title: Substance use and functional impairment among adolescents directly exposed to the 2001 World Trade Center attacks.
abstract: The relationship between exposure to the World Trade Center (WTC) attacks, increased substance use, functional impairment and mental health service use, controlling for depression and post-traumatic stress disorder, was assessed through an in-school survey of directly exposed students (N = 1040) attending the five middle and five high schools nearest the WTC. The survey was conducted 18 months after the attacks. Students with one WTC exposure risk factor had a five-fold increase in substance use, while those with three or more exposure risks had a nearly 19-fold increase. Increased substance use was associated with impaired school work, school behaviour and grades. Students reporting increased substance use were nearly twice as likely to want help but were no more likely than asymptomatic students to receive services. Adolescents reporting increased substance use, without co-morbidity, were less likely to receive psychological services than others. Attention to the needs of substance-using adolescents exposed to disaster is needed.
authors.affiliation: Departments of Psychiatry and Pediatrics, Mount Sinai School of Medicine, New York, New York 10029, USA. claude.chemtob@mssm.edu
authors.forename: Claude M
authors.initials: CM
authors.lastname: Chemtob
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nomura
authors.forename: Louis
authors.initials: L
authors.lastname: Josephson
authors.forename: Richard E
authors.initials: RE
authors.lastname: Adams
authors.forename: Lloyd
authors.initials: L
authors.lastname: Sederer
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000503:physiopathology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires