When the missiles stopped and the headlines moved on, the shaking didn’t. Not for the survivors of the Nova music festival. Not for the soldiers who saw things no one should. And not for the families who welcomed home partners, siblings, or children who looked the same, but weren’t.
After the Hamas mega-attack on Oct. 7, 2023, a quieter struggle emerged that remained unseen by the media. It seeped into everyday spaces like bedrooms, classrooms, and offices, settled into medicine cabinets and liquor bottles. It appeared as a form of coping, functioning, or simply getting through the day. However, as the Israel Center on Addiction (ICA) cautions, merely getting by can often be the first step toward breaking down.
“People didn’t start using more in October or November because it felt good,” says Roni Rokah, a social worker and couples’ therapist who heads ICA’s clinical division. “They started because they couldn’t bear the unbearable.”
Trauma leaves traces, addiction follows
Rokah has dedicated her career to working with families, couples, and now entire communities, helping them recover from trauma. The ICA, where she leads the treatment division, was founded in 2018 with a mission to transform how Israel understands and handles addiction. She says that the mission has become even more urgent.
“After the attack, we saw a sharp rise in PTSD symptoms,” Rokah explains. “The government invested heavily in trauma response – and that was necessary. It was the immediate crisis. But what people didn’t see, or didn’t want to see, was how many were self-medicating.”
Sleep aids, cannabis, alcohol, anti-anxiety pills. Substances that, in those first frightening weeks, gave a sense of control. A way to sleep. A way to forget. A way to turn off the images looping behind the eyes.
“But the thing is,” she adds, “when one pill becomes two, when a glass of wine becomes a bottle, when a joint at night turns into one in the morning – what started as a coping mechanism turns into a dependency.”
And it’s not just individuals who are realizing this. Rokah recalls offering a workshop on substance use to resilience centers just a month after the attacks. The response? “They told me, ‘We’re not there yet. People need to get back to basic functioning first.’” Now those same centers are reaching out to her again. Not just for assistance, but for answers.
Two years in, Rokah says she’s seeing the long-lasting effects of trauma and the growing impact of how people have tried to survive it. “The war will end, but the habit remains,” she says, echoing a slogan that has gained traction in ICA’s work.
“We’re meeting people now who’ve been using for nearly two years. They can’t go to work. Their marriages are strained. They’re still functioning on the outside, but inside, they’re lost.”
Among the hardest hit are young adults, especially those aged 18 to 26. “One in three in that age group is at high risk for problematic use,” Rokah states. “And for those dealing with PTSD, it’s one in two.”
She doesn’t need to look far to understand why. “This is the same generation that was stuck at home during COVID, isolated and anxious. Then they were drafted. Then they went to Nova and never came home the same. Some of them literally went from dancing in the desert to reserve duty within a week.” The combination is devastating – youth, trauma, access, and silence.
That mindset guides everything ICA does: harm reduction, education, and training first responders, from school counselors to family doctors, to recognize the signs. Even abroad, Rokah can’t help but ask questions.
“I was in India this summer, and everywhere I went, I asked young Israelis what they were using,” she says. “And what struck me most was how little they knew. No one had taught them how to stay safe. Not just about what they were using, but when, and why.” The goal isn’t abstinence, she says. It’s awareness. “We don’t say, ‘Don’t use.’ We say, ‘Let’s understand what you’re doing, and help you make safer choices.”
Rokah uses a simple metaphor to describe the crisis: a bucket with a hole in the bottom. “You can talk all day about mental health, about treating depression and anxiety, but if the bottom of the bucket is leaking, nothing holds,” she says. “That hole is substance use. Until we address it, nothing will stick.”
What ICA is calling for isn’t a minor change. It’s a comprehensive national strategy, including education, prevention, treatment, and policy. “We’re one nonprofit,” Rokah says. “We’re doing a lot. But it’s not enough. The ministries need to collaborate. There needs to be a coordinated response.” And urgent. “This isn’t going away. More soldiers will return. More trauma will surface. We are not at the end of this crisis; we’re in the middle of it.”
Ultimately, Rokah’s message is heartbreakingly simple. “Open your eyes,” she urges. “These aren’t bad people. They’re not weak. They’re suffering. And they need help.” No one chooses addiction. But healing isn’t optional either – not when silence, shame, and a system that still perceives addiction as something other than what it truly is: a public health crisis. A human one.
“There’s no mental health without talking about substance use,” Rokah states. “And there’s no health without mental health.” Her voice softens. “We need to stop being afraid to face this head-on. Because what’s at stake isn’t just recovery; it’s people’s lives.”
This article was written in cooperation with the Israel Center on Addiction.