Terrorism, civil war and related violence and substance use disorder morbidity and mortality: a global analysis

J Epidemiol Glob Health. 2014 Mar;4(1):61-72. doi: 10.1016/j.jegh.2013.10.003. Epub 2013 Dec 14.


Introduction: The purpose of this study is to examine associations between deaths owing to terrorism, civil war, and one-sided violence from 1994-2000 and substance use disorder disability-adjusted life years (DALYs).

Methods: The relationship between terrorism, and related violence and substance use disorder morbidity and mortality among World Health Organization Member States in 2002, controlling for adult per capita alcohol consumption, illicit drug use, and economic variables at baseline in 1994.

Results: Deaths as a result of terrorism and related violence were related to substance use disorder DALYs: a 1.0% increase in deaths as a result of terrorism, war and one-sided violence was associated with an increase of between 0.10% and 0.12% in alcohol and drug use disorder DALYs. Associations were greater among males and 15-44 year-old.

Conclusion: Terrorism, war and one-sided violence may influence morbidity and mortality attributable to substance use disorders in the longer-term suggests that more attention to be given to rapid assessment and treatment of substance use disorders in conflict-affected populations with due consideration of gender and age differences that may impact treatment outcomes in these settings. Priorities should be established to rebuild substance abuse treatment infrastructures and treat the many physical and mental comorbid disorders.

Keywords: Civil war; Disability-adjusted life years; One-sided violence; Substance use disorders; Terrorism.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cost of Illness
  • Disabled Persons / statistics & numerical data
  • Female
  • Global Health / statistics & numerical data*
  • Health Expenditures
  • Homeless Persons / statistics & numerical data
  • Humans
  • Life Expectancy
  • Linear Models
  • Male
  • Middle Aged
  • Mortality / trends*
  • Multivariate Analysis
  • Public Health
  • Quality-Adjusted Life Years
  • Refugees / statistics & numerical data
  • Sanitation / standards
  • Substance-Related Disorders / mortality*
  • Terrorism* / statistics & numerical data
  • Violence* / statistics & numerical data
  • Warfare*
  • World Health Organization
  • Young Adult