Reported Increase in Substance Use Following Mass Terrorism and the Role of Psychosocial Factors.

Importance: Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events. Objective: To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without. Design, Setting, and Participants: A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached. Main Outcomes and Measures: The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection. Results: A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08). Conclusions and Relevance: This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.

Test characteristics of shorter versions of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for brief screening for problematic substance use in a population sample from Israel.

BACKGROUND: Substance use is a leading cause of preventable morbidity and mortality worldwide. Population-wide screening for problematic substance use in primary health care may mitigate the serious health and socio-economic consequences of such use, but the standard Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.1) may be too long for wide-scale screening. How well validated shorter versions (ASSIST-Lite, ASSIST-FC) perform in identifying those with ASSIST 3.1 problematic use in different settings is unclear. METHODS: General population Jewish adults in Israel (N = 2,474) responded to an online survey that included the ASSIST 3.1 and sociodemographics. Across substances (alcohol, tobacco, cannabis, sedatives, prescription stimulants, prescription painkillers), receiver operator characteristic curve analysis determined that ASSIST-FC scores performed better than ASSIST-Lite at identifying those with problematic use, and evaluated differential ASSIST-FC performance by gender or age. Test characteristics and agreement were evaluated for binary ASSIST-FC versions, with ASSIST 3.1 problematic use as the gold standard. RESULTS: ASSIST-FC scores showed high ability to identify ASSIST 3.1 problematic use, with minimal differences by gender or age. Binary ASSIST-FC (most substances: threshold 3+; alcohol: 5+) showed high specificity and positive predictive value, acceptable sensitivity, and good agreement. CONCLUSIONS: The ASSIST-FC, which assesses frequency of use and other's concerns about use, appears useful for very brief screening in primary care to identify patients who may benefit from intervention. Early identification of those at-risk may prevent more severe consequences and ultimately decrease the significant costs of problematic substance use on the individual and population level.