Substance Use Tied to Historical Trauma Among Native Americans

The Research

Substance use is prevalent among the Native American population in the United States – with 10% having a diagnosed substance use disorder (SUD) and 7% an alcohol use disorder (AUD) – and some experts are connecting this to historical trauma that previous generations experienced as the result of colonization. To gain a deeper understanding of the relationship, researchers recently surveyed 198 rural tribal members (Native American and Alaska Natives) who self-reported substance use problems.

Julie Gameon and Monica C. Skewes at Montana State University led the study, exploring two distinct factors: historical trauma thoughts and historical trauma-related symptoms. Of note, the Administration for Children and Families describes historical trauma symptoms as: depression, fixation on trauma, low self-esteem, anger, and self-destructive behaviors, while historical trauma thoughts may be described as applying/connecting historical framework to current life.

Gameon and Skewes discovered that people with historical trauma thoughts who did not have historical trauma symptoms actually had better outcomes with their SUD, including fewer days of heavy drinking and more days of abstinence, than their counterparts. On the other hand, those with historical trauma symptoms and no historical trauma thoughts experienced fewer days of abstinence.  The researchers concluded that trauma thoughts may act as a protective factor for SUDs.

SUDs and Native Americans: Related Reports and Perspectives

  • A related study in the Journal of Trauma and Dissociation looks at how historical trauma – which the authors define as “a social determinant of health emanating from targeted mass group-level harm” – and post-traumatic growth, which looks at the “positive shifts in individuals coping with trauma.” They provide a framework that informs trauma recovery.
  • On the Ground Southwest Michigan shares the stories of several Native Americans affected by historical trauma and how they are trying to break the cycle.
  • The Journal of Transcultural Nursing includes a review that explores the impact of historical trauma on younger generations and also looks at protective factors.
  • New York Times shares a series on “repairing generations of trauma” in relation to recent anti-Asian attacks.
  • @KatieWitkiewitz (psychology professor) tweets: “Amazing community-based participatory work from Julie Gameon and @MonicaSkewes examined historical trauma thoughts and current substance use/problems among American Indian adults.”
  • @MonicaSkewes (author of the above study) says: “Historical trauma interventions are based on restoring relational ways of being in the world that were disrupted by colonization. We all benefit from relational ways of being.”
  • @nytimes (newspaper/media) posts: “’Not being counted is not new to us.’ Even with significant gaps in the data available, the rate of known coronavirus cases in the 8 U.S. counties with the largest populations of Native Americans is nearly double the national average, our analysis found.”

Trauma Care In Practice

Premenstrual Dysphoric Disorder (PMDD): Could UPA Be an Effective Treatment?

The Research

Many women experience premenstrual symptoms that can be uncomfortable, but about 5% to 8% of women have very serious symptoms that interfere with daily living. This severe form of premenstrual syndrome (PMS) is called premenstrual dysphoric disorder (PMDD). While this has been an age-old problem, and women who have PMDD often find their symptoms debilitating, a review published in StatPearls reveals that the diagnosis criteria for PMDD were only formalized recently. Now, the DSM-5 includes PMDD under Depressive Disorders.

Even when PMDD is properly diagnosed, there are not many effective treatment options beyond lifestyle modifications for clinicians to prescribe. For this reason, Erika Comasco, PhD, and team looked at the effectiveness of treating PMDD with a selective progesterone receptor modulator called ulipristal acetate (UPA). The findings were encouraging.

Comasco et al found that women who took UPA over a 3-month period had a 41% mean improvement in their self-reported Daily Record of Severity of Problems (DRSP) compared to 22% improvement in a placebo group. There were also significant improvements in the UPA group in depressive symptoms (42% compared to 22% in the placebo group), and anger/irritability (47% compared to 23%). Out of a total of 40 women in the UPA group, 50% of reported remission while taking the medication. Among the placebo group, 21.1% reported similar remission. The findings offer hope that this treatment may be useful in helping women manage the psychological effects of PMDD.

Why it’s complicated – Although the findings demonstrate the benefits of UPA in addressing emotional/mood changes for women with PMDD, the subjects did not report significant changes in physical symptoms. (See our Psy-Q below on how to address PMDD symptoms and related stigma.)

