The events of Sept. 11, 2001 altered the collective American psyche. While most people overcame trauma, many developed a mental illness or substance use disorder. DrugRehab.com spoke with counselors, therapists and the family member of a 9/11 survivor about the impact the tragedies had on drug and alcohol use, and treatment options for those affected by that infamous day.
It was a picturesque September morning in New York City. The skies were painted blue, the sun was beaming bright.
Marcy Borders, 28, arrived early to her employer, Bank of America, located in the north tower of the World Trade Center. The Bayonne, New Jersey, resident had worked as a clerical assistant at the financial institution for about a month. She showed up at 8 a.m. each day, elegantly dressed, full of optimism.
Marcy was on the 81st floor when a hijacked commercial jetliner struck the building, 12 floors above. Minutes later, another plane crashed into the neighboring south tower.
Hysteria ensued. Marcy fought her way down a crowded staircase, alongside hundreds of others. One hour later, she reached the street. She looked up. The south tower crumbed before her eyes.
Everything went dark.
Debris covered Marcy, head to toe, in ash and dust. Photojournalist Stan Honda snapped a shot of her, which would become an iconic representation of that day. People would refer to her as the “Dust Lady.”
Marcy narrowly survived, but her life would never be the same. She fell into a decade-long depression and battled addictions to alcohol and crack cocaine. In 2015, she succumbed to stomach cancer. She was 42.
“She went through some low points with the depression and drug use,” Michael Borders, Marcy’s younger brother, told DrugRehab.com. “It lasted for years, and it all stemmed from 9/11.”
Countless individuals, like Marcy Borders, struggled with mental illness and substance use disorders in the aftermath of the attacks. Reports show substance abuse became an epidemic among many Americans — witnesses and responders, adults and children.
Fifteen years later, people continue to battle mental disorders and addictions resulting from that day. Although some have sought help, many have not. However, treatment for mental or substance use disorders may lessen the burden of this tragedy on thousands of lives.
Nearly 3,000 people died in the terrorist attacks on Sept. 11, 2001. Families lost loved ones, students lost friends, first responders lost colleagues. America was traumatized.
At least 10,000 firefighters, police officers and civilians exposed to the attacks have post-traumatic stress disorder, according to the city’s three 9/11 health programs as reported by The New York Times in 2011. These symptoms include insomnia, paranoia, flashbacks, emotional numbness and a sense of hopelessness.
The tragedy greatly impacted lower Manhattan residents. Those living south of Canal Street, near ground zero, were three times more likely to experience symptoms of mental illness, per a 2002 study published in the American Journal of Epidemiology. Research estimates as many as 67,000 New York City residents experienced PTSD and 87,000 had depression in the weeks following 9/11.
“The most common problem we saw following 9/11 was PTSD,” Dr. JoAnn Difede, director of the Program of Anxiety and Traumatic Stress Studies (PATSS), told DrugRehab.com. “Even 15 years later, it still exists.”
PATSS is a trauma initiative within Weill Cornell Medical College’s Department of Psychiatry. It provides evidence-based treatment approaches to patients with mental health disorders. Difede said the program has seen numerous New Yorkers affected by the Sept. 11 terrorist attacks, including police officers, firefighters, construction workers and area residents who saw the planes crash into the towers.
Dr. Margaret Dessau witnessed the attacks. She heard the boom of a plane crashing into the first tower from her New York City apartment, eight blocks from the twin towers. In its aftermath, she had trouble sleeping and concentrating. She still replays the disaster in her mind and, as of August 2011, attends therapy regularly.
Esperanza Muñoz also saw the tragedy from a distance. Today, she battles constant flashbacks and nightmares. Her anxiety flares up at the sound of sirens or a passing plane. By 2009, she had twice attempted suicide. She cannot step foot in New York City without experiencing panic.
Dessau and Muñoz are far from alone in their struggles. A 2014 study by Columbia University found a high prevalence of PTSD and depression among survivors. The group consisted of rescue and recovery workers, New York City residents or area employees and passersby on the morning of Sept. 11, 2001.
However, individuals need not have witnessed the attacks to experience trauma. Newscasts replayed video footage of the tragedies on loop for months. Many Americans identified with the victims or may have had loved ones living in the New York City area. Others saw this as not just an attack on New York — but on the entire United States.
Just days after the attacks, researchers at Rand Corporation interviewed 560 U.S. adults at random and assessed their reactions to the events. Forty-four percent of participants experienced at least one substantial symptom of PTSD, such as disturbing memories or difficulty concentrating.
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About one-third of participants noted a stress response in their children. Difede says catastrophic events can greatly impact children, especially if their parents express open emotion. Research supports this claim.
A study published in the Archives of Pediatric & Adolescent Medicine found that preschoolers near the twin towers were at risk for developing insomnia and behavioral issues. Another report, published in Psychiatric Services, showed that 18 percent of adolescents in grades 6–12 used mental health services following the tragedies.
