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. 2026 Feb 24;42(2):e70155. doi: 10.1002/smi.70155

Substance and Behavioural Addictions Among Evacuees: Findings From Israeli Swords of Iron War

Gabriella Rubin 1,✉, Uri Lifshin 1,✉, Vera Skvirsky 1, Yoav Ankri 1, Dvora Shmulewitz 1, Maor Levitin 1,2, Merav Vider 1, Shaul Lev‐Ran 3,4, Ariel Kor 5, Mario Mikulincer 1
PMCID: PMC12933018  PMID: 41736387

ABSTRACT

War‐related evacuation is a stressful event that may cause mental health problems, which, in turn, might lead to increases in substance and behavioural addictions. We used data collected online during the Swords of Iron to examine associations between being evacuated during the war, mental health, problematic substance use, and behavioural addictions. Study 1 surveyed young adults (ages 18–26) from various areas of Israel. Measures included self‐reported anxiety, depression, problematic consumption of alcohol, cannabis, and prescription drugs, and problematic gambling, gaming, and pornography. Evacuees (n = 111) reported higher levels of anxiety, depression, problematic alcohol consumption, and problem gambling than non‐evacuees (n = 973), with increased depression, problematic alcohol consumption and problem gambling among men. In Study 2, we used data from a quasi‐representative sample of Jewish Israelis (ages 18–70), that included the same measures, in addition to problematic social media and internet usage. Findings replicated and extended those of Study 1: evacuees (n = 158) had higher rates of problematic use of all the assessed outcomes, compared to those not evacuated (n = 2485), with increased problematic use of alcohol, prescription drug, and gambling among men. In both Studies, the results held when controlling for exposure to war stressors and feelings of danger during the war, indicating that evacuation had a unique effect beyond the primary trauma of war. We discuss the limitations of the current research and consider its implications to addiction theory and gender differences in addictions and offer directions for future research and clinical considerations.

Keywords: addiction, alcohol, depression, evacuees, gambling, war

1. Introduction

Evacuating one's home during war is a stress‐inducing event, which may lead to difficulties and increase in mental health problems such as addiction (e.g., Augsburger and Elbert 2017; Saleh et al. 2023; Weaver and Roberts 2010). However, researching the effects of war‐related evacuation is challenging, as the circumstances that give rise to this situation are often unpredictable and chaotic. The current research was conducted following the October‐7 terror attack and the Swords of Iron war in Israel, as a unique real‐world case‐study examining the relationship between evacuation, mental health, and problematic substance use and behaviours.

On October 7, 2023, Israel faced a traumatic attack by the Hamas terror organisation, resulting in more than 1300 deaths and 240 hostages, triggering acute personal and national distress and a surge of addictive behaviours (e.g., Levi‐Belz et al. 2024; Lifshin et al. 2025). Thousands of citizens were displaced—some whose homes were destroyed, others evacuated due to rocket fire from Hamas in the south or Hezbollah in the north. Some evacuations were mandated, others voluntary. Substance use, specifically alcohol, and risk taking behaviours, such as gambling, often serve as a means for regulating negative emotions (e.g., Neophytou et al. 2023) particularly during stressful life events (Luce et al. 2016; Thurm et al. 2023), and might therefore emerge among evacuee communities exposed to sudden, war related displacement. This may be especially true for men (Zakiniaeiz and Potenza 2018; Lifshin et al. 2025). In the present study, we examined the relationship between evacuation during the war and problematic substance use (alcohol, cannabis, prescription drugs), addictive behaviours (gambling, gaming, pornography, social media and internet addiction), and mental‐health problems (anxiety and depression) among Israeli Jews.

Exposure to traumatic events such as terrorist attacks and war is well established as a predictor of negative psychological outcomes (O’Brien 2004; Fowler et al. 2013; Moore III and Grubbs 2021). Displacement resulting from such events functions as an additional stressor, disrupting access to familiar environments, social support networks, employment, and daily routines which may trigger heightened vulnerability (Augsburger and Elbert 2017; Saleh et al. 2023). Research consistently shows that evacuees display elevated levels of stress‐related distress, depression, and anxiety (Keyes 2000; Silove et al. 2017; Turrini et al. 2017), a pattern mirrored in findings from the Swords of Iron war, where displaced Israeli citizens exhibited higher levels of these symptoms than non‐evacuees (Hamama et al. 2025).

Stress‐related distress often includes difficulties in emotional regulation and increased susceptibility to maladaptive coping strategies. For evacuees, the hardships of displacement and threat to personal safety can fracture a sense of continuity and coherence, leading to even greater emotional instability and risk for longer‐term psychological harm (O’Brien 2004; Keyes 2000). Given these vulnerabilities, evacuees may resort to maladaptive coping mechanisms such as substance use and addictive behaviours as attempts to self‐regulate and manage emotional distress resulting from exposure to stress (Huang et al. 2023; Levin et al. 2021; Ueda et al. 2022).

Although the present study draws on research concerning refugees and forced migration, it is important to distinguish between these populations and evacuees displaced within their own country. Refugees often face prolonged displacement, legal uncertainty, and loss of social and national belonging (Silove et al. 2017), whereas evacuees—such as those in Israel during the Swords of Iron war—remain within national borders and typically anticipate return. Yet, both groups experience abrupt disruption and instability that can undermine well‐being. Evacuation outcomes differ by factors such as duration, controllability, and social support, highlighting the heterogeneity of evacuee experiences (Augsburger and Elbert 2017; Saleh et al. 2023).

