The Intentional Self-Medication of 9/11-Related PTSD Symptoms with Alcohol: 15 Years after the Disaster

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.

Alcohol Use and Mental Health among Older American Adults during the Early Months of the COVID-19 Pandemic

“…We add to previous literature on mental health and alcohol use, finding that both increases and decreases in usual alcohol were common, and were often experienced alongside mental health symptomatology among middle-aged and older US adults during the early COVID-19 pandemic, a period of collective adversity. Evidence suggests that increases in alcohol consumption are concomitant with adverse mental health outcomes following large-scale traumatic exposures, such as a natural disaster, widespread economic assault, or acts of terrorism [ 37 , 38 , 39 , 40 , 41 , 43 , 44 , 52 , 53 , 54 ]. Taken together, these findings generally support the tension reduction hypothesis, indicating that alcohol consumption may be used to cope with negative emotions triggered by stress [ 20 , 22 , 23 , 42 ].…”

“…Taken together, these findings generally support the tension reduction hypothesis, indicating that alcohol consumption may be used to cope with negative emotions triggered by stress [ 20 , 22 , 23 , 42 ]. For example, studies conducted on the immediate and long-term aftermath of the terrorist attacks on the World Trade Center on 11 September 2011 (9/11) found that adults with high 9/11-exposure or high 9/11-PTSD were at an increased risk of subsequent binge drinking [ 38 , 39 , 52 , 55 , 56 , 57 ]. Although we were unable to assess the severity of exposure to the COVID-19 pandemic or binge drinking in our study, our results corroborate previous findings by showing high proportions of adverse mental health symptomatology and notable changes in alcohol consumption in the face of myriad stressors produced by the COVID-19 pandemic.…”

Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders

“…The latter has been repeatedly invoked in the description of the PTSD-SUD relationship [ 24 – 27 ]. While previous research has focussed on adult patients with PTSD and SUD who reported coping motives with regard to their substance use [ 17 ], or on adolescents without SUD or PTSD [ 28 ] little research has been conducted to directly explore the relationship between PTSD, substance use, and coping motives.…”

Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors

“…This suggests that the mere presence of PTSD symptoms, whether enduring or not, may diminish one's sense of self-efficacy, and in turn, reduce one's ability to experience more social embeddedness. Garrey et al [44] found that those individuals who sought treatment had greater self-efficacy than those not in treatment for PTSD. Conversely, it may also be that people with low self-efficacy could be more likely to experience PTSD.…”