Artykuł 4

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Research Paper

Received: 2013.02.25

Accepted: 2013.05.07

Biopsychosocial correlates of psychoactive substance

Published: 2013.05.27

use in professional firefighters

Paweł Rasmus1, Józef Kocur2, Marcin Flirski3, Tomasz Sobów1

1 Department of Medical Psychology, Medical University of Łódź, Łódź, Poland 2 Department of Psychosocial Rehabilitation, Medical University of Łódź, Łódź, Poland 3 Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Łódź, Łódź, Poland Source of support: This research was supported by the funds from the Medical University of Łódź

no. 503/6-074-03/503-01

Summary

Background:

Stress and tension associated with events firefighters experience may increase the likelihood of a variety of harmful behaviors. The purpose of this study was to evaluate the magnitude of psychoactive substance use in a group of firefighters from the Lodz Fire Department, to investigate associations between psychobiological (anxiety, emotional control) and psychosocial factors (social support, coping with stress) and a tendency to use psychoactive substances.

Material/Methods: The participants recruited were 168 male professional firefighters from the Lodz Fire Department who participated daily in fire and rescue operations in response to local threats. The research protocol comprised 6 evaluation scales, including sociodemographic and risk behavior questionnaires, Spielberger’s STAI, Courtauld Emotional Control Scale, Nieland Social Support Questionnaire, and Coping Inventory for Stressful Situations.

Results:

Among the risk behaviors studied, the tested firemen most often reported drinking alcohol and smoking tobacco. Firefighters ONLY

reporting alcohol abstinence were characterized by higher control of negative emotions, including control of depression and anger. Alcohol consumption was associated with higher satisfaction from received social support. Furthermore, avoidance-oriented coping strategies, including distraction, may lead to a higher risk of harmful drinking. The frequency PERSONAL USE

of smoking could be associated with anxiety as a trait, and lower expression of anxiety characterized sporadic tobacco smokers.

Conclusions:

The issue of using specific psychoactive substances in the studied group of firefighters can be considered significant. The presence of associations between psychobiological factors and a tendency to use psychoactive substances was demonstrated.

key words:

firefighters • psychoactive substances

Full-text PDF: http://www.ceml-online.com/download/index/idArt/889093

Word count: 2750

Tables: 2

Figures: 1

References: 30

Author’s address:

Paweł Rasmus, Department of Medical Psychology, Medical University of Łódź, Sterlinga 5 St., 91-425 Łódź, Poland, e-mail: pawel.rasmus@umed.lodz.pl or rasmus.p@wp.pl 70

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Rasmus P. et al. – Biopsychosocial correlates of psychoactive substance use…

Background

employed in the Lodz Fire Department. The inclusion criterion was participation in firefighting or rescue operations The work of firefighters is unique because when perform-in response to local threats (e.g., traffic accidents, construc-ing their duties they may be involved in or witness events tion site damages, floods). The study group was randomly that most people never experience [1,2]. Stress and tension selected. Administrative Fire Department workers not tak-associated with these events may increase the likelihood of ing part in rescue events were excluded from the project.

a variety of harmful behaviors in individuals experiencing Eventually, 168 sets of completed questionnaires were avail-them and can directly endanger the psychological integri-able for the final analysis; 2 questionnaires were filled with ty of rescuers, affecting the effectiveness of their work and, flaws and thus had to be rejected. Both the respondents and indirectly, public safety [3,4].

their superiors consented to the firefighters’ participation in this anonymous research. All participants received iden-Adverse health behaviors such as consuming alcohol, smok-tical copies of the printed study questionnaires, with only ing tobacco, or using other psychoactive and addictive sub-closed questions; the respondents were therefore not ex-stances are described in the professional literature as risk pected to handwrite any words or longer phrases. Answers behaviors. These behaviors are of interest to representa-were marked using identical HB pencils. The completed tives of various scientific disciplines; not only doctors, but questionnaires were inserted by participants themselves into also psychologists, sociologists, educators, and other scien-a sealed and protected container to be opened no sooner tists involved in health promotion [5]. Risk behaviors are than the completion of questionnaire collection. This meth-defined as actions carrying a risk of negative consequences odology should have maximized responder anonymity and for the physical and mental health of individuals as well as attempting to elicit honest responses to questions about il-for their social environment [6,7].