Research shows that stress‐related distress is correlated with substance use disorders (e.g., Patton et al. 2024). Individuals facing stressful events may self‐medicate with alcohol or prescription drugs, to cope with emotional strain and anxieties (e.g., Khantzian 1997; Hawn et al. 2020). This might also further increase mental health and other problems (e.g., Humeniuk et al. 2010; Petry et al. 2018), and create a self‐perpetuating cycle, intensified by the stress of evacuation and displacement (Elkholy et al. 2023; Ueda et al. 2022).

Similarly, behaviours, such as problem gambling (PG), that disrupt or damage personal, interpersonal, or recreational pursuits (Lesieur and Rosenthal 1991; Goodwin et al. 2017), can function as maladaptive coping strategies, providing mood gratification and relief from distress (e.g., Neophytou et al. 2023). However, PG has been shown to lead to difficulties in emotion regulation (e.g., Rogier and Velotti 2018) and to exacerbation of mental health problems over time (e.g., Canale et al. 2022; Moore III and Grubbs 2021; Sancho et al. 2019; Neophytou et al. 2023). Other addictive behaviours, including media‐related addictions, have been shown to increase during collective crises such as the COVID‐19 pandemic (e.g., Alimoradi et al. 2022).

However, not everyone deals with stress in the same way. Gender can play a role in how individuals respond to triggers and engage in addictive behaviours. Gender differences may arise from societal norms and values as well as differences in emotion regulation strategies (e.g., Breen 2012; McMillen et al. 2007; Merkouris et al. 2016). Whereas men tend to cope with negative emotions through avoidance and suppression and externalise distress via behaviours such as substance use and gambling, women tend to internalise distress which may lead to elevated rates of anxiety and depression (Nolen‐Hoeksema 2012; Dir et al. 2017). Biological mechanisms also contribute to gendered responses to stress and addiction‐related cues. Men tend to exhibit more reward‐driven behaviour whereas women are more likely to report substance use aimed at regulating distress (Bobzean et al. 2014; Chaplin et al. 2008). These differences can be especially pronounced in contexts involving emotional regulation difficulties and addictions (Lifshin et al. 2025; Wetherill et al. 2013).

Despite the clear theoretical connection between mental health, and addiction (e.g., Patton et al. 2024; Shield and Rehm 2015), few studies have systematically examined these factors among evacuees during active conflict. The present research addresses this gap by investigating how evacuation during the Swords of Iron war in Israel relates to substance use, behavioural addictions, and mental health, while also considering gender differences. To this end, we conducted two studies among Israeli adults and examined associations between evacuation during the war and self‐reports of problematic substance use, addictive behaviours, and mental health problems. We hypothesised that evacuees would exhibit higher rates of mental health problems, substance abuse and addictive behaviour compared to non‐evacuees. We also hypothesised that heightened problematic substance use and addictive behaviours among evacuees would be more notable among men than women. Furthermore, in both studies, we tested if the effects occur beyond the increased experience of war‐related stressors by controlling for exposure to these stressors and subjective feelings of danger and by conducting the analyses within regions in Israel that are more adjacent to the war (i.e., south and north).

1.1. Study 1

Study 1 was conducted in a sample of young Israeli Jews during the Swords of Iron war. Participants completed online self‐report scales tapping their evacuation status, mental health (anxiety, depression), problematic substance use (alcohol, cannabis, prescription drugs, other drugs), and behavioural addictions (problematic gambling, gaming, and pornography consumption). We predicted that evacuees would report higher rates of mental health, substance use, and addictive behaviours than non‐evacuees. We also predicted that the associations between evacuation status and problematic substance use and addictive behaviours would be stronger among men than women. Finally, we conducted analyses to further establish that the effect of evacuation is not solely a function of increased war exposure, by statistically controlling for exposure to threat and feelings of danger and by looking at the results only among participants with relative geographical proximity to war zones (north and south Israel).

1.1.1. Method

1.1.1.1. Participants

The study was approved by the Institutional Review Board of an Israeli university. Jewish Hebrew speaking Israelis aged 18–26, from three major regions in Israel—southern, central, and northern areas, participated online for monetary compensation (via iPanel and all4panel; ∼20 ILS). Data was collected in August and September of 2024, during the Swords of Iron war. Additional demographic information of the sample is available in Supporting Information S1: Appendix 1.

The final sample included 1084 participants (422 men, 659 women and 3 did not report gender, M age = 23.09, SD = 2.27) 1 . Of these, 111 (10.2%) reported evacuating during the war. A sensitivity analysis using G*power (Faul et al. 2009) indicated that we could detect a small effect size (f 2  = 0.019) at 80% power in a MANOVA with 4 groups (evacuees and non‐evacuees, men and women) and nine outcome measures (including all outcomes).

1.1.1.2. Procedure and Materials

After completing informed consents, participants answered demographic questions (e.g., age, gender, religiosity, geographical district, family status, education). Then, they received self‐report questionnaires, tapping problematic substance use, addictive behaviours, and mental health. The survey included additional questions that are not the focus of this study and are not reported here. Data and detailed information are available upon request from the Gabriella Rubin.

Evacuation status was assessed by asking participants whether they were evacuated or had independently left their homes due to the war, and if they had since returned (80 participants reported being evacuated and returning). We created a dummy variable indicating evacuation (n = 111) or not (n = 973) 2 . The distribution of time elapsed from evacuation (1 = less than 1 month, 4 = more than 6 months) is available in Supporting Information S1: Appendix 1, Tables S1c and S2 (this variable was not related to any outcome, rs < 0.18, ps > 0.067 [in both Studies 1–2], and was not further analysed).

War related threat was measured with two items pertaining to objective exposure ‐ frequency of alerts and explosions heard (1 = not at all; 6 = all the time; r = 0.66, p < 0.001); and two items related to subjective feelings that one's life or family members life is in danger (1 = not at all; 6 = all the time; r = 0.73, p < 0.001). We computed a mean score for the two more objective items and a mean score for the two more subjective ones.

