that there is a dose dependent effect between assaultive trauma and alcohol use and alcohol-related consequences among AI adolescents, such that those who endorsed a greater number of assaultive traumas were more likely to endorse lifetime alcohol use and to experience a greater number of alcohol-related consequences. This result extends previous research in non-AI samples finding that that experiencing a greater number of lifetime traumatic events is associated with physical health and psychological conditions (Husarewycz et al., 2014, Petruccelli, Davis, & Berman, 2019). This finding suggests the need for early detection of assaultive trauma among AI adolescents. One important avenue for future research would be to better understand the potential aggregate effects of assaultive trauma alongside other unique forms of trauma that AI adolescents face. In particular, historical trauma, resultant from centuries of violence related to colonization, has been found to increase risk for alcohol use and related consequences (Skewes and Blume, 2019); this risk may be multiplicative when combined with lived traumas, such as assaultive trauma (Gameon and Skewes, 2021), which are more prevalent in the context of historical trauma (Myhra and Wieling, 2014, Gonzales et al., 2018).

In considering the potential implications of the current findings, it is important to acknowledge the cross-sectional nature of our design and small effect sizes. Nonetheless, if replicated longitudinally and across more AI communities (including those that are diverse in their cultures, languages, and histories), results may help inform interventions for reducing alcohol use and alcohol-related consequences among AI adolescents. Future efforts that focus on preventing individuals from perpetrating assaultive trauma may be an ideal first step for reducing alcohol use and alcohol-related consequences among AI adolescents. Yet, recognizing that such widespread and systematic change may take time and may be difficult to attain, our findings that alcohol use was highly prevalent and associated with increased alcohol-related consequences among individuals who had experienced assaultive trauma speak to the potential utility for trauma-informed approaches to address alcohol use and alcohol-related consequences among AI adolescents. Researchers have commented that interventions specifically designed for AIs who have experienced trauma—particularly children and adolescents—may hold promise for reducing risk for alcohol use (Whitesell et al., 2012), and culturally-grounded treatment approaches are more effective for AI communities than treatments designed for other cultural groups (Benish et al., 2011, Smith et al., 2011). Notably, however, there is a dearth of evidence-based treatment programs targeting both trauma and alcohol use that have been designed within AI communities. This is an important avenue for future research. In conducting this work, it is important to acknowledge that culturally adapted interventions are most effective when they incorporate values and beliefs from within specific cultures (Benish et al., 2011, Smith et al., 2011), and there are 574 tribes in the U.S., with unique cultures, languages, and histories, and alcohol use and alcohol-related consequences vary significantly between them (Whitesell et al., 2012). Future investigations in this area may provide valuable new knowledge to inform trauma-informed treatments for alcohol use and alcohol-related consequences among AI adolescents. As a final note, it is critically important for non-AI researchers to maintain awareness that AI communities are experts on what will be most effective and appropriate for their people, and that they should have full agency and voice in leading research and developing interventions for themselves. Further, funding agencies must be willing to fund research to test the efficacy and transportability of interventions that are already being used by communities so that other AI communities can benefit from that knowledge.

Results of the present study also speak to important future lines of research that should be pursued. First, while we found that experiencing assaultive trauma was significantly associated with alcohol use and alcohol-related consequences, it is likely that AI adolescents’ experiences of assaultive trauma are also related to a host of other forms of psychopathology that were not tested here. For instance, previous work has suggested that trauma exposure is associated with increased depressive symptoms (Vibhakar et al., 2019), anxiety (Suliman et al., 2009), sleep disruptions (Charuvastra and Cloitre, 2009), borderline personality disorder (Alafia and Manjula, 2020), and engagement in other impulsive, health-compromising behaviors (Contractor et al., 2020) in non-AI samples. Second, more work is needed to understand how assaultive trauma and historical trauma might impact one another (e.g., additive or multiplicative effects) to influence alcohol use and alcohol-related consequences. Third, additional work is needed to understand whether other factors might influence this relation. While we believe our relatively small effects are clinically significant, they suggest that there are other factors influencing the likelihood of alcohol use and alcohol-related consequences that are not being captured here. Research in this area may benefit from identifying protective factors to allow for the development of strengths-based intervention efforts. For instance, family has been found to play a more influential role in AI adolescents’ engagement in risky behaviors (such as alcohol use) compared to adolescents from other racial groups (Swaim and Stanley, 2016), and to be associated with substance use among AI adolescents (Schick et al., 2022, Spillane et al., 2020, Swaim and Stanley, 2016), and thus would be an important factor to consider in the associations between experiencing assaultive trauma and alcohol use and alcohol-related consequences among AI adolescents.