Children with PTSD are often clingy, exhibiting aggressive and regressive behaviors. These children are at an increased risk for developing a substance use disorder later in life, per the National Institute on Drug Abuse.
After 9/11, people searched for ways to cope with their anxiety. Numerous Americans with mental illness began drinking more or using drugs, which only exacerbated their symptoms.
Addiction is common among individuals with anxiety disorders. According to the Anxiety and Depression Association of America, about 20 percent of Americans with a mood disorder, such as depression, also have a substance use disorder.
Dr. David Vlahov, a dean and professor at the University of California San Francisco, evaluated the degree to which people used drugs or alcohol to cope with stress shortly after Sept. 11.
He and a team of researchers surveyed 988 New York City residents five to eight weeks after 9/11. Nearly 10 percent of participants reported an increase in smoking, and 24.6 percent consumed more alcohol in the days following the events. About 3.2 percent of respondents increased marijuana use.
Depression was common among those who increased use of cigarettes, alcohol and marijuana, the survey found. Vlahov estimates that 265,000 people used these substances more often during this time.
“This survey demonstrated that whole populations are affected by such disasters,” Dr. Vlahov said of his NIDA-funded research data. “The increases in use of cigarettes, alcohol, and marijuana across the population are large, making this a broad public health issue.”
A 2005 study published in Addictive Behaviors also linked psychological trauma among New Yorkers after 9/11 to alcohol consumption. About 12 percent of 1,681 adults reported an increase of two or more drinks per day in the year after the events. Participants also reported an increase in binge drinking during this time.
A 2014 study published in Drug and Alcohol Dependence found similar results: Nearly 14 percent of respondents highly exposed to the WTC attacks reported frequent binge drinking. Those experiencing PTSD were most at risk for engaging in the activity.
The study, conducted five to six years after the attacks, evaluated more than 41,200 people.
“This survey demonstrated that whole populations are affected by such disasters. The increases in use of cigarettes, alcohol, and marijuana across the population are large, making this a broad public health issue.”
“Understanding the effects of traumatic exposure on alcohol use is important to identify risk factors for post-disaster alcohol misuse, inform policy, and improve post-disaster psychological and alcohol screening and counseling,” the study’s researchers concluded.
Adolescents also engaged in substance abuse in its aftermath. Multiple studies evaluated drug and alcohol use among children in New York City following the attacks. Nearly 10 percent of children attending schools near ground zero reported an increase in alcohol or substance use in the 18 months following Sept. 11, according to a study published in the journal Disasters.
Those with three or more risk factors — such as having a relationship to someone who perished in the attacks or fearing for one’s own life — were nearly 20 times more likely to use drugs or alcohol, the study found. A high proportion of students developed a mental disorder in the wake of the tragedies.
Marcy Borders’ trauma has been widely reported. If an aircraft flew by, she’d panic. If she noticed a man standing atop a building, a wave of anxiety overtook her. She feared skyscrapers, making it difficult to explore her own city.
As a result, Marcy rarely left home.
“She never went back to New York City after that day,” said Michael Borders.
He noted how Marcy masked her problems and rarely talked about her feelings. She remained upbeat around family and friends. Internally, she struggled.
Marcy eventually found an outlet: Alcohol numbed her pain. Drugs got her high. However, these substances only worsened problems. She slipped into addiction, couldn’t secure a job and lost custody of her two children.
“I started smoking crack cocaine because I didn’t want to live,” she told the New York Post in 2011. “It was like my soul was knocked down with those towers.”
Research shows exposure to traumatic events increases the risk of drug or alcohol abuse. It can also cause relapse among those in recovery.
Between December 2002 and April 2003, the New York State Office of Alcoholism and Substance Abuse Services conducted a study of the impact of 9/11 on New York City drug treatment programs.
Researchers interviewed 75 patients and 16 administrators spanning 15 rehab centers. These facilities included methadone treatment, drug-free outpatient programs and residential programs in or around New York City. The purpose of the study was to identify problems rehab centers encountered after the attacks in order to prepare for future tragedies.
The results showed that relapse was a problem for treatment centers in the aftermath of the tragedies.
Men, individuals in outpatient care and patients with a history of mental illness were most at risk for reusing drugs or alcohol. More than half of patients attributed these issues to events on or following Sept. 11.
Many clinicians and addiction experts say stress is the most common trigger for relapse. Patients with PTSD are more prone to relapse than those without the disorder, according to the National Institute on Drug Abuse.
The trauma of Sept. 11 affected first responders, ranging from firefighters to police officers — from military personnel to first-aid workers. These workers witnessed the attacks or helped in the months-long recovery efforts in New York City and Washington, D.C.
