News Release

Do symptoms of post-traumatic stress disorder facilitate substance use as a coping method among children after a natural disaster?

Peer-Reviewed Publication


In a survey-based study of 3rd to 12th grade students in Puerto Rico after 2017’s Hurricane Maria, certain symptoms of post-traumatic stress disorder (PTSD) were linked with a higher risk of using drugs or alcohol.

The study, which is published in the Journal of Traumatic Stress, included 91,732 youths who completed a survey 5–9 months after Hurricane Maria made landfall in Puerto Rico. Associations between PTSD symptoms and substance use were examined using a network conceptualization, which views disorders as stemming from interactions between symptoms. This approach identified irritable behavior and angry outburst symptoms of PTSD as being associated with the greatest risk for coping through substance use after a natural disaster. This association was more pronounced among youths who did not have a supportive caregiver, friend, or teacher/counselor in their life.

Two PTSD symptom clusters were identified: 1) arousal and reactivity, negative alterations in cognition and mood, and substance use; and 2) avoidance and intrusion. Sleep disturbance and physiological reactivity to trauma reminders were identified as important bridge symptoms connecting these clusters. These findings suggest that interventions targeting sleep and physiological reactivity to trauma reminders after a natural disaster may be effective in disrupting the interaction between PTSD symptoms that maintain this disorder among youths.

“The current global climate crisis makes disaster inevitable in Puerto Rico, which can have a lasting impact on the lives of youths and the broader community,” said corresponding author Alejandro Luis Vázquez, PhD, of the University of Tennessee. “While it is useful to identify individual-level risk factors to guide triage intervention efforts, there is a need to address colonialist policies that have denied adequate investment and aid following natural disasters in Puerto Rico, which limits available support services and negatively impacts the mental health of youths.”

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Additional Information
The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout,

About the Journal
Journal of Traumatic Stress is an interdisciplinary forum for the publication of peer-reviewed original papers on biopsychosocial aspects of trauma. Papers focus on theoretical formulations, research, treatment, prevention education/training, and legal and policy concerns. It is the official publication of the International Society for Traumatic Stress Studies (ISTSS).

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