摘要：Objectives. We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack. Methods. At baseline (1991–1992) and at 1- and 10-year follow-ups, an adult community sample of drinkers living approximately 12 mi (19.2 km) from the World Trade Center were evaluated for alcohol dependence and major depression. Of this group, 82.2% were assessed regarding the impact of the September 11, 2001, attacks, including proximity to the World Trade Center, interpersonal loss, posttraumatic stress, and alcohol consumption. Results. In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post–September 11 alcohol consumption. Past alcohol dependence did not modify the proximity–drinking relationship, and past major depression did not modify the loss–posttraumatic stress relationship. Conclusions. Participants’ responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more-effective prevention and intervention efforts. In recent years, numerous large-scale terrorist attacks on civilian targets have occurred, with the attacks of September 11, 2001, on Washington, DC, and the World Trade Center in New York City being followed by attacks in Bali, Sinai (Egypt), Madrid, London, and Jordan. These events cause physical destruction, death, and injury, and they take an additional psychological toll on large groups that are exposed to these acts of violence but not physically injured. People can be exposed to terrorist attacks in terms of physical proximity as well as psychological proximity (e.g., losing someone via death or disappearance), 1 , 2 and reactions to such exposures include posttraumatic stress (PTS) symptoms and alcohol consumption. Studies involving national samples showed that physical proximity to the World Trade Center on September 11, 2001, predicted PTS symptoms and posttraumatic stress disorder. 3 , 4 However, studies involving individuals living in Manhattan indicated that although proximity of residence to the World Trade Center predicted PTS, 1 , 5 , 6 actual proximity to the World Trade Center at the time of the attacks did not. 7 There has not been a great deal of research on alcohol consumption in response to terrorist attacks. Studies have shown that adults seldom reported drinking to cope after September 11, 2001 (8%–13% of respondents reported having done so). 6 – 8 However, drinking to cope may be viewed as undesirable, so simple yet specific questions quantifying consumption may yield more-valid information. Vlahov et al. 9 found that 42% of Manhattan residents who reported that they consumed alcohol drank more the week after the World Trade Center attacks than the week before the attacks. The fact that drinking, but not PTS, continued 6 months later suggests the need for a better understanding of why individuals responded by consuming alcohol. 10 In a Midwestern workplace study, alcohol consumption rates were higher among women surveyed shortly after September 11 than among those surveyed before the attacks, 11 and earlier studies of survivors of the Oklahoma City bombing suggested that primarily individuals with a history of alcoholism responded by drinking. 12 , 13 By contrast, in a study conducted in Israel, 2 where rates of alcohol disorders are low, 14 physical proximity to a terrorist attack predicted binge drinking in a large sample of adolescents. Thus, previous alcohol dependence may not be the sole determinant of alcohol consumption in response to terrorist attacks. Predictors of anxiety and stress often differ from predictors of alcohol consumption, and determinants of stress or alcohol consumption in response to terrorism remain inadequately understood. Better knowledge in this area is important for 2 reasons. First, it can help develop public health preparedness for future attacks. Second, it can assist in addressing broader questions about alcohol consumption in response to traumatic stress. Risks for many types of trauma (e.g., accidents, combat exposure) are increased by the personality traits that also predict substance abuse. 15 , 16 These traits can thus confound human studies focusing on trauma and substance abuse. By contrast, exposure to terrorist attacks has been shown to be unrelated to the traits of the individuals exposed. 17 As such, terrorist attacks create unfortunate natural experiments, unconfounded by personality traits, in which the effects of traumatic stress on alcohol consumption can be examined. Such studies can be used to address whether different aspects of exposure (e.g., physical proximity or interpersonal loss) have specific effects on drinking or PTS symptoms and how such responses may be moderated by previous psychiatric history. A methodological problem associated with investigations of the moderating effects of previous psychiatric history on responses to terrorism is that postevent reports of such histories may be altered by the exposure itself (i.e., viewing one’s past differently after the event). To preclude such bias, histories should be obtained before terrorism exposure occurs, 2 but opportunities to examine responses to the September 11 attacks among previously evaluated individuals are rare. Most September 11 studies have been cross sectional, the exception 18 being the Midwestern study mentioned earlier. 11 A new opportunity for such research arose in a longitudinal study of 791 individuals originally living in New Jersey near lower Manhattan. 19 In this sample, we investigated the effects of physical and psychological exposure to the September 11 terrorist attacks and previously evaluated psychiatric history on postattack stress symptoms and alcohol consumption.