Carlos Negron, a certified EMT in New Jersey, helped with the New York City efforts. Afterward, feelings of hopelessness and dejection overwhelmed him. As the months progressed, these symptoms worsened.
“My depression was out of control and I had anxiety, but I thought I was just going through something,” he said in a 2014 YouTube video. “I was going down a road of self-destruction. There was a point where I did not want to live anymore.”
Tom Kelly, a former New York City firefighter and former marine, also responded to the 9/11 attacks on the twin towers. For days, he searched in vain for signs of life among the wreckage.
The images from the site haunted him. He battled insomnia, depression and suicidal thoughts. In response, he began using cocaine, which would later cost him his job.
Kelly was one of many first responders who turned to drugs after the attacks. Before 9/11, the FDNY counseling department saw 180 firefighters each year for substance abuse problems. By 2005, the unit handled 500 firefighters each month — 10 times more than they had before 9/11.
“Substance abuse among firefighters is so multilayered. Some use alcohol to numb their feelings because they are over-aroused. Others do it because they are always numb and need to feel more alive.”
The Smithers Institute at the School of Industrial and Labor Relations at Cornell University conducted a study to examine how firefighters were affected by the events. Sixty-two percent of the survey’s respondents were involved in 9/11 rescue and support efforts.
The survey indicated higher levels of depression, anxiety and stress among firefighters who helped in these efforts. They were also at an increased risk for drinking problems: 17 percent of participants were at risk of a moderate alcohol problem, and 11 percent were susceptible to a severe problem.
Only five percent of those surveyed said they would seek assistance for substance abuse.
“Substance abuse among firefighters is so multilayered,” Stephanie Cherry, associate director and counselor at Friends of Firefighters (FoF) in Brooklyn, told DrugRehab.com. “Some use alcohol to numb their feelings because they are over-aroused. Others do it because they are always numb and need to feel more alive.”
FoF is a nonprofit dedicated to addressing the physical and mental health of NYC firefighters and their families. It began as a grassroots organization in response to the events of Sept. 11, during which 343 FDNY members died or were reported missing. Since then, the organization has provided services to hundreds of firefighters, many of whom were directly affected by 9/11.
Ten percent of patients seeking mental health services at FoF list substance abuse as one of their top three health concerns, according to Cherry.
“Many of the retired firefighters may come in with stress related to 9/11,” said Cherry. “The more traumas you see, the more difficult it is to come back from them. As a result, some of them have turned to using drugs or alcohol.”
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Trauma also impacted police officers. A study published in the American Journal of Industrial Medicine found that numerous officers developed anxiety after assisting in recovery efforts. Many officers experienced emotional detachment, leading to alcohol abuse.
Countless first-aid workers supported civilians and fellow emergency workers in the days following Sept. 11. The American Red Cross provided more than 6,000 workers, served 14 million meals for first responders and victims and supported stranded airline passengers at airports on that day.
These responders, too, experienced hardships in the months and years that followed. A 2005 study published in The American Journal of Drug and Alcohol Abuse found that young Red Cross workers who responded to the attacks were at the highest risk of alcohol use among the group.
While 9/11 affected many Americans, most overcame the trauma. Many people leaned on loved ones for support. In some cases, individuals gave up substance abuse rather than starting it.
“There were adverse consequences [to 9/11], but there were also stories of resilience,” said Difede. “Most people find a way to cope with adversity.”
On Jan. 2, 2011, President Barack Obama signed the James Zadroga 9/11 Health and Compensation Act of 2010 into law. The law provides $4.3 billion to compensate and treat people with illnesses stemming from Sept. 11, including anxiety disorders and substance abuse.
The law, which is named after James Zadroga, an NYPD officer who spent more than 500 hours assisting in the rescue efforts at the twin towers and died of a respiratory disease in 2006, also established the World Trade Center Health Program.
The program is an initiative that provides healthcare for responders to and survivors of 9/11.The program provides medical monitoring, screening and treatment services for first responders and those who worked, resided or attended school in the New York City disaster area — the region south of Houston Street in Manhattan and any block in Brooklyn within a 1.5-mile radius of ground zero.
The act also covers costs for those who responded to the tragedies at the Pentagon and Shanksville, Pennsylvania. Thousands of people across the country rely on these services.
As of July 2016, the WTC Health Program has assisted nearly 75,000 responders, survivors or those who worked, lived or went to school in the disaster area.
According to the Centers for Disease Control and Prevention:
Negron believes the program can help responders, like himself, who battle mental illness.
“The World Trade Center Health Program offers mental health services. Please go see them,” he said. “I would hate for people to go through this depression, PTSD and anxiety. It’s not an easy thing to deal with.”
