Abstract
The self-medication hypothesis may explain the co-morbidity of affective and substance use disorders. Research shows increased prevalence, frequency, and intensity of binge drinking and post-traumatic stress disorder (PTSD) among those directly exposed to the 9/11 terrorist attacks on the World Trade Center (WTC), however, little is known about PTSD symptomology and intentional self-medication with alcohol (ISMA) among this group. We used WTC Health Registry data (N = 28,935) to describe the relationship between ISMA and specific symptom clusters of probable 9/11-related PTSD, the number of PTSD symptom clusters endorsed, and binge drinking intensity. Multivariable logistic regression models were used to estimate the adjusted odds ratios (AORs) and 95% confidence intervals (CI). ISMA was most strongly associated with the hyperarousal PTSD symptom cluster (AOR = 2.04 [1.88, 2.21]) and the endorsement of one (AOR = 1.80 CI [1.65, 1.95]), two (AOR = 2.51 CI [2.28, 2.77]), or three (AOR = 2.84 CI [2.55, 3.17]) PTSD symptom clusters, indicating a clear dose–response relationship. A significant number of 9/11-exposed persons continue to experience PTSD symptoms and engage in ISMA as a potential coping mechanism. Repeated screenings for self-medicative alcohol use among survivors of mass traumas with PTSD symptoms is of public health importance.
Highlights
Post-traumatic stress disorder (PTSD) was the most common mental health sequela of the September 11th, 2001, terrorist attacks on the World Trade Center (WTC) in New York City [1].The disaster exposed thousands of people, including volunteer and professional rescue/recovery workers, lower Manhattan residents, area workers, and passers-by, to a myriad of physical and psychological hazards of varying intensity and duration on the day of 9/11 and in the ensuing weeks and months
This study examines the topic of intentional self-medication with alcohol (ISMA) and specific PTSD symptomology and intensity in a post-disaster context among one of the largest disaster-exposed U.S cohorts with more than 15 years of data
Fifteen years post 9/11, a significant number of persons who were exposed to the disaster and continued to experience symptoms of 9/11-related PTSD used alcohol to intentionally self-medicate their symptoms
Summary
Post-traumatic stress disorder (PTSD) was the most common mental health sequela of the September 11th, 2001, terrorist attacks on the World Trade Center (WTC) in New York City [1].The disaster exposed thousands of people, including volunteer and professional rescue/recovery workers, lower Manhattan residents, area workers, and passers-by, to a myriad of physical and psychological hazards of varying intensity and duration on the day of 9/11 and in the ensuing weeks and months. Exposure to 9/11 had a significant long-term impact on the physical and mental health among directly exposed populations. Research shows that it resulted in an elevated PTSD prevalence, depending on the population, of 3.8% to 29.6%, immediately after the event and in the years since [2]. Increased alcohol consumption is a short-term effect that has been frequently observed in populations exposed to man-made disasters [3], natural disasters [4] and terrorist attacks [5,6]. Keyes et al [7] found that alcohol consumption increased in population samples directly exposed to 9/11 in the months after the event, and over the longer term for those with higher exposure levels. Another study demonstrated an increased prevalence, frequency, and intensity of binge drinking among those directly exposed to the 9/11 attacks [8] and the among survivors of
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