The terrorist attacks on Sept. 11, 2001 rekindled the same fear, rage and hopelessness in Tom N. that he felt when he witnessed, close-up, his classmates getting shot and killed at Kent State University three decades ago. "I recognized the rage, and I knew where my head could go, so I got myself to a meeting right away," said Tom, a recovering alcoholic. "I went to three successive AA meetings each day after 9/11. The first day I talked about my disbelief. At the second meeting, I told about my anger. At the third, I shared my grief and sorrow. Before AA, I would have never gotten to sorrow. I would have been locked in rage."

According to Sue Hoisington, executive director of Hazelden Mental Health Centers, recovering people like Tom might be better positioned to handle trauma and anxiety than those without such a support system, because they have healthy coping strategies already in place. "They have learned what it is to be powerless, they have a program that challenges them to be honest and to deal directly with their emotions, and they have the fellowship and support of others with whom they can express those emotions," said Hoisington.

Sudden and overwhelming disasters or traumatic events can take a significant emotional toll on us. Feelings can become intense and unpredictable. It is normal, said Hoisington, to experience fear, anxiety, or a sense of helplessness. Some of us might be more irritable than usual. Others might be angry or suspicious. Some of us may have trouble sleeping, concentrating, or remembering things. Many will feel an overriding loss of safety.

All these are very normal reactions to an abnormal event, and there is no magic formula that can predict when such unsettling feelings will subside. Some people react immediately, while others have delayed reactions. Initial feelings can also change as time passes.

It is the degree of impairment that distinguishes normal reactions from acute stress disorder and post-traumatic stress disorder (PTSD), said Hoisington. It is normal, for example, to be afraid to fly right now. "It is another thing, however, if you have to quit your job because you are terrified to travel or you can't sleep and are having intrusive recollections of trauma," said Hoisington. The symptoms of acute stress disorder and PTSD can be debilitating and similar. However, acute stress disorder occurs within the first month of exposure to trauma, whereas PTSD can occur long after the event, explained Hoisington.

Individuals with prolonged reactions that disrupt their daily functioning, job performance, or interpersonal relationships might benefit greatly by seeing a mental health professional. Hoisington advises recovering people to seek out mental health professionals who are familiar with addiction and the Twelve Steps. This is especially important if medication is being considered, because some medications are addictive and may not be safe for people in recovery.

People like Tom, who experienced significant trauma in their past, might re-experience symptoms of their original trauma in the form of flashbacks, memories, nightmares or frightening feelings. Tom said the Twelve Step program helped prepare him for the recurrence of anger he felt after 9/11. "In AA, we never say we're 'recovered.' It's an ongoing process, and I'm always working and reworking the Twelve Steps. The feelings and memories I have from 30 years ago didn't disappear. They're still there; I just know how to deal with them now."

Hoisington said that the first three steps of AA can be particularly helpful to recovering and non-recovering people alike in these months following the horrors of Sept. 11. "Step One is about acknowledging powerlessness. What happened, happened. We are powerless to change that, but there are behavior changes we can make that can help us cope with the reality. Step Two is about hope and belief -- believing there is a solution. And in Step Three we begin to take action and seek a solution. We can stay stuck in our anxiety or we can actively seek the guidance and comfort of our support system or Higher Power."

Managing Traumatic Stress: Tips for Recovering from Disasters and Other Traumatic Events, is available from the American Psychological Association's Web site at  http://www.helping.apa.org/ The National Mental Health Association (800-969-NMHA or http://www.nmha.org/) and American Red Cross (http://www.redcross.org/) also have many resources available.

--Published January 14, 2002