Self‐reported problematic substance use during the past 3 months was measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.1; Humeniuk et al. 2010) for alcohol, cannabis, prescription drugs (sedatives, stimulants, opioid painkillers), and other drugs (stimulants [e.g., cocaine, amphetamines] hallucinogens [e.g., LSD, ecstasy], opiates [e.g., heroin, codeine], etc.) 3 . For each substance category, participants responded to six items tapping problematic use—frequency of non‐medical use, craving, inability to stop using, and maladaptive consequences of use. Scores were computed by summation, according to the ASSIST protocol. Supporting Information S1: Appendix 2 details of how binary problem use categories were computed.

Behavioural addiction measures included three scales: the 9‐item Problem Gambling Severity Index (PGSI; Ferris and Wynne 2001; Stinchfield et al. 2007; for exmaple, ‘Have you bet more than you could really afford to lose?’; 0 = never to 3 = almost always; α = 0.92); the 6‐item Problematic Pornography Consumption Scale (Bőthe et al. 2021; e.g., ‘I felt that porn is an important part of my life’; 1 = never to 7 = very often\all the time; α = 0.87); and the 7‐item Game Addiction Scale (Lemmens et al. 2009; e.g., ‘Played computer games to forget about your real life’; 1 = never to 5 = very often; α = 0.88). All measures related to the past 3 months. Details of how all risk for problematic behaviour/addiction were computed are presented in Supporting Information S1: Appendix 2.

Anxiety was measured using the 7‐item General Anxiety Disorder questionnaire (Spitzer et al. 2006; α = 0.93). Depression was assessed using the 9‐item Patient Health Questionnaire‐9 (Kroenke et al. 2001; α = 0.89). Both measures related to the past 2 weeks. Overall scores for behavioural addictions, anxiety, and depression were calculated by summing all items in a scale.

1.1.1.3. Transparency and Openness

This study was not preregistered. It was a part of a larger study conducted by the Israeli Centre on Addictions and Mental Health (ICAMH) on substances and behavioural addiction among Israeli youth in the Swords of Iron war. Data are available upon sensible request.

2. Results

Preliminary analyses (detailed in Supporting Information S1: Appendix 3) indicated that evacuees and non‐evacuees did not differ in age, level of education, religiosity, military service, or history of ever gambling, watching pornography, gaming, using cannabis, stimulants, opioids, or other drugs. However, evacuees reported higher levels of exposure to war stressors and feelings of danger, and also more right wing views, lower economic status, and poorer physical health. There were also lower reported ever using alcohol among evacuees, and higher ever usage of sedatives. We therefore also tested the associations between evacuation and mental health and addictions while statistically controlling for these variables in our analysis. Means, SDs, and Spearman‐Rank order correlations of the key study variables by evacuation status are presented in Table 1.

TABLE 1.

Descriptive statistics and spearman rank‐order correlations of key measures among evacuees (above the diagonal, n = 111) and non‐evacuees (below the diagonal n = 973) in study 1 (N = 1081).

1 2 3 4 5 6 7 8
Evacuated M 6.05 0.89 1.17 0.95 10.86 8.19 8.36 9.95
SD 8.12 3.11 3.15 3.17 5.90 5.20 5.69 6.21
Not Evacuated M 4.39 1.12 0.52 0.22 10.02 8.70 7.14 7.68
SD 5.02 4.26 1.87 1.38 5.02 5.90 5.52 6.04
Pearson rs
1. Alcohol — 0.16 0.07* 0.40*** 0.00 0.24* 0.26*** 0.18
2. Cannabis 0.23*** — 0.06 0.04 −0.06 0.01 0.06 −0.07
3. P. Drugs 0.16*** 0.05 — 0.24* 0.22* 0.36*** 0.42*** 0.43***
4. Gambling 0.14*** 0.03 0.09** — 0.08 0.10 0.30** 0.23*
5. Gaming 0.10*** −0.05 0.09** 0.05 — 0.08 0.19 0.18
6. Pornography 0.22*** 0.13*** 0.08** 0.10** 0.20*** — 0.11 0.11
7. Anxiety 0.11*** 0.10** 0.18*** 0.07 0.15*** 0.04 — 0.71***
8. Depression 0.14** 0.08* 0.20*** 0.09 0.19*** 0.11** 0.80*** —
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*

p < 0.050.

**

p < 0.010.

***

p < 0.001.

We conducted a multivariate analysis of variance (MANOVA) predicting problematic substance use (alcohol, cannabis, prescription drugs, and other substances), behavioural addictions (gambling, gaming, and pornography), and mental health (anxiety and depression) by participants' evacuee statues (evacuated during the war vs. not) and gender (man, woman). 95% CIs for means and p‐values were estimated using bias‐corrected accelerated bootstrapping with 5000 resamples, considering that the mental health and addiction outcomes were not normally distributed (skewness > 8.28, kurtosis > 3.24), and that the groups had uneven size and variances. At the multivariate level, there were statistically significant main effects for evacuation, F(9, 1069) = 8.05, p < 0.001, η p 2 = 0.063, gender, F(9, 1069) = 17.95, p < 0.001, η p 2 = 0.131, and an evacuation × gender interaction effect, F(9, 1069) = 5.08, p < 0.001, η p 2 = 0.041.

At the univariate level, there were statistically significant effects with evacuees scoring higher than non‐evacuees in problematic alcohol use, F(1, 1077) = 22.97, p < 0.001, η p 2 = 0.021; prescription drugs, F(1, 1077) = 8.04, p = 0.077 (marginal bootstrap p), η p 2 = 0.007; problem gambling, F(1, 1077) = 33.23, p = 0.017, η p 2 = 0.030; general anxiety, F(1, 1077) = 3.94, p = 0.046, η p 2 = 0.004; and depression, F(1, 1077) = 17.94, p < 0.001, η p 2 = 0.016 (see Table 2). There were no differences in problematic use of cannabis, gaming, or pornography, Fs < 1.64, ps > 0.200.

