Alcohol use in New York after the terrorist attacks: A study of the effects of psychological trauma on drinking behavior
Introduction
Research has suggested increases in substance use among those recently exposed to community disasters (Grieger et al., 2003, Pfefferbaum & Doughty, 2001, Stewart, 1996, Stewart et al., 2004, Vlahov et al., 2002, Vlahov et al., 2004). In addition, substance use has been a documented co-morbid factor accompanying physical and psychological problems following exposure to traumatic events (Boscarino, 1981, Grieger et al., 2003, Kessler et al., 1995, Vlahov et al., 2002). These findings suggest that exposure to traumatic stressors might be a potential risk factor for substance abuse (Chilcoat & Menard, 2003, Ouimette & Brown, 2003). Furthermore, there is evidence to support a possible “self-medication” model in this association between substance abuse and traumatic stressor exposures (Chilcoat & Menard, 2003). That is, exposure to psychological trauma may be related to substance abuse because these experiences often result in adverse psychological symptoms (e.g., hyper-arousal, re-experiencing trauma experiences), which victims may attempt to relieve through the anesthetizing effects of alcohol or drug use (Epstein et al., 1998, Stewart & Conrod, 2003). Nevertheless, while studies of the association between substance use and exposure to psychological distress have a considerable history in behavioral research (Boscarino, 1981, Gottheil et al., 1987, Linsky et al., 1991, Ouimette & Brown, 2003), these findings have not been consistent. For example, while experimental studies tend to report links between alcohol use and stress reduction, community-based studies tend to show less consistent results (Gottheil et al., 1987). In addition, recent research suggests that this relationship is likely more complicated than originally conceptualized (Cooper, Russell, & George, 1988). For example, it has been suggested that individual coping styles related to expectations about alcohol use mediated the link between alcohol use and coping with stressful events (Cooper et al., 1988). In particular, it was reported that stressors were predictive of both alcohol use and drinking problems among those who relied on avoidant emotional coping or those who held positive expectancies about the reinforcing effect of alcohol (Cooper, Russell, Skinner, Frone, & Mudar, 1992). In contrast, stressors were negatively related among those who were low on these factors (Cooper et al., 1992).
In the present study, we examine the relationship between alcohol use within the context of the World Trade Center disaster (WTCD) on September 11, 2001. The WTCD was a unique, time-bounded event in the history of psychiatric epidemiology. We hypothesized that the magnitude of this event had the potential to overwhelm existing social resources and psychological mechanisms and could have put many individuals at risk for substance abuse. Approximately 2800 persons died during this event, which was one of the largest death tolls of any disaster in the United States (Centers for Disease Control and Prevention, 2002). Many residents directly witnessed the attacks and had relatives or friends who died in the disaster. In addition, a large area of lower Manhattan's business district was destroyed, further exacerbating social and economic hardships in the area. The scope of the attacks and their impact on the local community suggested that these events might have significant long-term consequences. Indeed, early post-disaster research documented a high prevalence of psychological symptoms and disorders among residents of New York City (NYC), with 7.5% of those living south of 110th Street in Manhattan having symptoms related to PTSD and 9.7% having symptoms related to depression 1 month after the attacks (Boscarino et al., 2004, Galea et al., 2002). These early post-disaster studies also documented the increased use of substances such as alcohol, cigarettes, and marijuana and linked these increases to psychological disorders (Vlahov et al., 2002, Vlahov et al., 2004, Vlahov et al., 2004). In the US, alcohol is readily available, most adults consume alcohol annually, and this substance is by far the most widely abused (National Institute on Alcohol Abuse and Alcoholism, 2000). Given these factors, we expected to see an association between trauma exposures and alcohol abuse in our study up to 2 years after the attacks.
Although level of event exposures and disaster-related losses are commonly associated with the psychological impact of traumatic events (Bland et al., 1996, Caldera et al., 2001@, Mecocci et al., 2000), there are other factors also involved. For example, research suggests that increased vulnerability often occurs among those with a history of mental health disorders, child abuse, or a history of previous traumas (Breslau et al., 1999, Shalev, 1996, Yehuda, 1999). Furthermore, demographic factors are known to be associated with these experiences (Kessler et al., 1995, Tierney, 2000). In addition, research has consistently identified the role of social support among those exposed to traumatic stress, both in terms of protecting individuals from the psychological consequences of these events (Ursano, Grieger, & McCarroll, 1996), and in terms of influencing effective treatment (Boscarino, 1995, van der Kolk et al., 1996). In summary, the degree of exposure, social factors, individual history, and other factors are believed to play a significant role in determining the impact of traumatic stressors and should be considered in evaluation efforts (Boscarino, 1995, Boscarino, 2000).