While the present study adds important knowledge to the body of literature regarding the association between experiencing assaultive trauma and alcohol use and alcohol-related consequences, the findings should be understood within the context of the study’s limitations. First, the cross-sectional and correlational nature of the data preclude our ability to make causal determinations. For instance, we tested assaultive trauma as a risk factor for alcohol use. However, other theories explaining this association have hypothesized that alcohol consumption might causally increase risk for assaultive trauma, perhaps because of alcohol’s disinhibitory effects (e.g., Allen et al., 2021), or because alcohol use may lead to increased engagement in other risky behaviors, subsequently increasing risk of assaultive trauma (Chilcoat and Breslau, 1998). Alternatively, the shared vulnerability hypothesis suggests that common factors might underlie both assaultive trauma and alcohol use (Norman et al., 2012). Results of the present study provide important initial support for this association and suggest the need for more intensive prospective designs to test the temporal ordering of these associations and to include other important factors (e.g., poverty, discrimination; Gibbs et al., 2018, Skewes and Blume, 2019) to examine their effects. Second, this study utilized self-report measures of assaultive trauma, alcohol use, and alcohol-related consequences, which may have led to over- or under-reporting as a result of issues with retrospective recall, or because adolescents may be hesitant to report such sensitive information as assaultive trauma and alcohol use (Brener et al., 2003). Third, this data represents a school-based sample and therefore does not represent those adolescents who have dropped out of school, including those for whom dropping out of school may have been a severe consequence of trauma (Porche et al., 2011) or patterns of alcohol use (Esch et al., 2014). Finally, while use of this large nationally-representative sample of AI adolescents attending schools on or near reservations is a notable strength of the present study, it is important to note that this may not capture the experiences of all AI adolescents. For instance, while AIs are more likely than Americans of other racial/ethnic groups to live in rural areas, the vast majority of AI people live off-reservation in urban and suburban areas (Snipp, 2000); it is possible that urbanicity versus rurality and living on or off reservation influence likelihood of experiencing assaultive trauma, drinking alcohol, and experiencing alcohol-related consequences. Future work is needed to test the effect of geographic location.

Despite these limitations, findings of the present study provide an important contribution to the literature regarding the associations between assaultive trauma and both alcohol use and alcohol-related consequences among AI adolescents. Specifically, our findings suggest the potential utility of trauma-informed approaches for alcohol use and alcohol-related consequences among AI adolescents. Further, our findings provide initial support for more intensive investigations of these associations, including prospective, longitudinal designs.

Supplementary Material

supinfo

Acknowledgments

This project was supported by the National Institute on Drug Abuse grant R01DA003371. Work on this paper by the last author was supported by National Institutes of Health grants K23DA039327 and P20GM125507.

Footnotes

1

We conducted exploratory analyses to examine whether sex significantly moderated the associations between experiences of assaultive trauma and alcohol use and alcohol-related consequences. We did not find significant interactions for either alcohol use (b = .01, SE = .10, t = −0.06, p = .95, OR = 0.99, 95%CI [0.81, 1.21]) or alcohol-related consequences (b = −.09, SE = .10, t = −0.86, p = .39, 95%CI [−.29, .11]).

