We may never know the true death toll of 9/11, nor the full extent of the psychological trauma the terrorist attacks caused. But by looking at rates of alcohol and other drug use among those who were directly and indirectly affected by the World Trade Center attacks, researchers are discovering insights into our complex psychological response to terror — and into the origins of drug addiction in general.
In a study of 988 Manhattan residents, conducted in the weeks following 9/11, researchers found that 29% reported an increase in substance use. About a quarter of people began drinking more; 1 in 10 smoked more cigarettes; and just over 3% said they smoked more marijuana.
In a 2004 study of 1,570 city residents surveyed six to nine months after 9/11, researchers found that 10% reported an increase in smoking, 18% an increase in alcohol use, and nearly 3% an increase in marijuana use, compared to the month before the terrorist attacks. The researchers also found that symptoms of depression and post-traumatic stress disorder (PTSD) were more common in those who increased their use of alcohol and other drugs, suggesting that those behaviors may have been in part an attempt to self-medicate. Six months later, however, while depression and PTSD among Manhattan residents living below 110th street declined, drug use rates remained elevated.
But do these trends mean that 9/11 caused increases in addiction? That’s not clear. Reseachers don’t know whether the people who started using more substances post-9/11 went on to become alcoholics or addicts, or whether they may have had earlier drug problems and relapsed. Among the smokers, however, the scientists found that the increase in smoking was seen primarily in pre-existing smokers, although there were some ex-smokers who relapsed and others who started smoking for the first time right after Sept. 11, 2001.
“I think the picture with substance use overall is very complicated,” says Sandro Galea, an author of the 2004 study, published in The American Journal of Drug and Alcohol Abuse, and chair of epidemiology at Columbia University. “Some studies say there was more use, some say less. I think this is a function of the fact that there are several trajectories.”
In other words, people’s reactions to trauma vary widely. Many people may respond by drinking, overeating, taking drugs or seeking other pleasures to soothe anxiety, but just as often, others seem to find meaning in staying clear-headed and taking actions to respond meaningfully to the situation. That may even mean kicking an addiction, rather than starting one, since substance misuse can be driven by a sense of meaninglessness, uselessness and hopelessness.
“We did find some patterns in our work,” says Galea. “My reading is that for every adult for whom a new addiction was created, there is someone who found meaning after 9/11 and stopped using.”
Indeed, the most senseless disasters can become a source of inspiration for some, leading to what has become known as “post-traumatic growth,” which spurs people to help others, work to prevent a repeat of the event or otherwise find a calling in the midst of the aftermath.
Children are at greatest risk for the most adverse outcomes following trauma — including later substance misuse — because their still-developing brains may be affected. In a 2008 study published in the journal Disasters, researchers looked at 1,040 students who were attending the five middle schools and five high schools closest to the Twin Towers when the planes hit. The researchers surveyed the students 18 months after the attacks.
Those who had just one indicator of significant exposure to trauma — factors like knowing someone who was killed, or being in fear for one’s own life or the lives of loved ones during the attacks — were five times more likely to report increased use of alcohol or other drugs, than kids who had no indicators of trauma. Kids who had three or more trauma-exposure factors were 19 times more likely to misuse substances than nonexposed kids.
Students who reported substance use were more likely to have lower grades, problems with schoolwork and to misbehave at school, suggesting that their use was heavy and frequent.