Reminders of historical loss for adults and children persist to this day, including economic disadvantage on rural reservations, national disrespect, perceived discrimination, and a sense of continual erosion of traditional cultures.25 Even where children are protected from the traumatic stories of their ancestors, the effects of past traumas still have an impact in the form of ill health, family dysfunction, community violence, psychological morbidity and early mortality. Historical trauma has been shown to have independent effects on depressive symptoms in adolescent AI children.25 Moreover, perceived discrimination has been shown to influence early and problem alcohol use in AI adolescents.6 In contrast, enculturation (restoration of culture) increases resilience against the development of alcohol abuse in AI adults26 and two components of enculturation, participation in traditional activities and traditional spirituality, have been shown to have positive effects on alcohol cessation.27 Treatment for historical trauma includes interventions based on traditional AI ceremonies as well as modern treatment modalities for grieving.23,28-30
