1
|
Sanz J, Hernández-Martínez T, Castillo-Burgos P, Sanz-García A, García-Vera MP. Prevalence of increased alcohol use and alcohol use disorders in adult victims of terrorist attacks: a systematic and meta-analytic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:705-722. [PMID: 38011685 DOI: 10.1080/00952990.2023.2275526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
Background: Previous studies have reviewed the evidence on the increase in alcohol consumption after a terrorist attack. However, an increase does not necessarily imply the presence of an alcohol use disorder.Objectives: To conduct a systematic and meta-analytic review of the literature on the prevalence of increased alcohol consumption and alcohol use disorders in adult exposed to terrorism.Methods: A search of PsycINFO, MEDLINE and PTSDpubs identified 29 studies published up to March 2023 in which 38 adult samples totaling 282,753 persons exposed to terrorism were assessed. Using inverse variance heterogeneity models, pooled prevalence rates of increased alcohol use and alcohol use disorders were calculated.Results: 6% (95% CI [2.9, 9.5]) of the adults exposed to a terrorist attack increased their alcohol consumption. The prevalence of increased alcohol use varied depending on the degree of exposure (p = .006, R2 = .18) and the procedure for measuring increases (p = .043, R2 = .37). The prevalence of alcohol use disorders in adults exposed to a terrorist attack was 5.5% (95% CI [3.7, 7.5]), a rate that was not higher than that obtained in the general population and varied depending on the type of alcohol disorder (p = .015, R2 = .30).Conclusions: A relevant number of adults exposed to terrorist attacks will subsequently increase their alcohol consumption, but this increase is not associated with an increase in the prevalence of alcohol use disorders. Effects of terrorism on people's health are potentially widespread, but concerns of excessive alcohol use after terrorist attacks may be unwarranted.
Collapse
Affiliation(s)
- Jesús Sanz
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Timanfaya Hernández-Martínez
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Patricia Castillo-Burgos
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - Ana Sanz-García
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| | - María Paz García-Vera
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Pozuelo de Alarcón (Madrid), Spain
| |
Collapse
|
2
|
Garrey SK, Locke S, Pollari C, Li J, Takemoto E. Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees. Psychiatry Res 2023; 328:115462. [PMID: 37734242 DOI: 10.1016/j.psychres.2023.115462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
In 2021, and average of 220 deaths from opioid-related overdoses occurred daily in the US. Recent evidence suggests there is an association between post-traumatic stress disorder (PTSD) and increased opioid misuse, while little is known about opioid-related hospitalizations. This study used data from the World Trade Center Health Registry (WTCHR), a longitudinal cohort consisting of individuals directly exposed to the September 11th terrorist attacks with a high prevalence of resulting PTSD (3.8-29.6%). We linked WTCHR data to New York State hospitalization data to examine the question: do opioid-related hospitalizations (first time and repeated) differ by PTSD status. In a study sample of 37,968 adults, 145 experienced at least one episode of opioid-related hospitalization and 64 had repeated episodes during the study period. We found that in the 13-years post-9/11, individuals with PTSD had a significantly higher risk of a first-time opioid-related hospitalization (Hazard Ratio: 3.6, 95% CI: 2.7, 5.0) and repeated opioid-related hospitalizations (Hazard Ratio: 3.9, 95% CI: 2.7, 5.8) than those who did not have PTSD. Improved treatment of and increased screenings for PTSD may reduce the likelihood of opioid misuse in this population and consequently overdoses, hospitalizations, and healthcare costs.
Collapse
Affiliation(s)
- Sascha K Garrey
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Sean Locke
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Cristina Pollari
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States.
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| |
Collapse
|
3
|
Dowling FG, Lowe SM. Substance use and related disorders among persons exposed to the 9/11 terrorist attacks: Essentials for screening and intervention. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:261-266. [PMID: 36847147 DOI: 10.1080/19338244.2023.2180614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
A growing body of research supports the association between direct exposure to the September 11, 2001, terrorist attacks, increased rates of alcohol and substance use and elevated risk of subsequent diagnosis with trauma-related and substance use disorders. Posttraumatic stress disorder (PTSD) is the most diagnosed psychiatric illness in individuals who witnessed the 9/11 attacks or participated in disaster response efforts, and substance use disorders (SUDs) are highly comorbid with PTSD. The presence of both conditions poses challenges for clinical management and highlights the importance of screening and offering intervention to this at-risk population. This paper provides background on substance use, SUDs, and co-occurring PTSD in trauma exposed populations, describes best practices for identifying harmful substance use, the role of psychotherapy and medication for addiction treatment (MAT), and recommendations for management of co-occurring SUD and PTSD.
