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Introduction

Substance Use Under Conditions of Uncertainty and Trauma: An Introduction

TIMOTHY P. JOHNSON1 AND MICHAEL FENDRICH2

1Survey Research Laboratory and Department of Public Administration, College of Urban Planning and Public Affairs, University of Illinois at Chicago, Illinois, USA 2Center for Addiction and Behavioral Health Research, Helen Bader School of Social Welfare, University of Wisconsin, Milwaukee, Wisconsin, USA

Numerous man-made and natural events can produce uncertainty and trauma in human pop- ulations. This special issue focuses on potential linkages between these events and substance use and misuse. Although far from exhaustive, four classes of events are considered in this collection of papers. Three are man-made: wars, acts of terrorism, and captivity. The fourth, hurricanes, is natural in origin. The casual reader can quickly add many other examples to this simple typology. Some other acts of nature that may traumatize populations—leading to uncertainty—include tsunamis, earthquakes, flooding, volcanic eruptions, mudslides, and avalanches. Additional human-generated traumas include forced migration, torture, and extreme environmental pollution. Other events, such as massive fires, and transportation mishaps may be either natural or induced by humans.

These traumatic events all have in common the ability to kill many innocents and to severely traumatize survivors. The effects of such traumas on the psychological health of affected populations are now well documented (DeLisi et al., 2003; Galea et al., 2002; Hoge, Terhakopian, Castro, Messer, and Engel, 2007; Janis, 1951; Kanter, 2008; Milliken, Auchterlonie, and Hoge, 2007; North et al., 1999; Silver, Holman, McIntosh, Poulin, and Gil-Rivas, 2002). Less well understood is the degree to which substance use and misuse may also be the reactions to the uncertainties that many victims may experience. Some of the available evidence, however, suggests reason for concern. Investigations of U.S. troops exposed to combat during the Vietnam conflict have demonstrated that combat ex- posure was associated with subsequent drug use, in some cases, even after several decades (Fischer, 1991; Reifman and Windle, 1996). Some evidence also documents increased al- cohol use among persons exposed to the World Trade Center attack (Boscarino, Adams, and Galea, 2006). Among refugees from nations involved in armed conflicts, there is also some evidence of long-term psychological effects of resettlement, although it is

Address correspondence to Dr. Timothy P. Johnson, Survey Research Laboratory, University of Illinois at Chicago, 412 S. Peoria St., Chicago, IL 60607. E-mail: [email protected].

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less clear that substance use disorders can be included among them (Marshall, Schell, Elliott, Berthold, and Chun, 2005). Likewise, available research indicates that substance use and/or misuse may also increase in reaction to natural events such as hurricanes (Sub- stance Abuse and Mental Health Services Administration, 2008) and tsunamis (Manickam and Basil, 2006). As substance abusers1 and those addicted to substances are often the most vulnerable and marginalized members of society, traumatic events may have particularly negative psychosocial consequences for this group. Making matters worse, for addicted pa- tients utilizing treatment services, such events may also disrupt service availability (Druss, Henderson, and Rosenheck, 2007; Wang et al., 2008); a scenario illustrated in this special issue in the work of Maxwell, Podus, and Walsh in their investigation of hurricanes Rita and Katrina in Texas.

Many of the papers in this special issue explore the linkage between traumas and substance use/misuse, within different contexts, and among differing populations that have been exposed to varying traumas. Richman and colleagues examine the effects on prob- lematic drinking of beliefs regarding terrorism two years after the September 11 attacks in the United States. Employing spatial modeling, DiMaggio and colleagues investigate the association between proximity to the site of the former World Trade Center Towers and substance related diagnoses.

Aqrawi and Humprheys provide an overview of current substance use trends in Iraq, a nation in which the citizens have endured repressive governments, several wars, and ethnic and religious conflict.

Several papers also examine the effects of natural disasters. As noted above, Maxwell et al., marshal data from numerous sources to evaluate the effects of Hurricanes Katrina and Rita on substance abuse in Texas. Timpson and colleagues compare psychological outcomes among samples of crack cocaine users after the Katrina hurricane. Flory and colleagues report the substance use behaviors of general population samples of Katrina survivors. Both studies collected data from persons still in New Orleans, and from samples relocated to other cities. Wagner and colleagues also review the potential effects of Hurricane Katrina on the substance use and other health-related outcomes among youth who were exposed to the event.

A final paper, by Hwahng, differs from the other contributions in this special issue in that it provides an account of a unique historical episode that took place during World War II, when drug injections were used to control sexually transmitted diseases and pregnancies among sexual slaves. We include the report of this particularly regrettable chapter in history as acknowledgment that not all substance use and misuse is voluntary, particularly under conditions of international war and armed conflict. Tragically, there are also examples of the use of drugs to control the behavior of soldiers during wartime. Child soldiers used in recent African civil wars are also known to have been provided with marijuana and other drugs as part of efforts to desensitize them to violence and death (Beah, 2007).

