Israeli researchers were surprised to find that alcohol use, as compared to psychedelics, contributed more significantly to psychological challenges amongst survivors of the October 7, 2023, Nova music festival attack, following a study, conducted by researchers from Sheba Medical Centre and Ben-Gurion University of the Negev. The study was published in October in World Psychiatry.

On October 7, about 4,000 people were attending the Nova music festival in southern Israel when Hamas militants entered early in the morning and began attacking their encampment. The massacre claimed the lives of nearly 400 people at the festival, as well as another 800 people living in surrounding rural communities and military outposts. Some 250 people, including about 40 festival goers, were also abducted by Hamas and taken to Gaza.

Many attendees had consumed various recreational drugs and alcohol, including LSD, MDMA, MMC, cannabis, and combinations of these. They had to react quickly, fleeing and hiding to save their lives.

The research team wanted to examine how the use of these drugs and alcohol impacted the way attendees responded to the attack, explained Prof Mark Weiser, chairperson of the Division of Psychiatry at Sheba and a professor at Tel Aviv University. The team hypothesised that survivors who were on drugs at the time would have been more hyper-aware of the event and their surroundings, thereby experiencing more post/trauma from the attack overall. However, they were wrong.

‘It was the alcohol’

“It was the alcohol,” he told Health Policy Watch. “These people were the ones who had more severe post-traumatic symptoms.”

After the attack, a total of 232 people sought treatment at Sheba Medical Center, located near Tel Aviv, which was treating post-trauma victims. Of these, 123 survivors qualified for the study, after excluding those with severe physical injuries or histories of mental disorders, including prior PTSD, as well as two participants who had used hallucinogenic mushrooms and ketamine before the event. The latter two were excluded due to the small sample size for these substances.

The average age of participants was 28. Most (61%) were male, 69% were single, and 68% had at least a high school diploma or equivalent. Amongst participants, 71 reported using psychoactive drugs, 12 only alcohol, nine only LSD, seven only MDMA, six only cannabis, three only MMC, 15 a combination including alcohol, and 19 a combination excluding alcohol.

The researchers administered a series of questionnaires to assess how these substances impacted participants’ cognitive and stress responses during the attack. They found that all participants experienced high levels of anxiety and hyperarousal-related symptoms, regardless of drug use. Amongst those who had taken drugs, such responses were significantly elevated during the crisis, which lasted for hours.

Alcohol consumption and brain function

Even so, those who consumed alcohol—either alone or with drugs—had a much greater likelihood of experiencing post-traumatic symptoms such as depression, anxiety, arousal and hyperactivity, as well as emotional numbness.

“Alcohol consumption exerts various effects on brain function and behaviour, ranging from anxiolytic and mild disinhibitory effects to sedation, motor incoordination, altered memory, and emotional processing,” the researchers wrote. “Therefore, pre-trauma alcohol consumption may have interfered with the cognitive, emotional, and psychological processes necessary to cope with the traumatic event.”

They researchers did not differentiate between the different types of drugs used as there was not a large enough sample size.

Weiser noted that this study only looked at participants up to two months after the event. To determine any potential long-term effects, or whether drugs and alcohol might impact cognitive responses differently over time, further research would be needed. Weiser said he hoped that he and his research team might follow up with these 123 participants to assess their status over a year after the attack.

He also emphasised the small sample size, which primarily includes “people who were treatment seekers,” meaning those who recognised their need for help.

“There were a lot of people at Nova who were frightened, saw horrible things, but they went home, and life went on,” Weiser said. “It is important to realise we are talking about treatment seekers and not a random sampling from the party.”

Weiser added that, statistically, 15% to 20% of people who experience trauma will develop longer-term post traumatic stress disorder (PTSD). He noted that PTSD has a very broad diagnostic range, including those who have recurring bad dreams or troubling memories as well as those whose trauma disrupts their daily lives and ability to function.

Suicide after trauma

Beyond this study, however, a comprehensive tracking of the health and mental health outcomes of the festival goers, has not been undertaken.

Just last week, one Nova festival survivor, 22-year-old Shirel Golan, took her own life after a year-long struggle with PTSD, according to her parents. Her death has sparked concerns about whether the country is providing enough support for survivors of the October 7 events.

Hundreds of survivors continue to face serious mental health challenges, including PTSD, survivor’s guilt, depression, and anxiety.

In April, festival survivor Guy Ben Shimon told a State Audit Commission that “there have been almost 50 suicides amongst the Nova survivors.” However, the Health Ministry quickly countered, stating it has no data confirming this claim, and Weiser agrees.

In response to October 7, the Israeli government established a public mental health support program offering free therapy. Survivors with PTSD qualify for up to 36 sessions, while others can receive up to 12. As of July, nearly 1,900 survivors had been referred for treatment. The government has committed about $5 million to this and related programs.

“Every suicide is a tragedy, but it is very premature and inappropriate to say [Golan] suicided because of her experience at Nova,” Weiser said.

“This does not mean it is not true, but suicide is a multifactorial event, and we don’t fully understand why one person may end their life while another does not.”

Both in Israel and the United States, studies have shown elevated suicide rates amongst those with PTSD, and especially those who served in the military.

As of 2021, 30,177 US active-duty soldiers and veterans who had served in Afghanistan, Iraq and other conflict zones over the past two decades, had died by suicide, as compared to 7,057 combat-related deaths over the same period, according to the United Service Organisations. In Israel, suicide also was the leading cause of death amongst soldiers in 2021, two years before the Gaza war broke out, with 11 soldiers taking their lives that year.

Image Credits: Kobi Gideon / GPO/Wikipedia, Chuttersnap/ Unsplash, Wikimedia.