Collapse
Affiliation(s)
- Frank G Dowling
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook, NY, USA
- World Trade Center Health Program, Stony Brook Clinical Center of Excellence, Commack, NY, USA
| | - Sandra M Lowe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- World Trade Center Health Program, Icahn School of Medicine at Mount Sinai Clinical Center of Excellence, New York, NY, USA
| |
Collapse
|
4
|
Ueda Y, Hayashi F, Ohira T, Maeda M, Yasumura S, Miura I, Itagaki S, Shimabukuro M, Nakano H, Kamiya K, Yabe H. A Six-Year Prospective Study on Problem Drinking among Evacuees of the Great East Japan Earthquake: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:319. [PMID: 36612640 PMCID: PMC9819237 DOI: 10.3390/ijerph20010319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Evacuees of the Great East Japan Earthquake have experienced adverse, long-term physical and psychological effects, including problem drinking. This study examined the risk and recovery factors for problem drinking among evacuees between fiscal years (FY) 2012 and 2017 using data on residents in the evacuation area from the Mental Health and Lifestyle Survey. With the FY 2012 survey as a baseline, a survey comprising 15,976 men and women was conducted in the evacuation area from FY 2013 to FY 2017, examining the risk and protective factors for problem drinking. Particularly, the Cutting down, Annoyed by criticism, Guilty feeling, and Eye-opener (CAGE) questionnaire was used to evaluate problem drinking. Univariate and multivariate Cox proportional hazard models were constructed to identify the risk and recovery factors of problem drinking. The findings indicated that the male gender, insufficient sleep, job change, trauma symptoms, mental illness, family financial issues, and heavy drinking (≥4 drinks per day) were significant risk factors for the incidence of problem drinking among the evacuees. Furthermore, a high blood pressure diagnosis could exacerbate problem drinking among men, while younger age and a diabetes mellitus diagnosis could increase problem drinking among women. Trauma symptoms and heavy drinking inhibited recovery from problem drinking after the disaster. Understanding these factors can shape effective long-term intervention strategies to physically and psychologically support evacuees.
Collapse
Affiliation(s)
- Yuka Ueda
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Fumikazu Hayashi
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masaharu Maeda
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Shuntaro Itagaki
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hironori Nakano
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan
| |
Collapse
|
5
|
Basedow LA, Wiedmann MF, Roessner V, Golub Y, Kuitunen-Paul S. Coping motives mediate the relationship between PTSD and MDMA use in adolescents with substance use disorders. Addict Sci Clin Pract 2022; 17:46. [PMID: 36057623 PMCID: PMC9441101 DOI: 10.1186/s13722-022-00329-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/17/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) often co-occur in adolescent patients. Previous research has shown that these patients differ from SUD patients without PTSD in terms of their substance use patterns. In this study, we aimed to test whether substance use in this population is related to an attempt to self-medicate PTSD-related symptoms. METHODS German adolescent patients (aged 13-18 years) at an outpatient clinic for SUD treatment, n = 111 (43% female), completed a self-designed questionnaire on use motives, a measure of PTSD-related experiences, and underwent a standardized psychiatric interview including structured substance use questions. Participants were subsequently classified as 'no traumatic experiences ('noTEs' but SUD), 'traumatic experiences but no current PTSD diagnosis' ('TEs' with SUD), and 'PTSD' with SUD. After establishing a self-designed motive measurement through exploratory and confirmatory factor analyses, we calculated non-parametric group differences and a mediation analysis in a linear regression framework. RESULTS The past-year frequency of MDMA use was highest in the PTSD group and lowest in the noTE group (H (2) = 7.2, p = .027, η2 = .058), but no differences were found for frequencies of tobacco, alcohol, cannabis, or stimulant use (all H ≤ 4.9, p ≥ .085, η2 ≤ .033). While controlling for sex, the three groups showed a similar pattern (highest in the PTSD group and lowest in the noTE group) for coping scores (F (103) = 5.77, p = .004, η2 = .101). Finally, mediation analyses revealed an indirect effect of coping score (b = 0.61, 95% CI [0.29, 1.58], p = .145) on the association between group membership and MDMA use frequency. CONCLUSIONS In adolescent SUD patients, we found an association of current PTSD and lifetime traumatic experiences with higher MDMA use that could be partially explained by substance use being motivated by an attempt to cope with mental health symptoms. This indicates a coping process involved specifically in MDMA use compared to the use of other psychoactive substances, possibly due to unique psychoactive effects of MDMA.
Collapse
Affiliation(s)
- Lukas Andreas Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
- Division of Clinical Psychology and Psychotherapy, Dept. of Psychology, Philipps-University of Marburg, Marburg, Germany.