Four years ago, Difede treated a police officer who had assisted in recovery efforts at ground zero. She noted that he experienced constant nightmares and anxiety. He developed PTSD and addictions to alcohol and prescription painkillers, which resulted in the dissolution of his marriage and a fractured relationship with his children.
With psychotherapy, his symptoms improved. PATSS employs virtual reality technology to help patients with PTSD. This evidence-based treatment approach combines exposure therapy with computer-generated images, vibrations and smells to recreate a traumatic experience.
PATSS’s Virtual World Trade Center simulates 11 different computer graphic scenes that reenact or reimagine 9/11. Patients may see a plane flying past the north tower rather than crashing into it. The simulator progresses gradually, ensuring patients are not overwhelmed.
The therapy technique has proved to ease anxiety disorders and speed recovery, said Difede.
Eventually, the officer’s nightmares and anxiety subsided. His relationship with his kids improved, and he began dating again.
“At the end of treatment, I remember him telling me, ‘Gosh, I wish I had done this 10 years earlier. Things would have been so different for me,’” said Difede.
She said avoidance is a normal human response for 9/11 first responders and witnesses. Many firefighters question their traumatic feelings, express shame over their anxieties or believe they don’t deserve help. Survivor’s guilt may also play a role in their reluctance to seek assistance.
However, failing to address mental health needs can create more problems, such as substance abuse.
“It is possible to address your problem, as painful as it is. You can find a way to get help and move forward with your life.”
“It is possible to address your problem, as painful as it is,” added Difede. “You can find a way to get help and move forward with your life.”
Help may come from employee assistance programs. EAPs are work-based programs that offer confidential resources to employees. These resources include assessments, counseling services, referral and follow-up services.
Fire departments offer strong peer-based education and intervention programs. These EAPs offer counseling for employees with personal problems, including substance abuse. Certified alcohol and substance abuse counselors, nurses, psychologists and colleagues may assist in these programs.
FDNY has a counseling service unit for its employees. Before 9/11, the unit comprised nine counselors who treated about 650 employees per year. It now has 28 mental health professionals who treat more than 2,000 people each year.
“One of the best tools we have is the help of firefighters who are detailed to help their fellow firefighters,” FDNY EAP Director Malachy Corrigan told Firehouse.com. “They relate. They know what they are going through. They are helping each other get through the tough times.”
Cherry agrees. Her organization encounters firefighters who would rather speak with their peers than counselors.
“One of the best tools we have is the help of firefighters who are detailed to help their fellow firefighters. They relate. They know what they are going through. They are helping each other get through the tough times.”
“They feel better understood upon speaking with another firefighter,” said Cherry. “They can better relate to each other.”
People with co-occurring disorders involving substance abuse should seek immediate treatment. Rehab centers across the country offer proven scientific approaches that cater to an individual’s specific needs. These facilities have helped countless people overcome substance use disorders.
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Rehab helped Marcy Borders defeat addiction. She talked about her battles with drugs and alcohol in numerous interviews around the 10th anniversary of the tragedy, four years before her death. She had just completed treatment, regained custody of her children and begun working again.
Her family remembers her not as the “Dust Lady,” but a mother, daughter and sister, who was outgoing, thoughtful and loving. She refused to let the depression, anxiety and substance abuse caused by the horrific events of 9/11 define her.
“I try to take myself from being a victim to being a survivor now,” she told The Jersey Journal, shortly before her death. “I don’t want to be a victim anymore.”
The WTC Health Program provides medical monitoring and treatment for responders to the Sept.11 attacks and survivors in the New York City disaster area. The program has assisted nearly 75,000 responders and survivors to date.
A psychotherapy organization dedicated to supporting individuals suffering from mental illness, the American Group Psychotherapy Association offers services to those affected by 9/11.
Friends of Firefighters is a nonprofit devoted to addressing the physical, mental health and wellness needs of New York City firefighters and their families. The organization has assisted firefighters who responded to the Sept. 11 terrorist attacks.
The Families of Freedom Scholarship Fund provides financial assistance for postsecondary study to dependents of those killed or disabled during the 9/11 attacks. As of September 2015, more than 2,820 scholarships have been awarded.
This nonprofit organization provides information, promotes resiliency and raises awareness for those affected by 9/11. The organization also aims to respond to terrorism, address its effects, and support efforts dedicated to eliminating the possibility of future attacks.
A leg of the Psychiatry Department at Weill Cornell Medical College, PATSS treats trauma-related mental health disorders. The organization has helped police officers, firefighters, construction workers and area residents affected by 9/11.
The Massachusetts 9/11 Fund commemorates and supports families with ties to Massachusetts who lost loved ones during 9/11. The nonprofit accomplishes these goals through community engagement, education and funding.
This charitable foundation is devoted to providing educational opportunities to children of firefighters and other victims of 9/11. The foundation is named after Michael Lynch, a New York City firefighter who died during the Sept. 11 attacks.