TABLE 2.

Means and 95% confidence intervals of all substances and behavioural addictions by evacuation and gender in study 1 (N = 1081).

Outcome Women Men
Not evacuated Evacuated Not evacuated Evacuated
Alcohol 3.66 [3.36, 4.03]a 4.18 [2.92, 5.63]a 5.45 [4.89, 6.03]b 10.45 [7.15, 13.88]c
Cannabis 1.04 [0.72, 1.38]a 0.55 [0.16, 1.01]a 1.24 [0.83, 1.67]a 1.70 [0.40, 3.27]a
P. Drugs 0.61 [0.47, 0.77]a 1.24 [0.65, 1.93]b 0.37 [0.23, 0.55]a 1.01 [0.77, 2.24]ab
Gambling 0.08 [0.05, 0.13]a 0.46 [0.10, 0.96]a 0.42 [0.25, 0.62]a 2.09 [0.73, 3.64]b
Gaming 9.54 [9.17, 9.94]a 10.89 [9.61, 12.26]b 10.71 [10.18, 11.27]b 10.79 [9.00, 12.61]b
Pornography 7.07 [6.82, 7.33]a 7.46 [6.64, 8.44]a 11.14 [10.36, 11.98]b 9.91 [7.92, 12.19]b
Anxiety 8.71 [8.28, 9.16]a 9.08 [7.78, 10.37]b 4.77 [4.33, 5.21]c 6.67 [4.97, 8.39]d
Depression 9.00 [8.50, 9.50]a 9.81 [8.35, 11.28]a 5.67 [5.14, 6.23]b 10.27 [8.11, 12.31]a
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Note: Different letters represent statistically significant differences at p < 0.050. 95% Confidence intervals were obtained using bias‐corrected accelerated bootstrapping with 5000 resamples.

Abbreviation: P. Drugs = prescription drugs (sedatives, stimulants, opioids).

Gender differences were observed with men scoring higher in problematic alcohol, gambling, and pornography consumption, Fs > 29.35, ps < 0.001, η p 2 > 0.027 (Table 2). Women reported overall higher levels of anxiety and depression than men, Fs > 5.06, ps < 0.029, η p 2 > 0.005. No other gender differences were observed, Fs < 2.18, ps > 0.140.

Importantly, there were also statistically significant evacuation × gender interaction effects on problematic alcohol consumption, F(1, 1077) = 15.20, p < 0.001, η p 2 = 0.014, problem gambling, F(1, 1077) = 13.28, p < 0.001, η p 2 = 0.012, and depression, F(1, 1077) = 8.86, p = 0.003, η p 2 = 0.008. No other interactions were observed, Fs < 1.82, ps > 0.178.

As shown in Figure 1, among men, there were higher rates of problematic alcohol consumption for evacuees than non‐evacuees, p = 0.005, η p 2 = 0.025. There were no differences between evacuees and non‐evacuees among women, p = 0.484.

FIGURE 1.

FIGURE 1

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Problematic alcohol consumption score by evacuation and gender (study 1, N = 1081).

As shown in Figure 2, among men, there were higher rates of problem gambling for evacuees compared to non‐evacuees, p = 0.040, η p 2 = 0.029. The differences between evacuee and non‐evacuee among women was not statistically significant, p = 0.154, η p 2 = 0.003.

FIGURE 2.

FIGURE 2

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Problem gambling severity index score, by evacuation and gender (study 1, N = 1081).

Finally, as shown in Figure 3, among men, there were higher levels of depression for evacuees compared to non‐evacuees, p = 0.001, η p 2 = 0.017. There were no such differences between evacuee and non‐evacuee among women, p = 0.287.

FIGURE 3.

FIGURE 3

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Depression (PHQ‐9) score, by evacuation and gender (study 1, N = 1081).

The results remained the same when controlling for the statistically significant covariates of health, age, education, economic status, religiosity, political view, as well as ever usage of alcohol and other substances. Importantly, aside from differences in general anxiety, the results were the same when controlling for exposure to war stressors or feelings of danger, or when only comparing evacuees and non‐evacuees from the northern and southern region who live close to the war zones of Gaza and Lebanon (see Appendix 4 in the Supporting Information S1 for details). Similar results were also obtained when examining the clinical/risk‐category scores as the outcomes (instead of total scores). The detailed analyses are available in Supporting Information S1: Appendix 4 (Table S3).

3. Discussion

The results indicated that participants who were evacuated reported overall higher rates of anxiety, depression, problematic alcohol consumption, and problem gambling compared to those not evacuated, with increased depression, problematic alcohol consumption, and problem gambling among men. The findings also held when statistically controlling for exposure to war stressors, feelings of danger during war, and geographical region in Israel, indicating that these effects are specific to evacuation rather than just increased exposure to war stressors.

3.1. Study 2

The results of Study 1 provided insight into the effects of evacuation status on mental health and addiction. However, they were obtained from a relatively small and non‐representative sample of young evacuees, and based on only one, partially exploratory study. Study 2 aimed to replicate and extend the results of Study 1 using a more representative sample of Israelis, who are older than 26 years of age, and including additional outcomes. In general, problematic substance use and behavioural addictions are prevalent in Israeli adults, ranging from about 3% to 16% (e.g., Bar‐Or et al. 2021; Gavriel‐Fried et al. 2023; Shmulewitz et al. 2023, 2024).

