Posttraumatic stress, alcohol use, and alcohol use reasons in firefighters: The role of sleep disturbance

Background: Firefighters are at elevated risk for posttraumatic stress and alcohol use, with research indicating that individuals with posttraumatic stress are likely to use alcohol as a coping strategy. A behavioral mechanism of clinical relevance to these associations is sleep disturbance. Thus, it was hypothesized that higher posttraumatic stress and sleep disturbance would be associated with higher alcohol use and alcohol use coping reasons; and sleep disturbance would moderate the association between posttraumatic stress and alcohol use and alcohol use coping reasons. Procedure: Participants included 639 urban career firefighters (93.6% male; 77.9% White; Mage = 38.5). Covariates included fire department years and occupational stress. Structural equation models were tested. Results: Posttraumatic stress severity was significantly, positively associated with alcohol use severity and alcohol use coping reasons. Similarly, sleep disturbance severity was significantly, positively associated with alcohol use severity and alcohol use coping reasons. After accounting for covariates and main effects, the interaction of PTSD severity and sleep disturbance was significantly associated with alcohol use severity, with the model accounting for 23.6% of variance, and alcohol use coping reasons, with the model accounting for 37.6% of variance. As predicted, the interaction of posttraumatic stress severity and sleep disturbance was not significantly associated with alcohol use enhancement, conformity, or social reasons. Conclusion: These findings indicate that posttraumatic stress severity is related to heightened alcohol use severity and alcohol use coping reasons, and this association is markedly stronger when firefighters' levels of sleep disturbance are heightened. Clinical and research implications are to be discussed. (C) 2018 Elsevier Inc. All rights reserved.