PMDD Diagnostic Criteria & Treatment Approaches

  • EdnoText provides HCPs with an in-depth look at the diagnostic criteria for PMDD.
  • A paper in the Journal of Psychiatric Research finds that females with ADHD experience more severe PMDD symptoms, have postpartum depression after giving birth, and experience more severe climacteric (physiological and psychological) symptoms.
  • An American Family Physician article explores the criteria for diagnosing PMDD and shares various lifestyle changes that can help relieve symptoms.
  • @IAPMD_clinical (Clinical Advisory Board for International Association for Premenstrual Disorders) tweets: “If these results are replicated, UPA could be a useful treatment for PMDD, particularly for the psychological symptoms associated with the disorder…”
  • @RickeyGillespie (physician) says: “Want to develop a multi-disciplinary clinic. Probably a huge area of health disparity. If PMDD gets missed in middle class patients then for people with limited resources it is probably rarely treated. Also intersection with trauma is not clear.”
  • #naps_pms (national association for premenstrual syndromes) notes: “those suffering severe #PMS #PMDD – this being around 800,000 in the UK alone.”
  • In a related report, women were shown to experience more rapid cycling in bipolar disorder than men.

Psy-Q Challenge

How can behavioral health providers help women with premenstrual dysphoric disorder (PMDD) manage their quality of life and related stigma? Kimberly A. Yonkers, MD, answers.

Get the Answer

Predicting Psychiatric Disorders & Treatment Responses with EEGs

The Research

Brainwaves may provide insight into a variety of psychiatric disorders, according to a review article in Brain and Behavior. The authors share the results of several research efforts that highlight the potential of brain waves to predict some diagnoses in advance. For instance, researchers from Boston Children’s Hospital have discovered that electroencephalography (EEG), which measures brain activity, may reveal patterns in the first year of life that predict the likelihood of a baby going on to develop autism spectrum disorder (ASD). The researchers suggest that in the future, pediatricians may be able to routinely conduct EEGs on infants to identify those at risk for autism and to intervene at the earliest opportunity.

A Stanford University and the University of Texas Southwestern team used brainwave patterns to predict how people may respond to antidepressants. The findings, which appeared in Nature Biotechnology, reveal that people who respond better to the antidepressant sertraline (Zoloft) showed increased activity in the prefrontal cortex of the brain. Now the researchers want to determine whether the findings are specific to sertraline or if they may predict responses to other depression treatments as well.

A third study out of Berlin, Germany, determined that patterns in brainwave oscillations may predict which individuals at high risk of psychosis will go on to experience their first episode. This may in the future offer clinicians an opportunity to intervene earlier to head off the onset.

Why it’s complicated – While EEG and other technologies that measure brain activities hold much promise to identify a number of diagnoses before they present, researchers caution that it’s important to have effective treatments available that can be used to head off the development of a condition once risk is identified.

Using EEG to Identify Autism, Psychosis, and More

  • A study published in the Journal of Psychiatric Research used EEG results to determine a relationship between2 CNV chromosomal carriers (deletions and duplications) on spontaneous neural activity their relation to psychiatric issues. These variations have been associated in prior research with psychiatric disorders such as autism and intellectual disability.
  • Brain Topography shares research findings based on EEG data on teenage exchange students that reveal changes in EEG microstates C and D (often found to be altered in people with psychosis) seem to directly correspond with psychotic symptoms.
  • A systemic review that appears in Neuroscience and Biobehavioral Reviews expresses the need for more large-scale studies using EEG and magnetoencephalographic (MEG) to explore how antipsychotic medications impact neural network changes as a person’s mental illness progresses and to ultimately discover new treatment approaches.
  • @treyvery (neuroscientist) tweets: “New paper showing the utility of #EEG in predicting #autism risk and diagnosis in early development. Great example of data sharing (International Infant EEG Data Integration Platform) & #opensource analysis tools (EEG-IP Lossless Pipeline)”

In Practice


Last Updated: Aug 26, 2021