Posttraumatic stress, alcohol use, and alcohol use motives among firefighters: The role of distress tolerance
Abstract
Firefighters represent a unique, vulnerable population at high risk for alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) symptomatology due to the high rates of occupational exposure to traumatic events. To inform specialized alcohol use interventions for firefighters, it is important to understand relevant malleable cognitive-affective factors related to PTSD and AUD symptoms. Distress tolerance (DT), defined as the perceived ability to withstand negative emotional states, is one promising factor relevant to this domain. The current study examined the moderating role of DT in the association of PTSD symptom severity with alcohol use severity and alcohol use motives. Participants included 652 trauma-exposed firefighters (93.3% male; M age = 38.7 years, SD = 8.6) who endorsed lifetime (ever) alcohol use. Results indicated that there was a significant interactive effect of PTSD symptom severity and DT on coping-oriented alcohol use motives but not other alcohol-related outcomes. These findings were evident after adjusting for alcohol consumption, romantic relationship status, number of years in the fire service, occupational stress, and trauma load. This is the first study to concurrently examine these variables among firefighters and this line of inquiry has great potential to inform intervention efforts for this vulnerable, understudied population.
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In a sample of 652 trauma-exposed firefighters, distress tolerance was significantly related to alcohol abuse and other coping motives.
“In a sample of 652 trauma-exposed firefighters, distress tolerance was significantly related to alcohol abuse and other coping motives [118].”
From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [118]
Low distress tolerance significantly predicts the use of maladaptive emotion regulation strategies, including suppression of emotions, avoidance, rumination and substance abuse.
“studies have shown that low distress tolerance significantly predicts the use of maladaptive emotion regulation strategies, including the suppression of emotions, avoidance, rumination and substance abuse”
From The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders. (2024) · cites this paper as [17]
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“Gender, relationship status, years in the fire service, and trauma load were included as covariates in the models due to their established associations with variables of interest in firefighter samples (e.g., Simons & Gaher, 2005; Zegel et al., 2019).”
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“Deficits in DT may, therefore in part account for the relationship between PTSD/CPTSD and alcohol use (Boffa et al., 2018; Brooks Holliday et al., 2016; Duranceau et al., 2014; Vujanovic et al., 2015; Zegel et al., 2019).”
BackgroundJitnarin, N., Haddock, C. K., Kaipust, C. M., Poston, W. S. C., & Jahnke, S. A. (2023) · Fire · doi:10.3390/fire6050183 · Cited by 3 · see citing works
Alcohol Misuse and Correlates with Mental Health Indicators among Firefighters
Rotunda, R. J., Herzog, J. R., Dillard, D. R., King, E. A., & Wilson, K. O. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2422975 · Cited by 3 · see citing works
“…the hypothesis that mental health indicators, especially symptoms of PTSD, were associated with more harmful drinking, although our data are not informative of the reasons (e.g., coping motives) that likely drive this relationship, at least in part (e.g., Lebeaut et al., 2020; Zegel et al., 2019).”
Noureddine, A., Malaeb, D. N., Sawma, T., Sakr, F., Dabbous, M., Obeïd, S., Hallit, S. R., & Fekih‐Romdhane, F. (2025) · Middle East Current Psychiatry · doi:10.1186/s43045-025-00541-x · Cited by 3 · see citing works
Zegel, M., McGrew, S. J., Wardle, M. C., & Vujanovic, A. A. (2022) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001240 · Cited by 2 · see citing works
Self-citationMental Health Issues in the Fire Service
Buser, S. J. (2023) · Springer eBooks · doi:10.1007/978-3-031-38149-2_2 · Cited by 2 · see citing works
Zaso, M. J., Troidl, I. R., & Read, J. P. (2024) · Clinical Psychological Science · doi:10.1177/21677026231215341 · Cited by 2 · see citing works
“Distress intolerance (Ranney et al., 2021; Zegel et al., 2019), intolerance of uncertainty (Paltell et al., 2022), psychological flexibility (L. D. Baker et al., 2022), and emotion dysregulation (Klanecky et al., 2015) did not moderate TR/PTSD-related drinking.”
Zaur, A. J., Bacanu, S., Amstadter, A. B., & Sheerin, C. M. (2024) · Military Psychology · doi:10.1080/08995605.2024.2387914 · Cited by 2 · see citing works
“A more extensive literature examines DT and PTSD, demonstrating consistent, negative associations (i.e., DT is negatively associated with PTSD symptom severity; Akbari et al., 2022; Zegel et al., 2019).”
InfluentialMcGrew, S. J., Zegel, M., Lebeaut, A., Schwartz, R. M., Gonzalez, A., & Vujanovic, A. A. (2024) · Cognitive Therapy and Research · doi:10.1007/s10608-024-10526-5 · Cited by 2 · see citing works
“Although being able to endure stressful situations is crucial to firefighter well-being (Smith et al., 2019 ; Zegel et al., 2019 ), firefighters’ perseverance despite extreme levels of emotional distress and negative consequences that arise from such distress (e.g., relationship problems, sleep…”
Self-citationMiller, A., Jahnke, S. A., & Singh, K. P. (2021) · International Journal of Emergency Services · doi:10.1108/ijes-01-2021-0003 · Cited by 2 · see citing works
“…session for significant others 18.8 Mobile mental health app 12.5 Individualized professional counseling 6 Events outside of work to allow bonding between families to create a larger “department family” 6 in the fire service comes from urban departments (Barlet et al., 2019; Zegel et al., 2019).”