We used cross‐sectional data collected online as part of the ICAMH longitudinal study (Shmulewitz et al. 2025) to examine if evacuation predicted problematic substance use (alcohol, cannabis, prescription drugs and other substances), addictive behaviours (gambling, gaming, and pornography as well as problematic internet and social media use) and mental health (depression, anxiety). We again conducted further analyses to establish that the effect of evacuation is not only a function of increased war exposure, by statistically controlling for exposure to war stressors and feelings of danger, and by looking at the results only among participants from north and south of Israel who live close to the war zones of Gaza and Lebanon.

3.1.1. Method

3.1.1.1. Participants

As detailed in Shmulewitz et al. (2025), respondents participated online (iPanel) for monetary compensation (∼20 ILS for a completed survey). Participants were Jewish and Hebrew speaking Israelis aged 18–70. The data were collected during the Swords of Iron war in Israel (March 2024), as part of a larger longitudinal study. The baseline sample (collected in December 2023, described in Shmulewitz et al. 2024) was constructed to be quasi‐representative, matching prevalence of gender, age, religiosity, and area of residence to the adult Jewish population in Israel (Central Bureau of Statistics 2023), allowing deviations of up to 3% from the quotas (Fricker Jr 2016). In March 2024, 69% of the participants from December 2023 completed the follow‐up survey. Here, we consider these data as a stand‐alone cross‐sectional sample that can be used to compare evacuees to non‐evacuees, rather than provide epidemiological (prevalence) data. We removed data from 121 participants (9 evacuees) who participated in the youth sample (Study 1), and 4 participants who did not report gender (see Supporting Information S1: Appendix 1 for demographics).

This cross‐sectional sample included 2643 participants (1296 men and 1347 women, M age = 44.14, SD = 14.16). Of these, 158 (6%) reported being evacuated during the war. A sensitivity analysis indicated that we could detect a very small effect size (f 2  = 0.004) at 80% power in a MANOVA with 4 groups (evacuees and non‐evacuees, males and females) and 12 outcome measures (including substances and behavioural addictions and mental health measures).

3.1.1.2. Procedure and Materials

Detailed procedure and materials are available at (Shmulewitz et al. 2025). The procedure and materials were mostly the same as in Study 1. We included the same measures of addictions and mental health from Study 1 (all α > 0.89), except that problematic pornography use was measured with the 12‐item Problematic Pornography Use Scale (Kor et al. 2014, α = 0.95). We also included the Bergen Social Media Addiction Scale (Andreassen et al. 2016; e.g., ‘You feel an urge to use social media more and more’; 1 = very rarely to 5 = very often), and the 20‐item Internet Addiction Test (Pawlikowski et al. 2013; Young 1998; for example, ‘How often do you find that you stay on‐line longer than you intended?’; 0 = not relevant to 5 = always).

3.1.1.3. Transparency and Openness

This study was not preregistered. Data was taken from a large multi‐study epidemiological project (Shmulewitz et al. 2025) and is available upon sensible request.

4. Results

Preliminary analyses (Supporting Information S1: Appendix 5) indicated that evacuees and non‐evacuees did not differ in level of education, health, religiosity, military/security service, and marital status. Evacuees were however younger (M = 39.19, SD = 13.86) than non‐evacuees (M = 44.45, SD = 14.13) and had slightly poorer economic status. Evacuees also reported higher levels of exposure to war stressors and feelings of danger. There were no differences in ever using alcohol or cannabis, but evacuees reported higher ever using sedatives, stimulants, and other drugs. We therefore also tested these variables as controls in our analysis. Means SDs and Spearman Rank‐Order correlations of the study variables by evacuation status are presented in Table 3.

TABLE 3.

Descriptive statistics and pearson correlations of key measures among evacuees (above the diagonal, n = 158) and non‐evacuees (below the diagonal n = 2485) in study 2 (N = 2643).

1 2 3 4 5 6 7 8 9 10 11
Evacuated M 7.11 3.03 2.72 2.46 12.65 7.26 14.25 29.37 6.28 7.80 25.65
SD 8.33 7.63 6.43 5.08 6.49 12.14 6.29 19.31 4.78 5.84 19.67
Not Evacuated M 5.02 1.35 0.84 0.93 10.45 4.57 11.37 22.64 4.22 5.36 15.87
SD 6.23 4.60 2.56 2.58 4.99 8.68 5.79 16.42 4.88 5.45 16.32
1. Alcohol — 0.36*** 0.23** 0.19* 0.15 0.28*** 0.20* 0.23** 0.15 0.20* 0.21**
2. Cannabis 0.27*** — 0.28*** 0.15 0.07 0.28*** 0.20*** 0.24** 0.15 0.24** 0.20**
3. P. Drugs 0.19*** 0.19*** — 0.43*** 0.51*** 0.56*** 0.38*** 0.43*** 0.38*** 0.47*** 0.37***
4. Gambling 0.24*** 0.10*** 0.14*** — 0.52*** 0.48*** 0.44*** 0.48*** 0.40*** 0.43*** 0.48***
5. Gaming 0.22*** 0.12*** 0.18*** 0.30*** — 0.35*** 0.38*** 0.49*** 0.47*** 0.45*** 0.49***
6. Pornography 0.31*** 0.19*** 0.12*** 0.31*** 0.27*** — 0.35*** 0.42*** 0.33*** 0.38*** 0.33***
7. S. Media 0.23*** 0.17*** 0.18*** 0.30*** 0.35*** 0.29*** — 0.82*** 0.57*** 0.60*** 0.63***
8. Internet 0.24*** 0.17*** 0.19*** 0.31*** 0.41*** 0.35*** 0.71*** — 0.55*** 0.58*** 0.63***
9. Anxiety 0.17*** 0.16*** 0.28*** 0.23*** 0.29*** 0.22*** 0.48*** 0.47*** — 0.81*** 0.73***
10. Depression 0.18*** 0.19*** 0.30*** 0.23*** 0.32*** 0.27*** 0.48*** 0.50*** 0.77*** — 0.75***
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*

p < 0.050.

