What are the rates of substance use following disasters?
The following findings from empirical disaster research
summarize the issue of disasters and substance abuse or
Rates of new onset alcohol dependence disorders after a
disaster, assessed according to DSM criteria, range from 0% to
Virtually no cases of new onset drug abuse emerged in any of
Although there are rarely new onsets, the total current
prevalence of diagnosed alcohol dependence disorders is
approximately 8%. Individuals in select groups who had
significant problems with alcohol before a disaster are likely to
have problems with alcohol use after a disaster.
Rates of self-reported problematic alcohol use are similar to
the total prevalence (7% - 9%).
Using alcohol occasionally as a way of coping is more common,
about 15% on average. These rates range from 6% - 40%. The high
rates occur among survivors with other psychological
Unlike rates of most other diagnoses and problems, rates of
alcohol abuse or dependence appear to be no higher in survivors
of mass violence than in survivors of natural disasters.
What has research shown about substance use following
Four studies on the aftermath of the bombing of the Murrah
Federal Building in Oklahoma City found only minimal increases in
alcohol use, abuse, or dependence.
North et al.
(1) conducted diagnostic interviews with 192 highly exposed
survivors and found no new onset substance use (alcohol or drug)
disorders. This finding is striking in light of the high
prevalence of other psychological disorders in the sample. For
example, 34% had disaster-specific PTSD and 13% had new onsets of
Major Depressive Disorder. Most of the survivors who used alcohol
as a way of coping to a significant degree were those who were
suffering from some other psychological disorder. That is, only
6% of respondents who did not meet criteria for a psychiatric
disorder used alcohol to cope compared to 13% - 40% of persons
who had one or more psychiatric diagnoses.
Shariat et al.
(2) surveyed 494 victims directly involved in a traumatic
event about various medical problems. At a rate of 7%, alcohol
use was among the least frequent problems. The most prevalent new
medical conditions were auditory problems (32%), anxiety (28%),
and depression (27%).
Smith et al.
(3) conducted a population survey of the Oklahoma City
metropolitan area using Indianapolis as a control community. The
rates of increased use of alcohol were approximately 2% and 1% in
the two communities, respectively.
In a study that has not yet been published, North
(4) found a high lifetime rate (50%) of alcohol
abuse/dependence among the firefighters who worked in Oklahoma
City. Although none of these disorders began after the disaster,
25% continued to abuse alcohol after the disaster. Other studies
of incidents of mass violence yielded similar results.
After a shooting spree in a Texas cafeteria, North et al.
(5) detected new onset alcohol use or dependence disorders in
4% of the men and 0% of the women. In contrast, the rates for new
onset PTSD were 21% for men and 29% for women, and the rates for
new onset depression were 5% for men and 8% for women. Fifteen
percent of the sample said they sometimes used alcohol to cope
North and her colleagues have studied a total of 10 disasters
(including the two mentioned above) using the same methods and
instruments. The remaining disasters spanned the range of mass
violence (shooting sprees), technological disasters (plane
crash), and natural disasters (tornado, firestorm, flood,
earthquakes). Tallied across all studies, 8% of 811 adults met
criteria for postdisaster alcohol dependence, but the rate of new
onset alcohol use disorders was only 1%. There were no new onset
drug problems in any of the studies.
Although few researchers have data as directly relevant, other
researchers have corroborated the findings that alcohol abuse is
not a common reaction to disaster.
After Hurricane Andrew, David et al.
(6) assessed a sample of area residents. New onsets of PTSD
(36%) and depression (30%) were common but alcohol dependence
(2%) was not.
Norris et al.
(7) reported that 9% of their sample of victims of Hurricane
Andrew "used alcohol or drugs to forget" at least sometimes, but
of the 25 symptoms that were assessed, only one symptom was less
Bravo et al.
(8) studied a large sample of victims of floods and mudslides
in Puerto Rico and found no increase in symptoms of alcohol use,
even within the most severely exposed group (predisaster = 0.9;
postdisaster = 1.1). In a regression analysis that controlled for
a number of important variables, exposure was correlated with
depressive, somatic, and posttraumatic stress symptoms but not
with alcohol use symptoms.
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Spitznagel, E. L., & Smith, E. M. (1999). Psychiatric disorders
among survivors of the Oklahoma City bombing.
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Shariat, S., Mallonee, S., Kruger,
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long-term health outcomes among Oklahoma City bombing survivors.
Journal of the Oklahoma State Medical Association, 92,
W., Christiansen, E. H., Vincent, R., & Hann, N. E. (1999).
Population effects of the bombing of Oklahoma City.
Journal of the Oklahoma State Medical Association, 92,
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