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The Impact of 9/11 and Its Aftermath on Substance Use and Psychological Functioning: An Overview

Like Pearl Harbor six decades previously, the tragic events of September 11, 2001 transformed this nation. In some respects, however, because the events occurred in the electronic age, and in the nation's capitol and its largest city, these events seemed to possess greater immediacy and possibly greater short- and long-range consequences as well. This Essay provides a brief summary and evaluation of findings on the mental health and substance abuse consequences of the events of 9/11 throughout the nation and in our cities. It also presents new data obtained from clients who entered substance abuse treatment in New York and other cities either before 9/11 or during a six-month period following the events. This Essay concludes with a discussion of how best to interpret these various research findings. Two general types of data have been used to explore the nature and extent of the consequences of the 9/11 tragedy. The first approach utilized retrospective reports either from interviews with randomly selected respondents (1) or from interviews with respondents who either represented groups with some specialized responsibility for addressing the consequences (for example, government officials charged with providing social services) (2) or who represented specific vulnerable populations (for example, drug addicts or children). (3) In each instance, these reports only contained data collected post-9/11 in which respondents were asked to report on their reactions at the time of the attacks or in their aftermath. (4) The second type of approach looked at data collection systems that had been in place before 9/11 and continued collecting information afterward. (5) Some of this ongoing research data enabled researchers to compare the responses of the same individuals before and after the terrorist attacks. (6) Other studies enabled researchers to compare the responses of different people before and after the terrorist attacks. (7) The Authors' research on the characteristics of clients entering substance abuse treatment facilities pre- and post-9/11 falls into this latter category. The results of the various retrospective studies suggest both the specific, localized effects, as well as the more widespread, national effects of the events of 9/11. For example, a telephone survey conducted by the Rand Corporation in the days immediately following the attacks found that while ninety percent of the 560 adults interviewed had one or more symptoms of stress to some degree, forty-four percent reported "one or more substantial symptoms." (8) Included among these stress symptoms were sleeplessness, nightmares, an inability to concentrate, and irritability. (9) These researchers also reported that although the effects were widespread, "the people we surveyed who were closest to New York had the highest rate of substantial stress reactions." (10) Similarly, a telephone survey of Manhattan residents directed by researchers at the New York Academy of Medicine found increased levels of self-reported alcohol, tobacco, and marijuana use. (11) While the increase in marijuana use was relatively small (3.2 percent), larger increases were reported for smoking (9.7 percent), and alcohol use (28.8 percent). (12) Interestingly, symptoms of post-traumatic stress disorder were associated with increases in marijuana use and cigarette smoking, while symptoms of depression were associated with increases in the use of each of the three substances. (13) Retrospective reports by current or former users of heroin and cocaine from a qualitative investigation designed to determine the impact of 9/11 events on this vulnerable population indicated that they also reported serious emotional turmoil, including anger, anxiety, and sadness. (14) In contrast to the increases in substance use observed in the telephone survey, (15) reports of lowered drug use were as commonly observed as reports of increased use among those interviewed by Dr. …