Substance use and related disorders among persons exposed to the 9/11 terrorist attacks: Essentials for screening and intervention

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.

Keywords:

• 9/11 substance use disorders
• comorbid PTSD and SUD
• disaster exposure and substance use
• September 11 terrorist attack
• World Trade Center
• WTC alcohol use disorder

Acknowledgements

The authors would like to thank all the 9/11 responders and survivors who participate in the World Trade Center Health Program, their families, the communities who support them, and the physicians and other healthcare providers committed to caring for them.

Disclosure statement

The authors report there are no competing interests to declare.

Disclaimer

The contents of this article are the sole responsibility of the authors and do not necessarily represent the official views of, nor an endorsement, by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (CDC/HHS), or the U.S. Government.

Institutional review board (IRB) review

This activity did not involve human subjects and therefore did not require IRB review.

Notes

1 Practice guidelines suggested in this paper were identified from the ECRI (Emergency Care Research Institute) Guidelines Trust (https://guidelines.ecri.org/), a compendium of CPGs that meet prespecified inclusion criteria (for details on selection criteria, see 5).

Additional information

Funding

This work was funded in part by the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (CDC/HHS). Dr. Lowe is supported by CDC/NIOSH Contract 75D30122C15516.