References

  1. ALAFIA J & MANJULA M 2020. Emotion dysregulation and early trauma in borderline personality disorder: An exploratory study. Indian Journal of Psychological Medicine, 42, 290–298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. ALLEN HC, WEAFER J, WESLEY MJ & FILLMORE MT 2021. Acute rewarding and disinhibiting effects of alcohol as indicators of drinking habits. Psychopharmacology, 238, 181–191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BACHMAN R, ZAYKOWSKI H, LANIER C, POTEYEVA M & KALLMYER R 2010. Estimating the magnitude of rape and sexual assault against American Indian and Alaska Native (AIAN) women. Australian & New Zealand Journal of Criminology, 43, 199–222. [Google Scholar]
  4. BEAUVAIS F 1992. The consequences of drug and alcohol use for Indian youth. American Indian and Alaska Native Mental Health Research, 5, 32–37. [DOI] [PubMed] [Google Scholar]
  5. BENISH SG, QUINTANA S & WAMPOLD BE 2011. Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of Counseling Psychology, 58, 279–289. [DOI] [PubMed] [Google Scholar]
  6. BLUMENTHAL H, BLANCHARD L, FELDNER MT, BABSON KA, LEEN-FELDNER EW & DIXON L 2008. Traumatic event exposure, posttraumatic stress, and substance use among youth: A critical review of the empirical literature. Current Psychiatry Reviews, 4, 228–254. [Google Scholar]
  7. BRAVE HEART MYH & DEBRUYN LM 1998. The American Indian holocaust: Healing historical unresolved grief. American Indian and Alaska Native Mental Health Research, 8, 56–78. [PubMed] [Google Scholar]
  8. BRENER ND, BILLY JO & GRADY WR 2003. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: Evidence from the scientific literature. Journal of Adolescent Health, 33, 436–457. [DOI] [PubMed] [Google Scholar]
  9. CASEY E, CARLSON J, TWO BULLS S, & YAGER A (2018). Gender transformative approaches to engaging men in gender-based violence prevention: A review and conceptual model. Trauma, Violence, and Abuse, 19, 231–246. [DOI] [PubMed] [Google Scholar]
  10. CHARUVASTRA A & CLOITRE M 2009. Safe enough to sleep: Sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 18, 877–891. [DOI] [PubMed] [Google Scholar]
  11. CHILCOAT HD & BRESLAU N 1998. Investigations of causal pathways between PTSD and drug use disorders. Addictive Behaviors, 23, 827–840. [DOI] [PubMed] [Google Scholar]
  12. COLETTA A 2021. What to know about Canada’s residential schools and the unmarked graves found nearby. The Washington Post. Available at: https://www.washingtonpost.com/world/2021/06/25/canada-schools-unmarked-graves/ [Google Scholar]
  13. CONTRACTOR AA, WEISS NH, KEARNS NT, CALDAS SV & DIXON-GORDON KL 2020. Assessment of posttraumatic stress disorder’s E2 criterion: Development, pilot testing, and validation of the Posttrauma Risky Behaviors Questionnaire. International Journal of Stress Management, 27, 292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. DAVIS KC, STONER SA, NORRIS J, GEORGE WH, & MASTERS NT (2009). Women’s awareness of and discomfort with sexual assault cues: Effects of alcohol consumption and relationship type. Violence Against Women, 15(9), 1106–1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. EASTON SD, ROH S, KONG J & LEE Y-S 2019. Childhood sexual abuse and depression among American Indians in adulthood. Health & Social Work, 44, 95–103. [DOI] [PubMed] [Google Scholar]
  16. ESCH P, BOCQUET V, PULL C, COUFFIGNAL S, LEHNERT T & GRAAS M & Ansseau M 2014. The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving. BMC Psychiatry, 14, 237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. FUTURES WITHOUT VIOLENCE. 2012. The facts on violence against American Indian/Alaskan Native women. Accessed from https://www.futureswithoutviolence.org/userfiles/file/Violence%20Against%20AI%20AN%20Women%20Fact%20Sheet.pdf
  18. GAMEON JA, & SKEWES MC (2021). Historical trauma and substance use among American Indian people with current substance use problems. Psychology of Addictive Behaviors, 35(3), 295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. GARLAND EL, PETTUS-DAVIS C & HOWARD MO 2013. Self-medication among traumatized youth: Structural equation modeling of pathways between trauma history, substance misuse, and psychological distress. Journal of Behavioral Medicine, 36, 175–185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. GIBBS A, JEWKES R, WILLAN S & WASHINGTON L 2018. Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model. PLoS one, 13, e0204956. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. GOLDSTEIN SC, SPILLANE NS, SCHICK MR & ROSSI JS in press. Measurement invariance and application of an alcohol-related harm scale for American Indian adolescents. Assessment. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. GONE JP, HARTMANN WE, POMERVILLE A, WENDT DC, KLEM SH & BURRAGE RL 2019. The impact of historical trauma on health outcomes for indigenous populations in the USA and Canada: A systematic review. American Psychologist, 74, 20–35. [DOI] [PubMed] [Google Scholar]
