Stress, Self-Medication, and What History Teaches Us

(Part One of a Three-Part Series: “Rebuilding A Workplace After COVID-19”)

The more you know about the past,
the better prepared you are for the future.

– Theodore Roosevelt

Looking backward to move forward.

History truly is the best teacher for those wise enough to mine it for the knowledge it yields. Today, we have that opportunity to learn from two 21st Century events that impacted each of our lives and the research into how they shaped our behavior in the immediate aftermath and beyond. This wealth of learnings should inform our actions when COVID-19 is finally on the wane.

“Consensus is emerging among disaster researchers that psychological disorders and substance abuse increases in the aftermath of both man-made and natural disasters.” – Centers for Disease Control

Human suffering and substance abuse go hand-in-hand.

On September 11, 2001 the shocking realities of a national nightmare penetrated the comfortable cocoon of everyday American life. Each televised image of a cityscape forever changed and a gripping awareness that thousands of American souls had been lost to unknown assailants profoundly affected us. In the ensuing days, the magnitude of the event took shape and for many, shock gave way to a soul-crushing dread that life would never be the same. For some, self-medication was the only way to soften that very real pain.

On August 29, 2005 a Category 5 hurricane literally consumed swaths of New Orleans as catastrophic flooding overwhelmed a woefully inadequate levee system. With the city and its surrounding parishes underwater, roads impassable and rescuers overtaxed, more than 1200 perished. Once again, and for many months to come, self-medicating was how many coped.

Post-Traumatic Stress Disorder (PTSD) is most commonly associated with wartime military personnel who find it impossible to find a “normal” again, putting them at extreme risk for self-medication, substance abuse, or worse.

The learnings and lessons from 9/11 and Hurricane Katrina studies tell us today’s conditions are ripe for self-medication.

Researchers have found that PTSD and depression similarly occur in the larger population during times of extreme stress. And with those two comes the same tendency to self-medicate with alcohol or other substances accompanied by an increased threat of dependency or addiction.

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NIDA 2002 Report on 9/11 PTSD
CDC 2016 Report on post-Katrina substance abuse

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Historical data is often a reliable predictor.

In 2002, the National Institute on Drug Abuse interpreted and shared a survey of New York City residents polled two months after the terrorist attacks on the World Trade Center. Conducted by the New York Academy of Medicine, its results provided the first scientifically-validated glimpse into how a population could be affected by a period of trauma.

  • Nearly 10% suffered depression and 7.5% showed diagnosed symptoms of PTSD
  • 20% of non-drinkers began consuming alcohol; 2.5% used marijuana for the first time
  • For previous smokers and drinkers, 41% increased their consumption

Similarly, a 2016 study by the Centers for Disease Control based on data provided by the Louisiana Department of Health and Hospitals found 35% more substance abuse hospitalizations after Hurricane Katrina than previous to the event. Taken together, the two studies paint a picture of how a population responds at times of high anxiety or stress, and certainly today’s climate is a contributor to both.

The 24-hour news cycle is a powerful trigger.

Despite a healthy economy, the near-constant recent barrage of negative news and divisiveness have taken a toll. A 2017 poll by the American Psychological Association found that nearly 60% of respondents across each generation felt this was the lowest point in American history they can remember; and that includes WWII, the Korean Conflict, War in Vietnam, 60’s social unrest and bombing of the World Trade Center. Add to that a COVID-19 crisis, and you have a powerful witches’ brew of anxiety-causing factors weighing on an increasingly weary public. In many cases, people are quarantined at home, fearful of job loss and isolated from family and friends. And worse yet, they are likely bombarded with negative news at a rate not seen since the last disaster.

As we rebuild our workplaces, what should we expect?

Truthfully, the very near-term future looks a lot like now. But at some point sooner than later, we go back to work. Returning and readjusting will come with anxieties and stresses all its own. And we live in a culture where liquor stores have been declared essential businesses during the current crisis. Let that sink in. Experience tells us that, for some, anxieties over the current crisis and stresses to come with returning to work will likely be tempered with liquor while others opt for a broad range of drugs. And if those substances find their way into our workplaces when we all return, we will have a whole new set of problems with which to deal.

Maybe all will be well, and no one returns with exacerbated chemical dependencies manifested in these unprecedented times. Maybe it is nothing on which any of us should dwell. But for the sake of the argument here is one closing thought. An additional study conducted six to nine months after the initial New York City 9/11 report by NIDA uncovered a sobering trend.

While rates of depression and PTSD were drastically reduced, substance abuse rates had not declined substantially. The results of both studies suggest that an increase in substance abuse after a disaster may be a cause for public health concern in the long term.

The workplace threat likely falls closer to what NIDA found than to what we wish it would be. Sadly, the chances are good that at least some of our coworkers will return with a new or heightened dependence on chemical relief. And being ready for that reality will be our collective post COVID-19 challenge.

Part 2 next week:

“A shifting threat and why 70% is a number to remember.”

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