Development of this special issue took much longer than we anticipated, and we thank all contributors for their patience as we worked to finalize this important volume. We also wish to acknowledge and thank those persons who served as reviewers for one or more of the manuscripts considered for this special issue. These include Robert Booth, Young Ik Cho, Halkan Demirtas, Max Dieber, Stanley Einstein, Jonathan Kanter, Prakash Laud, Adam Lippert, Jane Maxwell, Kavita Patel, Kathy Rospenda, and David Smith. It is our hope that this collection will encourage additional research into the association between trauma, uncertainty, and substance use and misuse.

1The journal’s style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor’s note.

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THE AUTHORS

Timothy P. Johnson, Ph.D., is director of the Survey Research Laboratory, professor of Public Administration, and research professor of Epidemiology and Biostatistics at the University of Illinois at Chicago. His recent work has focused on the social epidemiology of substance use, and measurement errors in survey research, with an em- phasis on the effects of respondent culture. He serves as vice-chair of one of the University’s Institutional Review Boards (IRBs), and is a member of the editorial board of Substance Use & Misuse and the Middle Eastern Summer Institute on Drug Use.

Michael Fendrich, Ph.D., is the director of the Center for Addiction and Behavioral Health Research and is a professor in the Social Work Department at the Univer- sity of Wisconsin, Milwaukee, Helen Bader School of Social Welfare. Dr. Fendrich’s research focuses primarily on the epidemiology of substance abuse, with particular attention to issues related to the measurement and the assessment of risk factors, as well as the correlates and consequences of substance abuse in the community. His work also explores the utility of drug testing in research and treatment contexts. He is a member of the editorial board of Substance Use & Misuse.

References

Beah, I. (2007). A long way gone: memoirs of a boy soldier. New York: Sarah Crichton Books. Boscarino, J. A., Adams, R. E., Galena, S. (2006). Alcohol use in New York after the terrorist attacks: a

study of the effects of psychological trauma on drinking behavior. Addictive Behaviors, 31:606– 621.

DeLisi, L. E., Maurizio, A., Yost, M., Papparozzi, C. F., Fulchino, C., Katz, C. L., et al. (2003). A survey of New Yorkers after the Sept. 11, 2001 terrorist attacks. American Journal of Psychiatry, 160:780–783.

Druss, B. G., Henderson, K. L., Rosenheck, R. A. (2007). Swept away: use of general medical and mental health services among veterans displaced by Hurricane Katrina. American Journal of Psychiatry, 164:154–156.

Fischer, B. J. (1991). Combat exposure and the etiology of postdischarge substance abuse problems among Vietnam veterans. Journal of Traumatic Stress, 4:251–277.

Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346:982–987.

Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164:150–153.

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Janis, I. L. (1951). Air war and emotional stress: psychological studies of bombing and civilian defense. New York: McGraw-Hill.

Kanter, E. D. (2008). The impact of war on mental health. In B. S. Levy & V. W. Sidel (Eds.), War and public health (pp. 51–68). Oxford: Oxford University Press.

Manickam, L. S. S., Basil, J. (2006). Alcohol abuse among the coastal communicties in Chen- nai district. Tamil Nadu Tsunami Resource Centre: Chennai, India. (http://www.un.org.in/ untrs/reports/Impact Tsunami Alcohol%20Abuse.pdf)

Marshall, G. N., Schell, T. L., Elliott, M. N., Berthold, S. M., Chun, C.-A. (2005). Mental health of Cambodian refugees 2 decades after resettlement in the United States. Journal of the American Medical Association, 294:571–579.

Milliken, C. S., Auchterlonie, J. L., Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298:2141–2148.

North, C. S., Nixon, S. J., Shariat, S., Mallonee, S., McMillen, J. C., Spitznagel, E. L., et al. (1999). Psychiatric disorders among survivors of the Oklahoma City bombing. Journal of the American Medical Association, 282:755–762.

Reifman, A., Windle, M. (1996). Vietnam combat exposure and recent drug use: a national study. Journal of Traumatic Stress, 9:557–568.

Silver, R. C., Holman, E. A., McIntosh, D. N., Poulin, M., Gil-Rivas, V. (2002). Nationwide lon- gitudinal study of psychological responses to September 11. Journal of the American Medical Association, 288:1235–1244.

Substance Abuse and Mental Health Services Administration. (2008). The NSDUH report: impact of hurricanes Katrina and Rita on substance use and mental health. Rockford, MD: Office of Applied Studies, SAMHSA. (http://www.oas.samhsa.gov/2k8/katrina/katrina.htm).

Wang, P. S., Gruber, M. J., Powers, R. E., Schoenbaum, M., Speier, A. H., Wells, K. B., et al. (2008). Disruption of existing mental health treatments and failure to initiate new treatment after Hurricane Katrina. American Journal of Psychiatry, 165:34–41.

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