Polydrug use and recreational motives are associated with lower posttraumatic symptoms in survivors of a mass trauma event

Objective: Drug use after trauma is common, but polydrug use patterns, motives, and associations with subsequent symptoms are poorly understood. We examined these associations among mass-casualty terror attack survivors, 72% of whom used drugs immediately before trauma exposure. Methods: Survivors of the October 7, 2023 Nova Festival attack reported use of six drug types (alcohol, cannabis, ketamine, stimulants, MDMA, psychedelics) and motives (avoidance, emotional regulation, self-medication, sleep, recreation) longitudinally at three timepoints (TP): 1-6 months (N=772), 8-12 months (N=453), and 17-24 months (N=302) post-attack. Separate latent class analyses of TP2 data characterized drug use, motives, and their combination. Linear regression and mixed-effects models examined associations between class membership and PTSD Checklist for DSM-5 (PCL-5) scores, adjusting for age, sex, time since trauma, and TP1 PCL-5 scores. Results: At TP2, 70% reported polydrug use, 17% used one drug, and 13% reported no use. The high drug-load class (mean 4.6 drug types) had lower PCL-5 scores than the low drug-load class (mean 1.5 drug types); this difference was evident among participants using ≥4 drug types and persisted through TP3. The self-medication-motive class had higher PCL-5 scores than the recreational-motive class. In joint analyses, recreational-motive users at both low and high drug loads had lower PCL-5 scores than participants reporting self-medication motives and primarily cannabis use. Conclusions: Polydrug use was common among the mass-trauma survivors in our study. Self-medication motives were associated with higher PTSD symptom severity than recreational motives. Unexpectedly, higher polydrug use was associated with lower PTSD symptom scores.