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New Yorkers Sought Solace in Substance Use After 9/11

Many continued drinking, smoking at higher levels six months later

TUESDAY, Feb. 3, 2004 (HealthDayNews) -- More than a quarter of Manhattan residents continued to use higher amounts of alcohol, marijuana and tobacco a full six months after the 9/11 terrorist attacks on the World Trade Center, a new survey reports.

The findings suggest the desire for escape or comfort didn't fade quickly, even as people got on with their lives.

"It seems that although mental health symptoms righted themselves, substance use remained elevated," says study co-author Dr. Sandro Galea, a researcher with the New York Academy of Medicine. "This raises questions about the long-term consequences of disasters."

Galea and colleagues have been studying the psychological aftereffects of Sept. 11, 2001, and changes in the lives of New York City residents. In the new study, released in the February issue of the American Journal of Public Health, the researchers examined the results of two telephone surveys of Manhattan residents.

The first survey, of 988 people who lived south of 110th Street, took place one month after the attacks. In the second survey, the researchers interviewed 854 residents in the same area six months after the attacks.

The researchers divided the survey participants into two groups -- those who weren't directly affected by the attacks, and those who were affected due to the loss of a loved one, injury, loss of possessions or a job, or participation in the rescue effort.

Those directly affected were more likely to report increased substance use; the differences between the two groups were small at the six-month mark, but somewhat larger at the one-month point.

A month after the attacks, 31 percent of the residents surveyed reported drinking more alcohol, smoking more tobacco or smoking more marijuana -- or some combination of the three-- than they did before Sept. 11. The number dropped only slightly, to 27 percent, at the six-month point.

Residents who reported increasing their substance use were most likely to say they drank more. On average, those who acknowledged increasing their substance use said they smoked 103 more cigarettes, downed 18 more drinks and smoked eight more marijuana cigarettes per month than before the attacks. The study findings don't examine how many of the residents surveyed became addicted.

The researchers say the findings are surprising because other surveys suggested that the number of New Yorkers suffering from symptoms of post-traumatic stress disorder fell from 7.5 percent between one and two months after Sept. 11, 2001, to 1.5 percent six months after the attacks.

"It may be that changes in mental health symptoms initially trigger changes in behavior, which then sustain themselves and persist beyond the resolution of mental health issues," Galea says.

Another explanation could be that those who turned to cigarettes, marijuana and alcohol may have been susceptible to depression and chronic anger before the attacks took place, says Dr. Redford Williams Jr., director of the Behavioral Medicine Research Center at Duke University Medical Center.

"Maybe those [people] were already predisposed based on their personality and psychological makeup," Williams says. "Both chronic anger and depression are associated with increased tobacco and alcohol use."

Genetic factors may also play a role, affecting how people react to stress, he says.

Both Galea and Williams say it's important to recognize the mental health risks facing people after disasters.

According to Williams, one solution could be to use the media to show people how to handle stress. "You could even have television programs teaching people meditation techniques for when they find themselves ruminating. [Or] some ways to evaluate the little things that are happening so you can put them into perspective, so you don't have to react and continue to be psychologically distressed," he says.

"There are techniques to do this, but we're talking about doing this for 8 million New Yorkers," he adds. "You're going to have to have a way to deliver it on a mass basis."

More information

Get details about coping with the aftermath of trauma from the American Psychological Association. Learn about the treatment of post-traumatic stress disorder from the National Center for PTSD.

SOURCES: Sandro Galea, M.D., M.P.H., Dr.PH, Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York City; Redford Williams Jr., M.D., director, Behavioral Medicine Research Center, Duke University Medical Center, Durham, N.C.; February 2004 American Journal of Public Health
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