Stress, Depression and Drug Abuse: Fallout of September 11

Last Editorial Review: 9/8/2003

A survey of New York City residents in the wake of the September 11, 2001, terrorist attacks found high levels of both depression and posttraumatic stress disorder (PTSD) among respondents and documented an increase in substance abuse. The survey, conducted by NIDA-funded researchers Dr. David Vlahov and his colleagues at the New York Academy of Medicine 5 to 8 weeks after the terrorist attacks, quantifies the relationships among stress, depression, and substance abuse. The results provide insight into public health service delivery needs as well as clues to effective treatment strategies to help individuals cope with traumatic events.

Map of Study Area

Stress has long been recognized as one of the most powerful triggers for drug craving and relapse to drug abuse. Research has shown that survivors of disasters are prone to stress-related problems such as PTSD and depression. People who experience major trauma and those with PTSD or depression may self-medicate with drugs or alcohol to relax, cope with stress, or relieve symptoms. "This study is one of the first to capture data on the effects of traumatic events on substance abuse patterns," says Dr. Jacques Normand of NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse. "The increase in substance abuse found here was of significant magnitude. This study reminds counselors and treatment providers to be alert to increased use of alcohol, tobacco, and marijuana in the wake of such events."

Survey respondents reported post-attack rates of depression and PTSD that were approximately twice the baseline levels previously documented in a 1999 benchmark national study. Some 9.7 percent had symptoms of depression, and 7.5 percent qualified for a diagnosis of PTSD compared to baseline levels of 4.9 percent for depression and 3.6 percent for PTSD.

In looking at rates of new substance use among respondents, the researchers found that, of respondents who did not use these substances during the week before September 11, 3.3 percent started smoking cigarettes after September 11; 19.3 percent started drinking alcohol; and 2.5 percent began using marijuana. Overall, the percentages of respondents who smoked, consumed alcohol, and used marijuana increased 9.7 percent, 24.6 percent, and 3.2 percent, respectively, after the attacks.

Almost 29 percent of respondents reported that they were smoking more cigarettes and/or marijuana and/or drinking more alcohol. Among those who were already using these substances before September 11, 41.2 percent smoked more cigarettes and 41.7 percent drank more alcohol after the attacks. Among smokers, 8.2 percent smoked at least one additional pack of cigarettes a week; 20.8 percent of drinkers had at least one additional drink a day.

"The survey results are significant for the sheer numbers of people revealed to be affected by the disaster, the scope of the problem on a citywide scale, and challenges to the delivery of services," says Dr. Vlahov. He estimates that of the approximately 911,000 people in the area of New York under study, 67,000 had PTSD and approximately 87,000 had depression at the time of the study. Likewise, he estimates that 265,000 people increased their use of any of the substances in question:

  • 89,000 smoked more cigarettes,
  • 226,000 consumed more alcohol, and
  • 29,000 used more marijuana.

"This survey demonstrated that whole populations are affected by such disasters," says Dr. Vlahov. "The increases in use of cigarettes, alcohol, and marijuana across the population are large, making this a broad public health issue."

While the initial survey goal was to perform a public health assessment to document the scope of the problems and to help authorities apply for appropriate aid, Dr. Vlahov says that other questions also drove the research. "From a scientific perspective, we knew that attention typically focuses on victims, rescue workers, and their families. But here was an event that affected everyone in a major way. We asked, how do people cope with the stress of a disaster? Do they turn to cigarettes, alcohol, or marijuana? What are the implications for public health planning and delivery?"

Association Between Respondents' 9/11 Experiences and Current Posttraumatic Stress Disorder and Depression
Characteristics Number of Respondents PTSDa Depressiona
Odds Ratio
(95% C.I.)
Odds Ratio
(95% C.I.)
Had symptoms of a panic attack during or soon after the events of 9/11/01 124 7.6
Lost possessions 36 5.6
Lost job because of the attacks 64 NSb 2.8
Friend or relative killed 108 NSb 2.3
Two or more life stressors in the previous 12 months 183 5.5
Low social support in previous 6 months 358 NSb 2.4
Residence south of Canal Street 50 2.9
Hispanic ethnicity 114 2.6

a Current PTSD and depression defined as symptoms consistent with the diagnosis within 30 days before the interview.
b Not a significant association.

Certain characteristics of survey respondents were found to significantly elevate the odds that they would report symptoms consistent with a diagnosis of PTSD or depression. For example, respondents who reported symptoms of a panic attack during or soon after the terrorist attacks were 7.6 times more likely to suffer from PTSD and 2.6 times more likely to suffer depression than respondents who did not report panic attack symptoms.

For more, please visit the following areas: Source: National Institute on Drug Abuse, National Institutes of Health (


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