Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders

Posttraumatic stress disorder (PTSD) symptoms have been shown to increase the likelihood of substance use in the general population. First responders (e.g., EMTs, paramedics, and firefighters) are routinely exposed to potentially traumatic events (PTEs) as part of their regular duties, increasing their risk for a range of adverse mental health outcomes including PTSD symptoms. However, no study to our knowledge has explored the relationship between PTEs, PTSD symptoms, and substance use in this population. In the current study, we examined whether PTSD symptoms were associated with alcohol and drug use in first responders above and beyond demographic variables, job-related characteristics, social support, and cumulative work-related PTE exposure, and whether work-related PTE exposure had an indirect effect on substance use via PTSD symptoms.

Participants (N = 885; mean age = 37.13; 59.0% male; 91.5% White) were recruited from all 50 U.S. states, the Virgin Islands, and Puerto Rico to complete an online survey.

In hierarchical regression analyses, PTSD symptoms were significantly associated with alcohol and drug use above and beyond all the other variables. Work-related PTE exposure was not a significant predictor of either outcome once PTSD symptoms were included, suggesting that PTEs confer risk for substance use via their association with PTSD symptoms. This finding was confirmed by an analysis showing that PTE exposure had a significant indirect effect on both alcohol and drug use via PTSD symptoms.

Results support the need for periodic assessment of both PTSD symptoms and substance use in first responders.