**

p < 0.010.

***

p < 0.001.

As in Study 1, we conducted a multivariate analysis of variance (MANCOVA) predicting excessive substance use (alcohol, cannabis, prescription drugs), behavioural addictions (gambling, gaming, pornography, social media, internet), and mental health problems (anxiety, depression) by evacuation status (evacuated vs. not) and gender (men vs. women). The 95% CI were obtained using bias‐corrected accelerated bootstrapping with 1000 resamples.

At the multivariate level, the analysis yielded statistically significant effects for evacuation, F(10, 2630) = 10.84, p < 0.001, η p 2 = 0.040, gender, F(10, 2630) = 21.20, p < 0.001, η p 2 = 0.075, and an evacuation × gender interaction effect, F(10, 2630) = 3.62, p < 0.001, η p 2 = 0.014.

At the univariate level, there were main effects for evacuation on all outcomes, all Fs > 20.39, ps < 0.004, η p 2s > 0.008. Evacuees reported higher problematic substance use, behavioural addictions, and mental health problems than non‐evacuees (see Table 4). Gender differences were observed, with men scoring higher than woman on all problematic substance use and behavioural addictions, Fs > 9.77, ps < 0.002, η p 2s > 0.004, aside from gaming, which was marginally significant, F(1, 2639) = 3.70, p = 0.055, η p 2s = 0.001 (Table 4). Women reported slightly higher anxiety than men, F(1, 2639) = 3.95, p = 0.055, η p 2s = 0.001. No gender differences were found in depression, Fs < 2.15, ps > 0.143. Replicating Study 1, there were evacuation × gender interactions on problematic alcohol consumption, F(1, 2639) = 14.77, p < 0.001, η p 2 = 0.006, and gambling, F(1, 2639) = 22.00, p < 0.001, η p 2 = 0.008. There was also a significant interaction for problematic use of prescription drugs, F(1, 2639) = 13.23, p < 0.001, η p 2 = 0.005. No other significant interactions were observed, Fs < 2.83, ps > 0.092.

TABLE 4.

Means and 95% confidence intervals of all substances and behavioural addictions by evacuation and gender in study 2 (N = 2643).

Outcome Women Men
Not evacuated Evacuated Not evacuated Evacuated
Alcohol 3.84 [3.57, 4.13]a 4.50 [3.46, 5.64]a 6.22 [5.86, 6.58]c 10.86 [8.42, 13.63]d
Cannabis 1.07 [0.85, 1.31]a 2.24 [1.05, 3.60]b 1.65 [1.39, 1.90]c 4.17 [2.31, 6.21]d
P. Drugs 0.85 [0.72, 0.99]a 1.99 [1.17, 2.96]b 0.84 [0.68, 1.00]a 3.76 [2.07, 5.77]c
Gambling 0.59 [0.48, 0.70]a 1.29 [0.66, 1.97]b 1.28 [1.12, 1.44]b 4.14 [2.80, 5.77]c
Gaming 10.36 [10.06, 10.67]a 12.05 [10.84, 13.26]b 10.55 [10.28, 10.83]a 13.49 [11.82, 15.40]b
Pornography 1.48 [1.28, 1.71]a 4.16 [2.39, 6.25]b 7.72 [7.12, 8.39]c 11.69 [8.38, 15.55]d
S. Media 12.01 [11.70, 12.32]a 14.60 [13.40, 15.70]b 10.73 [10.43, 11.01]c 13.74 [12.29, 15.35]b
Internet 23.27 [22.34, 24.21]a 28.79 [24.88, 32.63]b 22.00 [21.15, 22.84]a 30.20 [25.68, 35.18]b
Anxiety 4.88 [4.60, 5.20]a 6.39 [5.33, 7.37]b 3.54 [3.28, 3.81]c 6.12 [4.74, 7.40]b
Depression 5.77 [5.46, 6.09]a 7.57 [6.44, 8.75]b 4.94 [4.64, 5.24]c 8.12 [6.47, 9.76]b
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Note: Different letters represent statistically significant differences at p < 0.050. 95% Confidence intervals were obtained using bias‐corrected accelerated bootstrapping with 1000 resamples.

Abbreviation: P. Drugs = prescription drugs (sedatives, stimulants, opioids).

As shown in Figure 4, among men there were higher rates of problematic alcohol consumption for evacuees compared to non‐evacuees, p = 0.020, η p 2 = 0.013, but no difference was found between evacuees and non‐evacuees among women, p = 0.090.

FIGURE 4.

FIGURE 4

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Problematic alcohol consumption score, by evacuation and gender (study 2, N = 2643).

As shown in Figure 5, among men there were higher rates of problem gambling for evacuees compared to non‐evacuees, p < 0.001, η p 2 = 0.025. Among women, this difference was also statistically significant but smaller, p = 0.047, η p 2 = 0.002.

FIGURE 5.

FIGURE 5

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Problem gambling severity index score, by evacuation and gender (study 2, N = 2643).

As shown in Figure 6, among men there was higher problematic prescription drug usage for evacuees compared to non‐evacuees, p = 0.004, η p 2 = 0.023. Among women, this difference was statistically significant but smaller, p = 0.023, η p 2 = 0.005.

FIGURE 6.

FIGURE 6

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Problematic prescription drugs use ASSIST scores (sedative, stimulants, opioids), by evacuation and gender (study 2, N = 2643).