  23. GONZALES KL, JACOB MM, MERCIER A, HEATER H, NALL GOES BEHIND L, JOSEPH J & KUERSCHNER S 2018. An indigenous framework of the cycle of fetal alcohol spectrum disorder risk and prevention across the generations: Historical trauma, harm and healing. Ethn Health, 1–19. [DOI] [PubMed] [Google Scholar]
  24. HAWN SE, CUSACK SE & AMSTADTER AB 2020. A systematic review of the self-medication hypothesis in the context of posttraumatic stress disorder and comorbid problematic alcohol use. Journal of Traumatic Stress, 33, 699–708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. HENRY KL, MCDONALD JN, OETTING ER, WALKER PS, WALKER RD & BEAUVAIS F 2011. Age of onset of first alcohol intoxication and subsequent alcohol use among urban American Indian adolescents. Psychology of Addictive Behaviors, 25, 48–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. HUSAREWYCZ MN, EL-GABALAWY R, LOGSETTY S & SAREEN J 2014. The association between number and type of traumatic life experiences and physical conditions in a nationally representative sample. General hospital psychiatry, 36, 26–32. [DOI] [PubMed] [Google Scholar]
  27. INDIAN HEALTH SERVICE 2019. Fact Sheet: Disparities.
  28. KHANTZIAN EJ 1997. The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244. [DOI] [PubMed] [Google Scholar]
  29. KIM H-Y 2013. Statistical notes for clinical researchers: assessing normal distribution using skewness and kurtosis. Restorative Dentistry & Endodontics, 38, 52–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. KIRK-PROVENCHER KT, SCHICK MR, SPILLANE NS & TOBAR-SANTAMARIA A 2020. History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents. Addictive Behaviors, 108, 106441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. KOSS MP, YUAN NP, DIGHTMAN D, PRINCE RJ, POLACCA M, SANDERSON B & GOLDMAN D 2003. Adverse childhood exposures and alcohol dependence among seven Native American tribes. American Journal of Preventive Medicine, 25, 238–244. [DOI] [PubMed] [Google Scholar]
  32. LIBBY AM, ORTON HD, NOVINS DK, SPICER P, BUCHWALD D, BEALS J, MANSON SM & AI-SUPERPFP T 2004. Childhood physical and sexual abuse and subsequent alcohol and drug use disorders in two American Indian tribes. Journal of Studies on Alcohol, 65, 74–83. [DOI] [PubMed] [Google Scholar]
  33. LOVING AM 2014. Alcohol use and misuse among american indians: Applying a modified historical trauma model. 75, ProQuest Information & Learning. [Google Scholar]
  34. MARRONE S 2007. Understanding barriers to health care: a review of disparities in health care services among indigenous populations. International Journal of Circumpolar Health, 66, 188–198. [DOI] [PubMed] [Google Scholar]
  35. MCKENZIE HA, DELL CA & FORNSSLER B 2016. Understanding addictions among Indigenous people through social determinants of health frameworks and strength-based approaches: a review of the research literature from 2013 to 2016. Current Addiction Reports, 3, 378–386. [Google Scholar]
  36. MCLAUGHLIN KA, KOENEN KC, HILL ED, PETUKHOVA M, SAMPSON NA, ZASLAVSKY AM & KESSLER RC 2013. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 815–830. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. MIKHAIL JN, NEMETH LS, MUELLER M, POPE C & NESMITH EG 2018. The social determinants of trauma: a trauma disparities scoping review and framework. Journal of Trauma Nursing, 25, 266–281. [DOI] [PubMed] [Google Scholar]
  38. MYHRA LL & WIELING E 2014. Psychological trauma among American Indian families: A two-generation study. Journal of Loss & Trauma, 19, 289–313. [Google Scholar]
  39. NORMAN SB, MYERS US, WILKINS KC, GOLDSMITH AA, HRISTOVA V, HUANG Z, MCCULLOUGH KC & ROBINSON SK 2012. Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder. Neuropharmacology, 62, 542–551. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. OETTING ER & BEAUVAIS F 1990. Adolescent drug use: Findings of national and local surveys. Journal of Consulting and Clinical Psychology, 58, 385–394. [DOI] [PubMed] [Google Scholar]
  41. PETRUCCELLI K, DAVIS J, & BERMAN T 2019. Adverse childhood experiences and associated helath outcomes: A systematic review and meta-analysis. Child Abuse & Neglect, 97, 104127. [DOI] [PubMed] [Google Scholar]
  42. PORCHE MV, FORTUNA LR, LIN J & ALEGRIA M 2011. Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults. Child Development, 82, 982–998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. ROBIN RW, CHESTER B, RASMUSSEN JK, JARANSON JM & GOLDMAN D 1997. Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community. American Journal of Psychiatry, 154, 1582–1588. [DOI] [PubMed] [Google Scholar]