Within this context, the current study assesses the effects of exposure to psychological trauma in New York City on alcohol use among a random population sample of 1681 adults. Based on previous research, we hypothesized that exposure to WTCD-related traumatic events was related to both alcohol consumption and misuse up to 2 years after the WTCD, independent of other risk factors, such as demographic characteristics, history of traumatic exposures, stressful life events, and psychological or social resources. To our knowledge, given our sample and the number of risk factors examined, this analysis has not been previously undertaken. To guide our analytical approach, we used a general stress process model (Adams & Boscarino, 2005, Pearlin, 1989, Thoits, 1995). This model suggests that individuals subjected to challenged environments often respond physiologically through alterations in neuroendocrine and hormone functions (Boscarino, 1996, Boscarino, 1997, Boscarino, 2004), psychologically, usually through alterations in cognitive functioning (Keane et al., 1985, Thoits, 1995), and behaviorally, usually through physical responses such as changes in sleep behavior, use of psychoactive substances, or through caloric intake (Boscarino, 2004), as well as through help-seeking behaviors, such as accessing available social support (Adams & Boscarino, 2005, Pearlin, 1989, Thoits, 1995). Most investigators tend to define alcohol use as an avoidant coping strategy, which usually is thought to be ineffective in reducing stress or its adverse psychological consequences (Adams & Boscarino, 2005). Serious environmental challenges that result in significant biological, psychological, or behavioral alterations are typically defined as stressful and referred to as “stressor events” (Adams & Boscarino, 2005, Pearlin, 1989, Thoits, 1995). The consequence of exposure to these aversive stimuli can be psychological and physical distress, often involving depression, anxiety, and other negative psychological states (Adams et al., 2002, Boscarino, 2004, Bromet et al., 2002, Norris et al., 2002, Thoits, 1995), as well as the concomitant physiological, psychological, and behavioral alterations noted in an effort to adapt to these adverse conditions (Boscarino, 2004).
Section snippets
Data and methods
The data for the present study come from a 2-wave panel study of English or Spanish speaking adults living in NYC on the day of the WTCD and on the day of their interview. For the baseline survey (W1), we conducted a telephone survey 1 year after the attacks, using random-digit dialing. When interviewers reached a person at a residential telephone number, they obtained verbal consent and then ascertained the area of residence. If more than one eligible adult lived in the household, interviewers
Alcohol use and problem drinking measures
In our analyses, we focused on factors that would predict W1 and W2 alcohol use, which included measures of alcohol consumption, binge drinking, and alcohol dependence as our outcomes measures. Following the standard for assessing binge drinking (Allen & Columbus, 1995, Naimi et al., 2003), in the survey we asked how many times in the past year the respondent had 6 or more alcoholic drinks on one occasion. We dummy coded the responses, with never or less than monthly (coded 0) compared to
Background demographic characteristics
Our analyses contained demographic variables, including age, education, gender, marital status, race/ethnicity, and income. Although the same predictor variables were used for all of the analyses, we coded some of them differently depending on whether the outcome variable was binary or continuous. For the three binary dependent variables (binge drinking, alcohol dependency, and increase drinks per day), age was coded into four categories, 18–29, 30–44, 45–64, and 65+, with 65+ as the reference
Statistical analysis
Our analytic strategy proceeded in several steps. First, we present descriptive statistics for the five outcome variables discussed. Then, we estimate a series of logistic and ordinary least-squares (OLS) regression equations. More specifically, using logistic regression, we regressed binge drinking, alcohol dependency, and 2+ drink/day increase in alcohol use, respectively, on the independent variables discussed. For number of drinks per month and number of drinks per day when drank, we follow
Results
Changes in reported alcohol use from 1 year prior to the WTCD, to 2 years post-WTCD, revealed small and statistically nonsignificant, increases in pathological drinking behavior as measured by binge drinking and alcohol dependence (Table 1). About 14% of the sample reported drinking 6 or more alcoholic beverages in one occasion at least once a month before the WTCD. That percentage increased slightly to 16% 1 year post-WTCD and decreased slightly to 15% 2 years post-disaster. The percentage of
Discussion
The focus of our study was to assess the effects of exposure to recent psychological trauma on alcohol use among a large population sample of adults. We had hypothesized that exposure to WTCD events would be related to both alcohol use and misuse up to 2 years after the WTCD, independent of other risk factors, such as demographic characteristics, history of past traumatic exposures, stressful life events, social psychological resources, and history of anti-social behavior. To guide our
Acknowledgement
This study was supported by a grant from the National Institute of Mental Health (Grant #R01 MH66403) to Dr. Boscarino.
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2021, Drug and Alcohol DependenceCitation Excerpt :Trauma-exposed individuals often use substances as a form of avoidance coping to alleviate negative affective states (Dixon et al., 2009). For example, witnesses of terrorist attacks or victims of interpersonal violence are more likely to engage in heavy episodic drinking, and this association is mediated by drinking to cope motivations (Boscarino et al., 2006; Kaysen et al., 2007). Moreover, recurrent work-related trauma also increases the likelihood of developing common mental health problems, such as depression and anxiety (Feinstein et al., 2002; Gianni and Papadatou, 2016; Jones, 2017; Stevelink et al., 2018), and there is a known high co-occurrence of alcohol with common mental health problems (Debell et al., 2014; Jacobsen et al., 2001; Kessler et al., 2005).