High Rate of Drug/Alcohol-Related Deaths in WTC Survivors

Rescue and Recovery Work and PTSD Are Among the Risk Factors

People who were exposed to the terrorist attacks at the World Trade Center (WTC) have elevated rates of alcohol- or drug-related death, reports a study in the October 2018 issue of the Journal of Occupational and Environmental Medicine. "Following a major disaster, alcohol- and drug-related mortality may be increased," according to the new research by Jim Cone, MD, and colleagues of the New York City Department of Health and Mental Hygiene.

The researchers analyzed data on more than 71,000 individuals with some type of direct exposure to the September 11, 2001, attacks, enrolled in the WTC Health Registry. Through 2012, there were 1,193 deaths in this group of WTC survivors. Sixty-six deaths were related to drugs or alcohol: a rate of 5.5 percent.

Several factors were linked to a higher risk of mortality from drugs or alcohol. Men accounted for about 82 percent of drug/alcohol-related deaths, compared to 53 percent of deaths from other causes. Forty-two percent of deaths from drugs or alcohol were in young people aged 18 to 44, compared to ten percent of deaths from other causes.

"The odds of dying from an alcohol- or drug-related cause were two times greater among enrollees with 9/11-related post-traumatic stress disorder [PTSD], compared to those without," Dr. Cone and coauthors write. Risk was also elevated for rescue/recovery workers and those who sustained an injury on 9/11.

The findings are consistent with previous post-disaster studies reporting high levels of alcohol use and binge drinking among rescue/recovery workers. "Rescue/recovery workers in our cohort likely experienced WTC exposures that were of greater intensity and duration…which may explain part of the greater odds of alcohol- or drug-related mortality observed in this group," the researchers write.

They note that PTSD — which has been linked to excessive alcohol use — was also a strong risk factor. "Screening for both current substance use disorders and at-risk alcohol and drug use behaviors should be included as part of post-disaster mental health assessments," Dr. Cone and coauthors conclude. "Moreover, it is imperative that substance use be addressed concomitantly with the treatment of comorbid health conditions such as PTSD and depression."
About the Author — Dr. Cone may be contacted for interviews at jcone@health.nyc.gov.

About ACOEM — The American College of Occupational and Environmental Medicine (www.acoem.org), an international society of more than 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.

About JOEM — The Journal of Occupational and Environmental Medicine (www.joem.org) is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Welch A, Zweig KC, Liao T, et al. Alcohol and drug-related mortality among enrollees in the World Trade Center Health Registry (WTCHR), 2004 to 2012. J Occup Environ Med. 2018;60(10);875-9.