legal substance use. The study protocol was approved by the Bioethics Committee of the Medical University of Lodz Psychiatry and psychology research defines activities carry-

(RNN/222/06/KB).

ing the risk of negative consequences for health of an individual as direct (overt, acute) and indirect (chronic, latent) The research was based on a pen-and-paper questionnaire self-destructive behaviors. Indirect self-destructive behavior method. A sociodemographic questionnaire designed by the is defined as a tendency for an individual to choose behav-authors was used in the study to collect data on age, senior-iors that increase the likelihood of negative consequences ity in the State Fire Service, education, place of residence, and reduce the likelihood of positive ones, or as any inten-marital status, and number of children. We also used anoth-tional and adverse behavior [7,8]. Bad habits, addictions, er self-designed anonymous questionnaire, with questions and negligence (including health negligence) are, among evaluating frequency and type of risk behaviors (e.g., drink-others, classified as indirectly self-destructive [9,10].

ing alcohol, smoking tobacco, taking prescribed medications, and illicit drug use. In addition, other standard eval-Risk behaviors may not always be of a self-destructive nature.

uation scales were used comprising the Spielberger’s State Willingness to take risks can be both adaptive and optimal, Trait Anxiety Inventory (STAI) [11], which is a self-report especially under the conditions of psychological stress. Self-instrument consisting of two 20-item scales addressing state and trait anxiety. Respondents are asked to rate each of the 20 items on a 4-point Likert-type rating scale. For the current study, only the trait anxiety subscale was used.

Another tool used was the Courtauld Emotional Control other uniformed ser

ONLY

destructive risk behaviors are diagnosed when, considering the magnitude and frequency of risk, the losses are likely to outweigh the gains.

The researchers also point to the fact that firefighters and PERSONAL USE

vices do not choose such occupations

Scale (CECS) [12], a Polish adaptation by Juczynski, devel-by chance and their choice can be determined tempera-

oped by Watson and Greer,. CECS comprises 3 subscales: mentally (low reactivity, high demand for stimulation) and anger, depressed mood, and anxiety. It is used to measure by personality traits (openness to new experiences, open-the extent to which individuals control their anger, depres-ness to experience and stimulation) [8,10].

sion, and anxiety in difficult situations.

The danger of engaging in risk behaviors seems higher in The Coping Inventory for Stressful Situations (CISS) was people exposed to traumatizing events. Therefore, the aim also used to evaluate 3 coping styles: task-oriented coping of the study was to assess the prevalence and nature (quan-

(CISS-T), emotion-oriented coping (CISS-E), and avoid-tity and quality) of risk behaviors in a group of professional ance-oriented coping (CISS-A). Respondents were asked firefighters. Another goal of the study was to determine the to rate each of the 48 items on a 5-point Likert-type rating psychobiological and psychosocial factors potentially affect-scale ranging from “Not at all” to “Very much” as an indi-ing the onset, frequency, and persistence of health-hazard-cation of “how much you engage in these types of activities ous behaviors. Other objectives included correlating trait when you encounter a difficult, stressful, or upsetting situ-anxiety and level of emotional control with the tendency ation.” The multidimensional approach to the assessment to use psychoactive substances in the studied population, of coping with stressful situations provides great precision as well as evaluating the impact on risk behaviors tendency in predicting preferred coping strategies [13].

of the overall rate of social support and coping with stress.

The level of social support was estimated with the Nieland’s Material and Methods

Social Support Questionnaire [14], which contains a list of potential social support sources, including close family mem-The study was conducted on a representative sample of bers, friends, healthcare professionals, and charity and non-170 male professional firefighters out of 650 firefighters government organizations. Support is rated according to 3

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Research Paper

criteria: expected support, received support, and received 120

support rating. Support sources are evaluated on a 4-point Yes

scale ranging from 1 (“none”” to 4 (“exceptionally lot”) in-100

dependently for each criterion. In the current analysis only 10.1

the last (support rating) criterion was used.

