Persons with alcohol and substance use/abuse and disasters (Ch 8)
Baker LR, Cormier LA. Disasters and vulnerable populations: Evidence-based practice for the helping professions. Springer Publishing Company; 2014 Aug 26.
Substance abuse and dependence are common problems little studied in the disaster context. What research has been done is mostly around substance use after a disaster in the stress of recovery and rebuiliding. The stigma of addictions can hinder accurate self-
reporting of substance use. And withdrawal and other effects of dependence may not manifest until long after the event. There are a wide variety of substances people abuse and form dependency on - alcohol, stimulants, opiates and other sedatives, hallucinogens, and solvents like glue or gasoline. Even nicotine, though not as dangerous in withdrawal as others, would be in important consideration for many. For all these reasons, an evidence-based view of disaster planning for people with addictions is lacking.
There is evidence both for and against the idea that substance use increases, addictions begin, and relapses occur in the aftermath of disasters. Similarly, criminality is observed in both negative (looting to support addictions) and positive (increased altruistic behavior) ways in disasters and their recovery. Social networks are disrupted and altered, formal and informal behavior controls are disrupted, markets (including street drug markets) change, and property rights are temporarily redefined. All these factor in to the needs and resources of people with addictions.
The first recommendation, as always, is personal preparedness, taking into consideration the special needs of one's circumstances. Responders would benefit from an understanding and awareness of the effects of different substances in intoxication and withdrawal - both conceivable problems in the medical assessment and treatment of disaster victims. There is a need to better understand how to help people with addictions and dependence prepare for disasters.