BackgroundInfluentialFirst Responders and Mental Health
Ryan, M., Hasan, F., Molina, L., Cervoni, C., Palladino, J., Vujanovic, A. A., & Gonzalez, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00161-8 · Cited by 4 · see citing works
Self-citationTavakoli, N., Correa-Fernández, V., Lebeaut, A., & Vujanovic, A. A. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2383977 · Cited by 1 · see citing works
“Moreover, anxiety was significantly and positively related to all four alcohol use motives, which aligns with previous literature establishing associations between similar anxiety-related constructs and drinking motives among firefighters (Lebeaut et al., 2020a; Zegel et al., 2019).”
Self-citationTopçu, G., Baştuğ, G., Ergül‐Topçu, A., & Ozel-Kizil, E. T. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2538251 · Cited by 2 · see citing works
“…al., 2021), sleep disturbances (Vargas de Barros et al., 2012; Zegel et al., 2021), elevated suicide risk (Boffa et al., 2018; Klimley et al., 2018; Zegel et al., 2021), alcohol use disorders (Haddock et al., 2017; Zegel et al., 2019, 2021), and diminished life satisfaction (Bastug et al., 2019).”
Geuzinge, R., Visse, M. A., Vermetten, E. H. G. J. M., & Duyndam, J. (2025) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2025.100629 · Cited by 1 · see citing works
Plaitano, E. G., Frumkin, M. R., Jacobson, N. C., Gray, J. J., Panchal, A. R., Watson, P., & Marsch, L. A. (2026) · npj Mental Health Research · doi:10.1038/s44184-026-00201-w · Cited by 1 · see citing works
“In prior studies of fi rst responders, stress coping accounted for the most variation in alcohol use; however, socially-motivated use accounted for the second most variation 155 .”
Brumfield, L., Miner, S. M., Tydings, D. M., & Carey, M. G. (2023) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002787 · Cited by 1 · see citing works
“One study provided data that stated one of five firefighters struggles with behavioral issues during some point in their career.(11) These behavioral issues create loss of interest, difficulty concentrating, and agitation and memory problems among those firefighters.”
BackgroundInfluentialOverlapping Neural Substrates of Alcohol- and Anxiety-Related Behavior in the Rat
Barchiesi, R. (2021) · Linköping University medical dissertations · doi:10.3384/diss.diva-174707
Shahbahrami, M., khani, S. M., & Akbari, M. (2021) · فصلنامه علمی و پژوهشی اعتیادپژوهی · doi:10.52547/etiadpajohi.15.60.325
ANALISIS FAKTOR DISTRESS PADA PETUGAS PEMADAM KEBAKARAN : SISTEMATIK REVIEW
Arieffani, F., & Erwandi, D. (2023) · Jurnal Kesehatan Tambusai · doi:10.31004/jkt.v4i2.15306
First Responders of Color: A Qualitative Approach to Understanding Mental Health
Belsches, L. J., & Blackmon, G. W. (2023) · Springer eBooks · doi:10.1007/978-3-031-38149-2_25
Song, Y. M., Jeon, S., Cho, A., Chung, S., Ahn, Y., Suh, S. A., & Kim, J. K. (2025) · medRxiv · doi:10.1101/2025.10.27.25338848
“Additionally, organizations with high stress, such as firefighters, who must always be prepared to respond to the next emergency, are more vulnerable to using alcohol or other substances with the purpose of sleep induction (Zegel et al., 2019).”
Individual and occupational predictors of CBT-I response patterns among shift-working firefighters
Song, Y. M., Jeon, S., Cho, A., Chung, S., Ahn, Y. S., Suh, S. A., & Kim, J. K. (2026) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2026.100605
Distress Overtolerance and Suicide Risk in Firefighters: Incremental and Longitudinal Associations
Lebeaut, A., Leonard, S. J., Zegel, M., Doshetty, G., Albanese, B. J., & Vujanovic, A. A. (2026) · Fire · doi:10.3390/fire9070275
Self-citationZegel, M., Vujanovic, A. A., & Gallagher, M. W. (2026) · Fire · doi:10.3390/fire9070282
“Research has consistently demonstrated that firefighters report drinking to cope with, avoid, or “numb” negative affect [5,6].”
InfluentialSelf-citationThe Role of Alcohol in EMS Culture: Perspectives from Frontline Providers
Koeppel, M. D. H., Shlansky, B., Jitnarin, N., Haddock, C. K., & Jahnke, S. A. (2026) · Occupational Health · doi:10.3390/occuphealth1030041
“Studies of firefighters have documented high rates of binge drinking and problematic alcohol use, with alcohol often described as a means of un-winding after shifts, promoting social cohesion, and managing exposure to traumatic events [17,20,21,26,27].”
- Authors
- Zegel, M., Tran, J. K., & Vujanovic, A. A.
- Affiliations
- University of Houston (US)
- Corresponding author
- Vujanovic, Anka A.
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 282
- Pages
- 112633
- ISSN
- 0165-1781 (ISSN-L)
- OpenAlex
- W2987357206
- Cited by
- 48
- References
- 67
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 6 · 2021: 10 · 2020: 3
- FWCI
- 5.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Keywords
- post-traumatic stress disorder, alcohol consumption, drinking motives, distress tolerance, firefighters, occupational trauma exposure, alcoholism, moderating effect
- MeSH terms
- Occupational Stress, Psychological Distress, Adaptation, Psychological, Adult, Alcohol Drinking, Alcoholism, Female, Humans, Male, Middle Aged, Motivation, Stress Disorders, Post-Traumatic, Young Adult, Firefighters
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