61.9

The statistical analysis of the studied variables was carried 60

(%)

out with a Mann-Whitney U test, a non-parametric equiva-89.9

97.6

98.8

lent of the Student’s t-test for unpaired variables. For mul-40

tidimensional statistical analysis, a nonparametric Kruskal-Wallis ANOVA test of rank was used.

38.1

2.4

1.2

results

Tobacco

Drinking

Taking

Illicit

smoking

alcohol

prescribed

drug use

The study group was characterized based on the informa-medications

tion from the personal sociodemographic questionnaire.

The average study participant age was 36.3 years (±11.54), Figure 1. The prevalence of psychoactive substances use in the and the firefighters’ work experience ranged from 1 to 25

studied population.

years (13.5 years [±8.26] on average). Most (67%) respondents were residents of Lodz and 20% lived in the country-The frequency of alcohol use was also significantly related to side. Eighty percent of respondents (134 people) declared satisfaction with received social support, with highest satisfac-secondary or higher education. Most participants were mar-tion observed in sporadic alcohol drinkers. No differences ried (87%) with children (73%).

were found between drinkers and non-drinkers (Table 1).

Based on the risk behaviors questionnaire, the vast major-Consumption of alcoholic beverages appeared significant-ity of respondents reported alcohol consumption (89.9%) ly related to avoidance-oriented coping strategy, including and tobacco smoking (38.1%).There were very few partic-its subscales: Distraction and Social Diversion. Compared ipants using prescribed psychotropic medications or illicit to non-drinkers, drinkers scored higher on average on the drugs (2.4% and 1.2%, respectively) (Figure 1).

avoidance-oriented coping strategy, on distraction, and on coping with stress in the form of social diversion (Table 1).

The frequency of alcoholic beverages consumption was

not related to trait anxiety – the average level of anxiety re-The frequency of smoking was significantly negatively asso-mained almost unchanged (Table1). On the other hand,

ciated with anxiety as a trait and anxiety control. More fre-drinking habits turned out to be related to negative emotions quent tobacco use (several times a day) was associated with control, with significantly lower average emotional control a lower average trait anxiety level and a lower average lev-in firefighters drinking alcohol than in non-drinkers. The el of anxiety control compared to sporadic smoking (from same pattern was observed for both anger and

Table 1. The associations between psychological variables and alc ONLY

depression

time to time) (Table 2).

control in drinkers compared to non-drinkers (Table 1).

ohol use.

Drinking alcohol

Psy

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chological

Yes

Frequency

variable

From time Several times Several times

(n=151)

(n=17)

to time

a month

a week

(n=103)

(n=34)

(n=14)

Anxiety as a trait

35.41 (±6.35) 35.17 (±4.77)

p>0.05

34.86 (±6.47) 37.41 (±6.23) 34.64 (±4.88)

p>0.05

Control of emotion (general) 51.68 (±8.29) 56.64 (±6.70) p<0.01

51.65 (±8.36) 52.70 (±6.58) 49.42 (±11.25)

p>0.05

Control of anger

16.54 (±3.57) 19.29 (±3.23)

p<0.01

16.51 (±3.61) 17.60 (±3.17) 16.22 (±5.32)

p>0.05

Control of depression

16.36 (±3.52) 18.64 (±3.27)

p<0.01

16.07 (±3.58) 16.63 (±3.23) 16.19 (±4.81)

p>0.05

Satisfaction from received

social support

26.55 (±8.05) 25.47 (±8.05)

p>0.05

27.30 (±5.48) 24.70 (±4.65) 25.64 (±5.51)

p<0.05

Avoidance-oriented coping

strategy(general)

33.20 (±6.96) 28.76 (±5.39)

p<0.01

33.43 (±6.57) 32.32 (±7.59) 33.64 (±8.52)

p>0.05

Distraction

17.00 (±4.84) 14.47 (±3.43)

p<0.05

16.31 (±4.88) 15.47 (±4.13) 15.03 (±3.74)

p>0.05

Social Diversion

16.20 (±3.46) 14.29 (±3.36)

p<0.05

15.94 (±3.57) 14.37 (±4.51) 14.80 (±4.73)

p>0.05

The mean values of examined parameters and standard deviation (± SD) are given in the cells.