| | - Melina Felicitas Wiedmann
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Chair for Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Chemnitz, Germany
| |
Collapse
|
6
|
Mazurkiewicz DW, Strzelecka J, Piechocka DI. Terrorism’s Impact on Mental Health Outcomes among Directly and Indirectly Exposed Victims and the Development of Psychopathology. J Clin Med 2022; 11:jcm11092630. [PMID: 35566764 PMCID: PMC9104983 DOI: 10.3390/jcm11092630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
After the events of 9/11, many police-responders developed post-traumatic stress disorder (PTSD) and were potentially vulnerable to developing depression and/or anxiety; in addition, nearly half of police with probable PTSD had comorbid depression and anxiety. Having in mind that victims who experience the effects of terrorism are exposed to high levels of psychological damage, we thus aimed to determine how sequelae of a terrorist act directly and indirectly affect victims. Quantitative synthesis findings were concluded on the basis of 200 records that met the inclusion criteria out of a total of 650. We grouped the patients according to their level of exposure to the WTC terrorist attack on 11 September 2001. The Level I group included individuals who had experienced the traumatic event and/or those who had observed the attack. The Level II group consisted of rescuers and/or persons who cleaned up debris in the area after the attack. The Level III group comprised the victims’ families. Our research enabled us to create a profile for those who were most vulnerable to mental disorders after the WTC terrorist attack. Patients who had survived the terrorist attack and/or those who had observed the incident exhibited fewer traumatic symptoms and a lower percentage of suicidal thoughts in comparison to individuals who had worked as rescuers or cleaning staff in the area after the attack. The number of symptoms rose along with increased contact time with the stressor. The dominant symptom was the triad of intrusion, avoidance, and hyperarousal. The findings may confirm the positive effect of protracted court cases in legal proceedings for compensation on the maintenance and development of psychopathology. Our research may contribute to a better understanding of the consequences of terrorism outcomes on the human psyche and be used in the development of standards for dealing with victims of terrorism’s impact.
Collapse
Affiliation(s)
| | - Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, Al. Żwirki and Wigury 63A Street, 02-091 Warsaw, Poland;
| | - Dorota Izabela Piechocka
- Department of Gynecology and Practical Obstetrics, Medical University of Bialystok, Szpitalna 37 Street, 15-295 Bialystok, Poland;
| |
Collapse
|
7
|
Associations of Embeddedness and Posttraumatic Stress Disorder among 9/11 Survivors. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:608-620. [PMID: 36417219 PMCID: PMC9620943 DOI: 10.3390/epidemiologia2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022]
Abstract
Following exposures to traumatic events on 9/11, survivors have reported heightened levels of posttraumatic stress disorder (PTSD). Multiple factors contribute to both the exacerbation and amelioration of PTSD symptoms, including social integration and support. This cross-sectional study aimed to understand and identify associations of embeddedness and psychosocial risk factors by PTSD status for survivors and first responders of 9/11. Results indicate that those with chronic PTSD had the lowest prevalence of both social and emotional embeddedness and many who reported no PTSD symptoms following 9/11 reported moderate levels of social and emotional embeddedness. Overall, our findings suggest those individuals who reported little to no PTSD also reported the most social/emotional embeddedness; whereas those individuals who report greater or chronic PTSD report the least social/emotional embeddedness. As such, it may be beneficial for clinicians across multiple care disciplines and contexts to consider and address the social lives and needs of those individuals experiencing symptoms of PTSD to ensure their emotional and physical needs are truly being met.
Collapse
|
8
|
Cone JE, Santiago-Colón A, Lucchini R. 9/11 Health Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126383. [PMID: 34204753 PMCID: PMC8296210 DOI: 10.3390/ijerph18126383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Affiliation(s)
- James E. Cone
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA
- Correspondence:
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA;
| | - Roberto Lucchini
- School of Public Health and Social Work, Florida International University, Miami, FL 33199, USA;
| |
Collapse
|
9
|
Eastman MR, Finlay JM, Kobayashi LC. Alcohol Use and Mental Health among Older American Adults during the Early Months of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4222. [PMID: 33923483 PMCID: PMC8073103 DOI: 10.3390/ijerph18084222] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
Poor mental health associated with the COVID-19 pandemic may prompt the utilization of various coping behaviors, including alcohol use. We aimed to investigate the relationships between mental health symptomatology and self-reported changes in alcohol consumption at the onset of the pandemic. Data were from the nationwide COVID-19 Coping Study of US adults aged ≥55 in April and May 2020 (n = 6548). We used population-weighted multivariable-adjusted multi-nomial logistic regression models to estimate odds ratios (ORs) for the associations between mental health (of depression, anxiety, and loneliness, each) and self-reported increased alcohol consumption (vs. no change in consumption). One in ten adults (717/6548; 11%) reported an increase in their alcohol consumption in the past week compared to their usual pre-COVID-19 drinking. Mental health symptomatology was associated with increased drinking since the pandemic onset (depression: OR = 2.66, 95% CI: 1.99-3.56; anxiety: OR = 1.80, 95% CI: 1.34-2.42; loneliness: OR = 2.45, 95% CI: 1.83-3.28). Participants who screened positive for all three mental health outcomes were substantially more likely to report increased alcohol consumption since the onset of the pandemic (OR = 3.87, 95% CI: 2.52-5.96, vs. no mental health outcomes). This study demonstrates potentially harmful changes in alcohol intake among middle-to-older aged adults experiencing mental health symptomatology during the early months of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Marisa R. Eastman
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| | - Jessica M. Finlay
- Survey Research Center, Institute for Social Research, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA;
| | - Lindsay C. Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA;
| |
Collapse
|