Grief, mental health, historical trauma, and alcohol use among American Indian and Alaska Native populations.

American Indian and Alaska Native (AI/AN) communities experience disproportionately high rates of alcohol-related mortality, which stems from colonization, systemic oppression, and intergenerational historical trauma. Complicated grief and historical trauma have been implicated in health disparities among AI/ANs, including disparities related to alcohol and other drug (AOD) use. However, limited research has examined the relationship between grief and alcohol use among AI/ANs. This study aimed to explore this association using data from a national sample of 600 AI/AN adults who had recently experienced the death of a loved one. Participants completed measures of alcohol use, complicated and adaptive grief, mental health symptoms, and historical trauma. Alcohol use scores were used to categorize participants into three groups: high-risk drinking, low-risk drinking, and non-drinking. People in the high-risk drinking group reported significantly higher levels of complicated grief, historical trauma, PTSD, anxiety, and depression compared to those with low-risk or no alcohol use. Differences in complicated grief were not explained by the number of losses reported or funerals attended. Notably, participants who abstained from alcohol reported the highest levels of adaptive grief. Results underscore the need for interventions that address grief alongside alcohol use, particularly among those struggling with loss. Integrating culturally grounded grief support into alcohol use prevention and treatment programs may enhance outcomes for AI/ANs by addressing the interconnection between grief, trauma, and alcohol problems. Future research is needed to confirm these relationships and guide the development of holistic, culturally responsive care.