New discovery: Drugs did not worsen the condition of Nova survivors, it was something else

Israeli researchers studied more than 100 survivors of the Nova Music Festival party, many of whom had consumed drugs and alcohol during the event. Their findings should raise concern for all of us—not just for those who use mind-altering substances.

Participants of the Nova music festival became victims of the October 7 Massacre terror attack. They were forced to react swiftly to the massacre at the party site, running and hiding for extended periods to protect their lives, all while many were under the influence of drugs and alcohol.

A joint study conducted by Sheba Medical Center and Ben-Gurion University of the Negev found that alcohol, a legal substance, had the most significant and harmful effect on the stress response to the event. The findings were published in the journal World Psychiatry.

In addition to the euphoria and disinhibition that accompany drug and alcohol use at parties, these substances affect cognitive functions such as anxiety, motor coordination, memory, and emotional processing. But how do they impact responses during and after a traumatic event? Research teams led by Prof. Hagit Cohen of the Faculty of Health Sciences at Ben-Gurion University and Dr. Nitza Nakash-Axelrod, a world-renowned expert in post-trauma treatment at Sheba Medical Center, examined this question by studying the effects of alcohol and drug consumption on mental responses after the event.

Disturbing and surprising results

The results revealed that survivors who reported using drugs and alcohol during the party experienced significantly higher levels of anxiety, depression, and stress responses compared to those who did not use substances. The findings also showed that among all the drugs consumed at the party, alcohol—either on its own or combined with other drugs—had the strongest effect, increasing hyperarousal, anxiety, depression, and acute stress more than other substances or no substance use at all. None of the other drugs taken caused such reactions. Additionally, alcohol use led to longer and more frequent dissociative episodes during the traumatic event.

Traumatic dissociation can disrupt the processing and integration of traumatic memories, delaying recovery and increasing the risk of developing post-traumatic stress disorder. Unprocessed memories can linger, fragmented, and unresolved.

"It’s possible that alcohol consumption before the attack interfered with cognitive, emotional, and physiological processes that are crucial for coping with trauma," Dr. Nakash-Axelrod explained. "In this case, the traumatic event lasted many hours, so survivors may have experienced hangovers, which could have heightened their anxiety and traumatic stress."

The Nova massacre provides a unique opportunity to explore how alcohol and drug consumption before a trauma affects mental health outcomes and post-traumatic responses. "Given the widespread consumption of alcohol in social settings, alongside increasing incidents of sexual assault, physical attacks, and road accidents, these findings hold significant social and clinical relevance. They help us understand the biological processes behind responses to traumatic experiences," Prof. Cohen concluded.

In addition to examining the impact of drugs on survivors' mental state, short-term cognitive-behavioral therapy, specifically prolonged exposure, was provided to those suffering from severe stress symptoms (nightmares, flashbacks, avoiding leaving home or going to public places, avoiding music, hypervigilance, and increased arousal). The treatment was offered at Sheba’s Dror Clinic.

The research team included Prof. Hagit Cohen and students Gal Levy and Yarden Dajourno from Ben-Gurion University's Department of Psychology and Faculty of Health Sciences, as well as Dr. Nitza Nakash-Axelrod, Prof. Yossi Zohar, Tal Malka, Prof. Mark Weiser, Ilanit Woll, Neta Sheinfeld, Guy Metziani, and Dr. Raz Gross from the Drora and Pinchas Zakai Department of Mental Health at Sheba Medical Center.