Early life trauma, characterized as emotional abuse and neglect, physical abuse and neglect and sexual abuse, is unfortunately common in all societies and ethnic groups and is a predictor of adult psychopathology, including AUD and drug use disorders (DUD).16 Several studies have demonstrated high levels of childhood trauma in some AI/AN communities.15,17-19 A study in AI women attending a primary care setting showed that childhood trauma was common and that severity was associated in a dose dependent manner with lifetime psychiatric disorders including post-traumatic stress disorder and substance use disorders.17 In a Southwestern American Indian tribe, men and women exposed to severe childhood sexual abuse (CSA) were more likely to be diagnosed with more than three psychiatric disorders.19 CSA in women significantly increased the risk for lifetime AUD and DUD.19 A study in 1362 individuals from six AI tribes with a high lifetime prevalence of AUD found that in men, childhood physical abuse and CSA was associated with an increased risk of AUD whereas for women, all forms of abuse and neglect increased the risk of AUD .15 In this
