Abstract
Developing research suggests that the co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is a significant clinical concern across first responder populations. This comorbidity is difficult to treat and marked by a more costly, complex, and chronic clinical course when compared to either disorder alone. Significant associations between PTSD/AUD comorbidity and various psychological, behavioral, and physical health outcomes among first responder samples have been documented. This chapter provides a theoretical framework and empirical review of the literature relevant to PTSD/AUD in the context of firefighter, police, and other first responder populations (e.g., emergency medical technicians). Future directions, utilizing varied methodologies and assessment tools, and focusing upon varied first responder populations are enumerated to build upon this preliminary, yet clinically meaningful, empirical foundation. This research domain has great potential to inform specialized, evidence-based clinical care for first responders.
TopIntroduction
The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is an increasingly significant clinical concern across first responder populations (e.g., firefighters, police officers, rescue workers; Chopko, Palmieri, & Adams, 2013; Harvey et al., 2016; Ménard & Arter, 2013; Paulus, Vujanovic, Schuhmann, Smith, & Tran, 2017). While the PTSD/AUD comorbidity is well-established and highly prevalent among both the general population and military veterans (e.g., Fuehrlein et al., 2016; Grant et al., 2015; Kessler, Chiu, Demler, & Walters, 2005; Milliken, Auchterlonie, & Hoge, 2007; Pietrzak, Goldstein, Southwick, & Grant, 2011), our understanding of PTSD/AUD among first responders is much more limited. Broadly, across populations, both research and clinical practice have demonstrated that PTSD/AUD is difficult-to-treat and marked by a more costly, complex, and chronic clinical course when compared to either disorder alone (e.g., McCauley, Killeen, Gros, Brady, & Back, 2012; Mills, Teesson, Ross, & Peters, 2006; Schafer & Najavits, 2007; Vujanovic, Bonn-Miller, & Petry, 2016). Among first responder populations, available literature suggests that first responders may use alcohol to cope with PTSD-related symptomatology (Simons, Gaher, Jacobs, Meyer, & Johnson-Jimenez, 2005; Smith, Gallagher, Tran, & Vujanovic, 2018; Tomaka, Magoc, Morales-Monks, & Reyes, 2017). Further, emergent literature suggests that PTSD/AUD has important clinical implications among first responders due to documented associations with various mental health concerns (e.g., depression and suicidality; Chopko et al., 2013; Pietrzak et al., 2012; Violanti, 2004), behavioral health issues (e.g., sleep disturbance; Yun, Ahn, Jeong, Joo, & Choi, 2015), and occupational problems (e.g., occupational stress, critical incidents, work productivity; Chopko et al., 2013; Kim, Park, & Kim, 2017; Ménard & Arter, 2013, 2014).
Available research among first responders suggests that PTSD and AUD symptoms are both highly prevalent. This extant research also underscores the potential clinical relevance of this comorbidity, although epidemiological studies documenting actual prevalence rates within first responder populations are lacking. Building upon our understanding of the PTSD/AUD comorbidity among first responders can inform evidence-based prevention and intervention efforts. While attention to first responders has increased in recent years, several methodological challenges and gaps exist, which warrant future scientific attention. Thus, the objective of the current chapter is to provide a clinically-informed theoretical framework and summary of the literature regarding of PTSD/AUD among first responders. Current methodological limitations will be enumerated and future directions will be discussed to propel this domain of inquiry further and to advance evidence-based mental health services for first responders.
Key Terms in this Chapter
Problematic Alcohol Use: A drinking pattern that results in significant and recurrent adverse consequences.
Trauma: Exposure to an event, such as actual or threatened death, serious injury, or sexual violence through direct experience, witnessing an event occurs to others, learning that an event occurred to a close family member or friend, or repeated occupational exposure to details of events.
Alcohol Use Disorder: A pattern of problematic alcohol use leading to clinically significant impairment or distress, as manifested by symptoms such as failure to fulfill major role obligations, alcohol craving, and recurrent alcohol use in physically hazardous situations (e.g., while driving).
Comorbidity: The presence of one of more mental health conditions occurring at the same time.
Posttraumatic Stress Disorder: A mental health problem that some people develop after experiencing or witnessing a violent or life-threatening event, like combat, physical assault, natural disasters, transportation accidents, or sexual or physical abuse or assault.
Specialized Evidence-Based Interventions: Mental health interventions that have been developed and/or modified through research for the needs of unique populations.
Transdiagnostic: Beliefs, behaviors, or patterns of emotional responding that are associated with various mental health conditions and may be implicated in their development, maintenance, or treatment.