Study finds that Nova survivors' trauma recovery significantly impacted by substance use

Young people who drink alcohol and/or recreational drugs before attending a party feel liberated, unrestrained, and elated, making it easier to make friends and enjoy the action. However, researchers at Ben-Gurion University of the Negev (BGU) in Beersheba and Sheba Medical Center at Tel Hashomer have found that alcohol and other drugs also trigger anxiety, memory changes, and a decline in cognitive and brain function and emotional processing.

That is what happened to many participants in the deadly Supernova music festival in the South on October 7, 2023, which likely contributed to their deaths in the vicious Hamas terrorist massacre that resulted in the murder of some 400 among the 4,000 participants.

Prof. Hagit Cohen from BGU’s Faculty of Health Sciences and Dr. Nitza Nakash from Sheba led the research, which has just been published in the journal World Psychiatry under the title “Impact of pre-trauma recreational drug use on mental health outcomes among survivors of the Israeli Nova Festival terrorist attack.”

The research group also included students Gal Levy and Yarden Dajarno from BGU’s psychology department, and Nakash, Profs. Yossi Zohar, Mark Weiser, and Raz Gross and student Tal Malka from Sheba.

After the event, the team studied the effects of alcohol and drug consumption on mental health. They postulated a significant correlation between the pre-trauma use of psychostimulants or hallucinogens and the severity of peritraumatic dissociation, anxiety, depression, and acute stress disorder (ASD) symptoms in survivors.

Methodology of the study

A total of 232 festival survivors sought help at Sheba and underwent clinical evaluation. Among them, 123 met criteria that excluded additional trauma, such as serious physical injuries, first-degree family members killed during the attack, and a history of mental disorders, including post-traumatic stress disorder (PTSD).

However, due to the small sample size for these drugs, the analysis excluded one survivor who reported using hallucinogenic mushrooms and another who reported using ketamine prior to the traumatic event, leaving 123 participants.

The average age of the subjects was 28, 60.9% of whom were men. More than half – 71, or 57.7% – reported using psychoactive drugs at the festival. Of the 71 who reported using psychoactive drugs, 12 consumed only alcohol, nine only lysergic acid (LSD), seven only 3,4-methylenedioxymethamphetamine (MDMA), six only cannabis, and three only methylmethcathinone (MMC). Others used 15 different drug combinations that included alcohol, while 19 did not include alcohol.

All participants completed several questionnaires assessing traumatic dissociation during the event, anxiety, acute stress response, and depression. 

The festival participants, who became victims of the October 7 attack, were forced to react quickly to the massacre that took place in and around the outdoor party compound, running and hiding for long periods to protect their lives.

A significant proportion of the participants were under the influence of drugs and alcohol. The BGU and Sheba researchers found that alcohol, which is a legal but potentially dangerous drug, had the strongest and most damaging effect on the stress response to the event.

Results of the study

The results of the study show that survivors who reported using drugs and alcohol during the party had significantly higher levels of anxiety, depression, and stress responses compared to survivors who did not. The findings also show that more than any other drug consumed during the party, alcohol (alone or combined with other drugs) increased hyper-arousal, anxiety, depression response, and severe stress responses. At the party, no other drug elicited similar reactions.

Additionally, alcohol use resulted in longer-lasting and increased dissociation during the traumatic event. Dissociation is a mental process in which an individual disconnects from his or her feelings, thoughts, memories, or sense of identity.

Dissociative disorders include dissociative amnesia, depersonalization disorder, and dissociative identity disorder, and they can disrupt the processing and integration of traumatic memories. This can delay recovery and increase the likelihood of developing post-traumatic disorders because trauma-related memories persist in a fragmented and unprocessed state.

“In marked contrast to our expectations, we found that only pre-trauma alcohol consumption, with or without other drugs, significantly increased the risk of peri-traumatic dissociation, anxiety, depression, and ASD symptoms,” the researchers said.

“It’s possible that alcohol consumption before the attack interfered with cognitive, emotional, and physiological processes,” Nakash suggested. Importantly, the traumatic event was prolonged; participants had to run and hide for eight to 20 hours until they were rescued. Therefore, the survivors may have experienced a hangover, which could have increased their anxiety and traumatic stress after the event.”

Zohar, the director of Sheba’s PTSD Research Center, told The Jerusalem Post that the team wondered whether there was a “Golden Hour” or a “window of opportunity” when treatment for PTSD was best performed, similar to what happens after a heart attack or a stroke. “What is best to do soon after the trauma? We are interested in studying prolonged exposure and secondary prevention of PTSD. We presumed that drinking alcohol was the ‘most innocent” drug, compared to recreational drugs, but it wasn’t so.”

He added that he has worked for years with BGU’s Cohen and that she and her Beersheba colleagues contributed significantly to the collection of the data and its processing.

“The rare massacre at the Nova festival provides a tragic but unique opportunity to investigate how alcohol and drug consumption before trauma affects mental health outcomes and post-traumatic response,” Cohen concluded. “In light of the widespread prevalence of alcohol consumption in social encounters and the increasing incidents of sexual assault, physical assault, and traffic accidents, these findings are also of social and clinical interest that enable understanding of the biological process of response to traumatic experiences.”