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Recent evidence suggests that changes in brain structure associated with alcohol abuse are compounded in individuals dually diagnosed with alcohol abuse and schizophrenia. To investigate the separate, and possibly interacting, effects of these diagnoses, an event-related brain potential (ERP) measure of auditory information processing (P50 sensory gating paradigm) and neuropsychological measures were administered to healthy control participants with either (1a) no history of alcohol abuse/dependence, or (1b) a remote history of alcohol abuse/dependence, and patients with schizophrenia with either (2a) no history of alcohol abuse/dependence, or (2b) a remote history of alcohol abuse/dependence. Schizophrenia was associated with impaired P50 sensory gating and poorer performance across neuropsychological scores compared to measurements in healthy control participants. Those with a positive alcohol history had impaired gating ratios in contrast to those with a negative alcohol history. There were additive effects of schizophrenia diagnosis and alcohol history for P50 sensory gating and for neuropsychological scores: attention, working memory, and behavioral inhibition. For executive attention and general memory there was an interaction, suggesting that the combination of schizophrenia and history of alcohol abuse results in greater impairment than that predicted by the presence of either diagnosis alone.

pervasive trauma exposure, collective histories of communal suffering, and elevated risk for depression and posttraumatic stress disorder. In addition to socioeconomic barriers, access to culturally responsive treatment is limited, which may compromise treatment engagement. The Iwankapiya study piloted the Historical Trauma and Unresolved Grief Intervention (HTUG), combined with Group Interpersonal Psychotherapy (IPT), to reduce symptoms of depression and related trauma and grief. The study hypothesized that HTUG ϩ IPT would lead to greater group engagement and decreased depression and related symptoms compared with IPT-Only. American Indian adults (n ϭ 52) were randomized into one of two 12-session interventions, HTUG ϩ IPT or IPT-Only, at two tribal sites: one Northern Plains reservation (n ϭ 26) and one Southwest urban clinic (n ϭ 26). Standardized measures assessed depression, posttraumatic stress disorder, grief, trauma, and substance use. Data were collected at screening, baseline, end of intervention, and 8 weeks postintervention; depression and group engagement measures were also collected at Weeks 4 and 8 of the intervention. Depression scores significantly decreased for both treatments, but there were no significant differences in depression between the two groups: IPT-Only (30.2 Ϯ 6.4 at baseline to 16.7 Ϯ 12.1 at follow-up) and HTUG ϩ IPT (30.2 Ϯ 8.1 at baseline to 19.9 Ϯ 8.8 at follow-up). However, HTUG ϩ IPT participants demonstrated significantly greater group engagement. Postintervention, clinicians expressed preference for HTUG ϩ IPT based upon qualitative observations of greater perceived gains among participants. Given the degree of trauma exposure in tribal communities, these findings in a relatively small sample suggest HTUG should be further examined in context of treatment engagement. Clinical Impact StatementQuestion: Does the Historical Trauma and Unresolved Grief Intervention (HTUG) combined with Group Interpersonal Psychotherapy (IPT) result in lower depression and increased treatment engagement than IPT alone? Findings: The Iwankapiya study suggests that American Indian adults with trauma histories are more engaged when therapy includes an emphasis on collective trauma and cultural values and practices, as in the HTUG component; depression scores decreased comparably for both treatment conditions groups. Meaning: Integrating the cultural and historical context increases treatment engagement, contributing to greater capacity for treatment gains such as reducing depression, trauma, and related symptoms. Next Steps: Given the degree of trauma exposure in tribal communities, these findings suggest HTUG should be further examined in a larger group in the context of minimizing barriers to treatment and examining the influence of treatment engagement.

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