  44. SARTOR CE, BACHRACH RL, STEPP SD, WERNER KB, HIPWELL AE & CHUNG T 2018. The relationship between childhood trauma and alcohol use initiation in Black and White adolescent girls: Considering socioeconomic status and neighborhood factors. Social Psychiatry and Psychiatric Epidemiology, 53, 21–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. SCHICK MR, NALVEN T, THOMAS ED, WEISS NH, & SPILLANE NS 2022. Depression and alcohol use in American Indian adolescents: The influence of family factors. Alcoholism: Clinical & Experimental Research, 46, 141–151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. SKEWES MC & BLUME AW 2019. Understanding the link between racial trauma and substance use among American Indians. American Psychologist, 74, 88–100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. SMITH TB, RODRÍGUEZ MD & BERNAL G 2011. Culture. Journal of Clinical Psychology, 67, 166–175. [DOI] [PubMed] [Google Scholar]
  48. SNIPP C 2000. Selected demographic characteristics of Indians. American Indian health: Innovations in health care, promotion, and policy, 41–57. [Google Scholar]
  49. SPILLANE NS, KIRK-PROVENCHER KT, SCHICK MR, NALVEN T, GOLDSTEIN SC & KAHLER CW 2020. Identifying competing life reinforcers for substance use in First Nation adolescents. Substance Use & Misuse, 55, 886–895. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. STANLEY LR, HARNESS SD, SWAIM RC & BEAUVAIS F 2014. Rates of substance use of American Indian students in 8th, 10th, and 12th grades living on or near reservations: update, 2009-2012. Public Health Reports, 129, 156–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. STANLEY LR & SWAIM RC 2015. Initiation of alcohol, marijuana, and inhalant use by American Indian and white youth living on or near reservations. Drug Alcohol Depend, 155, 90–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. SULIMAN S, MKABILE SG, FINCHAM DS, AHMED R, STEIN DJ & SEEDAT S 2009. Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive psychiatry, 50, 121–127. [DOI] [PubMed] [Google Scholar]
  53. SWAIM RC & STANLEY LR 2016. Multivariate family factors in lifetime and current marijuana use among American Indian and white adolescents residing on or near reservations. Drug and Alcohol Dependence, 169, 92–100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. SWAIM RC & STANLEY LR 2018. Substance use among American Indian youths on reservations compared with a national sample of US adolescents. JAMA Network Open, 1, e180382–e180382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. TABACHNICK BG & FIDELL LS 2019. Using Multivariate Statistics, New York, NY, Pearson. [Google Scholar]
  56. THEGE BK, HORWOOD L, SLATER L, TAN MC, HODGINS DC & WILD TC 2017. Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC psychiatry, 17, 1–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. TOMLINSON KL & BROWN SA 2012. Self-medication or social learning? A comparison of models to predict early adolescent drinking. Addictive Behaviors, 37, 179–186. [DOI] [PubMed] [Google Scholar]
  58. VIBHAKAR V, ALLEN LR, GEE B & MEISER-STEDMAN R 2019. A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma. Journal of Affective Disorders, 255, 77–89. [DOI] [PubMed] [Google Scholar]
  59. WARNE D, DULACKI K, SPURLOCK M, MEATH T, DAVIS MM, WRIGHT B & MCCONNELL KJ 2017. Adverse childhood experiences (ACE) among American Indians in South Dakota and associations with mental health conditions, alcohol use, and smoking. Journal of Health Care for the Poor and Underserved, 28, 1559–1577. [DOI] [PubMed] [Google Scholar]
  60. WEST S, FINCH J & CURRAN P 1995. Structural equation modeling: concepts, issues and applications Thousand Oaks, CA, SAGE Publications. [Google Scholar]
  61. WHITESELL NR, BEALS J, CROW CB, MITCHELL CM & NOVINS DK 2012. Epidemiology and etiology of substance use among American Indians and Alaska Natives: Risk, protection, and implications for prevention. The American Journal of Drug and Alcohol Abuse, 38, 376–382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. WHITESELL NR, BEALS J, MITCHELL CM, MANSON SM, TURNER RJ & TEAM A-S 2009. Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation. Journal of Studies on Alcohol and Drugs, 70, 971–981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. WINDLE M (1994). Substance use, risky behaviors, and victimization among a US national adolescent sample. Addiction, 89(2), 175–182. [DOI] [PubMed] [Google Scholar]
  64. YUAN NP, KOSS MP, POLACCA M & GOLDMAN D 2006. Risk factors for physical assault and rape among six Native American tribes. Journal of Interpersonal Violence, 21, 1566–1590. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

supinfo
NIHMS1793229-supplement-supinfo.docx (13.3KB, docx)

RESOURCES