These results remained the same when controlling for the statistically significant covariates of health, age, level of education, economic status, or ever usage of any substances. Importantly, the results were similar when controlling for exposure to war stressors and feelings of danger. However, comparing evacuees and non‐evacuees from the northern and southern region yielded somewhat different results, as it also included a much smaller sample of evacuees. Here the only pairwise difference that remained the same was for alcohol. For prescription drugs there were higher rates only among women who were evacuated but not among men, and the differences between evacuees and non‐evacuees in problem gambling was not statistically significant. There were also lower rates of problematic pornography consumption among men who were evacuated than among men who did not evacuate (see Supporting Information S1: Appendix 6). Similar results were also obtained when examining the clinical/risk‐category scores as the outcomes (instead of the total scores). The details are available in Supporting Information S1: Appendix 6 (Table S4).

5. Discussion

The results of the study replicate and extend findings from Study 1. Evacuees had overall higher rates for problematic use of all the assessed substances, behavioural addictions and mental health problems compared to those not evacuated, with increased problematic use of alcohol, prescription drug, and gambling among men. Findings held when controlling for exposure to war stressors and feelings of danger, although additional analyses with a small sub‐sample of Israelis from north and south Israel did not replicate all the patterns of results.

Overall, Study 2's results extend and strengthen Study 1's findings in a more representative sample of Israelis beyond only younger adults. The additional measures of behavioural addictions help to further generalise and consolidate the findings from Study 1 across different types of addictions and mental health problems. These findings suggest that evacuation may increase mental health problems and trigger general mechanisms of addiction that might affect individuals beyond any specific substance or behaviour.

5.1. General Discussion

This research examined the associations between war‐related evacuation, mental health, and problematic substance use and addictive behaviours among Israeli Jews during the Swords of Iron war. Across two studies, evacuees reported higher rates of mental health problems, substance abuse, and addictive behaviour than non‐evacuees. In Study 1, young evacuees (ages 18–26) reported higher rates of anxiety, depression and problematic alcohol consumption, and problem gambling compared to those not evacuated. In Study 2, findings were replicated in a more representative sample of adult Israeli Jews and extended to problematic use of internet and social media. In both studies, the associations between evacuation and problematic alcohol consumption and gambling were observed mainly among men. No consistent differences between evacuees and non‐evacuees were observed in problematic use of cannabis, gaming, or pornography. In both studies, findings remained significant after controlling for self‐reported exposure to war stressors and feelings of danger and when limiting analyses to participants living closer to the southern and northern frontlines.

Emotion regulation theories emphasise that extreme disruptions to safety and security can destabilise psychological functioning and increase reliance on short‐term coping methods (O’Brien 2004). Consistently, evacuees in the present studies reported higher problematic alcohol consumption, prescription drug use, and gambling than non‐evacuees. These findings align with prior research showing that displacement undermines stability and emotional regulation (Augsburger and Elbert 2017; Hamama et al. 2025), heightening vulnerability to maladaptive coping strategies such as substance and behavioural addictions (e.g., Hawn et al. 2020; Neophytou et al. 2023). Although such behaviours may temporarily restore a sense of control or relief, they ultimately perpetuate distress through avoidance and dependence.

In addition to increased addictive behaviours, evacuees consistently reported higher levels of depression and anxiety, compared to non‐evacuees. These findings are consistent with recent evidence showing elevated emotional distress among evacuees during the Swords of Iron war, reflecting the psychological toll of ongoing uncertainty and exposure to threat (Peleg and Gendelman 2025). Theoretical perspectives on stress‐related distress emphasise that ongoing threat and uncertainty can heighten anxiety and vigilance by undermining perceived safety and control (O’Brien 2004). Over time, the strain of displacement and disrupted social bonds may contribute to depressive symptoms characterised by demoralisation and loss of meaning (Keyes 2000). The heightened anxiety observed among evacuees align with theoretical models emphasising the role of chronic uncertainty and hypervigilance following forced displacement (O’Brien 2004). Emotional outcomes such as depression and anxiety may reflect the longer‐term emotional consequences of loss, disconnection, and diminished hope (Keyes 2000). Together, these results highlight a pattern of heightened anxiety alongside emotional fatigue and demoralisation—factors that could contribute to increased vulnerability to maladaptive coping mechanisms and addiction.

Gender has also been identified as a relevant factor in patterns of stress responses and addiction risk (e.g., Chaplin et al. 2008), though considerable variability exists within gender. Prior research indicates that, on average, men are more likely to externalise their distress and engage in substance abuse and addictive behaviours (Dir et al. 2017) whereas women may rely more on interpersonal or emotional coping strategies (Nolen‐Hoeksema 2012). Supporting this, the present studies showed that associations between evacuation status and problematic alcohol and gambling behaviours were particularly pronounced among men but not women. These findings underscore the need for gender‐sensitive interventions following crises and displacement and for future research on the complex ways gender shapes coping and behaviour.

The current studies have several important limitations. First, both Studies 1 and 2 were cross‐sectional correlational studies. Although the study was conducted during a war and uses a more ‘natural’ evaluation of evacuation status, without random assignment into conditions it is hard to completely dismiss alternative directions of influence that might play a role in the observed effects. This limits our ability to deduce causal directions of influence to know if depression and anxiety contributed to substance abuse and behavioural additions or vice versa, or if a third variable influenced both. Of course, no study can or should manipulate actual evacuation, but laboratory studies could for example examine if thoughts about evacuation (compared to a control condition) among evacuees might lead to a greater desire to consume alcohol or gamble. Further research should also attempt to examine the association between evacuation, mental health, and addictions using longitudinal data following evacuees over time, and perhaps also more focused qualitative data to confirm and further explore the findings.

Second, we used epidemiological data that focused on the general population rather than on people who suffer from high levels of problematic substance use and addictive behaviours. This limits our ability to draw conclusions on clinical populations. Further research should replicate the current findings in clinical samples focusing on each substance of behaviour separately. Studies should also better test how characteristics of the evacuation (e.g., current or past, forced or voluntary, time elapsed since evacuating) might influence the observed effects.

A third limitation, which relates to former, is that our outcome variables were not normally distributed, as most people do not suffer from mental health and addiction problems. Although we compensated for this issue using bias‐corrected accelerated bootstrapping, further studies should try to focus on samples that may have a more normal distribution of these variables—by focusing only on individuals with problematic substance use or behaviours.

Fourth, although the samples were relatively large, the number of evacuee participant were limited, restricting our ability to comprehensively explore additional evacuation characteristics, such as degree of choice involved, duration, proximity to danger, and exposure to loss that may also moderate the effects of evacuation on mental health and addiction.

Fifth, we assessed only the most researched behavioural addictions (problematic gambling, gaming, and pornography) which are more prevalent among men, but not other addictions, such as compulsive shopping or food‐related addictions, which may be prevalent among women (e.g., Charzyńska et al. 2021). Future studies should also explore these topics among evacuees.

Sixth, although both samples were large, they were not representative of the Israeli population and included only Israeli Jews. This limits our ability to generalise the findings, especially considering that this war and circumstances may have been unique to Israeli Jews (e.g., Hirschberger et al. 2010). Furthermore, many non‐Jews in Israel report high levels of problematic gambling than Jews (e.g., Gavriel‐Fried et al. 2023). Nevertheless, the mechanisms linking evacuation‐related loss of stability to addiction and mental health difficulties are likely universal, as disruptions to social cohesion and perceived control pose similar risks across contexts of war, or natural disasters (Ueda et al. 2022; Saleh et al. 2023). Future research should examine these processes in different contexts to further generalise these findings.

Finally, evacuation in our study may be better understood as a substantial stressor that compounded the stress derived from acute exposure to terrorism. It is therefore hard to clearly distinguish between the effects of war and those of evacuation on mental health and addiction. Although we controlled for exposure to war stressors and feelings of danger and examined the effects only within north and south Israel, these measures were limited. We also did not examine three‐way interactions between war exposure, evacuation, and gender, due to our limited sample size of evacuees. Hence we cannot rule out the possibility that increased mental health problems and addictions in evacuees are due to the broader context of war.

Despite these limitations, this study has several important implications. First, highlighting the possible causes of problematic substances use and behavioural addictions may advance the theoretical understanding of addictions in general, and particularly alcoholism and gambling among men. The fact that different kinds of substance and behavioural addictions arise as ways of coping with stress‐related distress suggests common mechanisms in many addictions (e.g., Khantzian 1997). Moreover, findings underscore the crucial role of contextual stressors.

Second, this study further highlights the psychological toll and risk of being evacuated from one's home. The findings highlight the need for effective health‐management policies, including mental health screening and intervention among evacuees, during displacement and after return. Integrating addiction prevention and emotional regulation training into emergency response frameworks could mitigate long‐term psychological harm. Emergency protocols could also incorporate structured referral pathways to mental‐health services and collaboration between community organisations and health authorities to ensure continuity of care during displacement. Gender‐sensitive approaches targeting male evacuees may benefit from addressing avoidance‐based coping, while programs for women might focus on internalized distress and social support. More broadly, understanding evacuation and its associated challenges emphasises the need for targeted interventions and support for populations facing evacuation during collective crises.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information S1

SMI-42-e70155-s001.docx (69KB, docx)

Endnotes

1

Because there were only three participants who reported a non‐binary gender, they were not included in the main analysis that included gender as a moderator.

2

In Study 1, returning and non‐returning evacuees had similar levels of threat, depression, problematic alcohol, cannabis, other drugs, pornography, and gaming, all ps > 0.153. However, non‐returning evacuees reported higher anxiety (n = 31, M = 10.10, SD = 4.49) than those who returned (n = 80, M = 7.69, SD = 6.00), p = 0.040, and compared to non‐evacuees (n = 973, M = 7.14, SD = 5.55), p = 0.003 (those who returned did not differ from non‐evacuees, p = 398); and higher problematic prescription drug usage (M = 1.99, SD = 0.37) than returning (M = 0.85, SD = 0.28), p = 0.009, and non‐evacuees (M = 0.52, SD = 0.07), p < 0.001 (those who returned did not differ from non‐evacuees, p = 0.153). In contrast, returning evacuees had higher problematic gambling (M = 1.99, SD = 0.37) than non‐returning (M = 0.10, SD = 0.30), p < 0.001, and compared to non‐evacuees, (M = 0.22, SD = 0.05), p < 0.001 (those that did not return did not differ from non‐evacuees p = 0.690). The key interactions reported in the results were still statistically significant when using the 3‐levels of evacuation. Considering the small sample size of these subgroups we did not elaborate on these differences. In Study 2 there were no differences between returning (n = 133) and non‐returning evacuees (n = 25) on all mental health and addiction outcomes, ps > 0.210. In Study 2, 121 participants self‐evacuated versus 37 who reported being forced. No differences emerged between these groups on any outcome, ps > 0.063.

3

We categorised prescription drugs by computing the mean scores of stimulants, sedatives, and opioids, since there were low rates of each in the sample. Results for “other drugs” were not included in both studies due to low problematic usage frequency.

Contributor Information

Gabriella Rubin, Email: gabriellarubin@yahoo.com.

Uri Lifshin, Email: uri.lifshin@mail.huji.ac.il.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Supplementary Materials

Supporting Information S1

SMI-42-e70155-s001.docx (69KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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