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Rasmus P. et al. – Biopsychosocial correlates of psychoactive substance use…

Table 2. The associations between psychological variables and tobacco use.

Smoking tobacco

Psychological

Yes

Frequency

variable

From time

Several times

(n=64)

(n=104)

to time

a day

(n=15)

(n=49)

Anxiety as a trait

35.09 (±6.20)

35.59 (±6.22)

p>0.05

38.43 (±5.84)

34.14 (±6.05)

p<0.05

Control of emotion (general)

51.36 (±8.74)

52.70 (±8.00)

p>0.05

54.14 (±7.99)

50.75 (±9.11)

p>0.05

Control of anxiety

19.01 (±4.17)

19.47 (±5.21)

p>0.05

20.28 (±3.36)

18.06 (±3.74)

p<0.05

Satisfaction from received social

support

26.48 (±6.01)

26.43 (±6.52)

p>0.05

25.43 (±6.88)

26.54 (±6.04)

p>0.05

Avoidance-oriented coping

strategy(general)

32.58 (±7.92)

32.86 (±6.31)

p>0.05

31.64 (±9.96)

32.81 (±7.44)

p>0.05

The mean values of examined parameters and standard deviation (±SD) are given in the cells.

No significant associations were demonstrated between preselected State Fire Service employees. Moreover, fire-avoidance oriented coping strategy and smoking (Table 2).

fighters are subject to constant health check-ups, therefore the chance of having a positive drug-screening test discussion

result would be high and would immediately end their career in the Fire Service. The results of this anonymous sur-Based on data presented in Figure 1, Lodz firefighters seem vey can be regarded as optimistic, proving that the use of to use different psychoactive substances in varying degrees.

street drugs or psychotropic medications does not consti-The participants most frequently declared the use of alco-tute a significant clinical or social problem in professional hol (89.9%), with 9.3% of this group drinking a few times a firefighters-rescuers.

week. According to the latest report of the National Institute of Public Health – National Institute of Hygiene in Warsaw, The study did not confirm the presence of any associations this number is almost 5% lower than that claimed by adult between trait anxiety and psychoactive substance use among Poles (14%) and almost 35% lower than the European

professional firefighters.

Union average (44%) [15]. The fact that firefighters (as a highly preselected group) statistically consume less alco-The control over negative emotions was lower in firefight-ONLY

hol per week than the general population seems positive.

ers who drink compared to non-drinkers. However, lack of any associations between emotional control in general and The second most commonly used harmful substance was to-the frequency of drinking gives grounds to believe that this bacco. Thirty-eight percent of firefighters smoked (Figure 1), personality trait does not significantly influence the regular-the majority of whom (29.2%) used tobacco several times ity of alcohol consumption. A detailed analysis confirmed a day

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. The results of another study carried out on a group similar correlations for anger and depression control, with of firefighters from the Wielkopolska region [16] indicat-better mastery over negative emotions in non-drinking ed even higher ratios of firefighters smoking daily and oc-firefighters. It can be assumed that people deliberately recasionally (46% and 10%, respectively). Other studies [17]

fraining from alcohol use are so strongly preoccupied with demonstrated that although almost all firefighters (99% of the need for emotional control that they avoid substances respondents) believed smoking was harmful and were high-known for their relaxing and control-reducing properties ly motivated to quit smoking (84%), they still continued to

[21]. The results of the CECS questionnaire validation stud-smoke, mostly due to occupational stress. Smoking may have ies conducted on a group of 241 male firefighters-rescuers a special role in the pathogenesis of certain diseases in pro-from diverse social backgrounds indicate that, on average, fessional firefighters, including coronary heart disease [17].

they scored slightly higher on all 3 negative emotion con-Over 40% of firefighters who died on duty because of car-trol scales (anger, depression, anxiety). Another study us-diovascular diseases were smokers [18,19]. Moreover, it is ing the same diagnostic tool in 3 different clinical popula-believed that carbon monoxide from cigarette smoke adds tions (diabetics, patients undergoing dialyses, and patients to the effects of carbon monoxide contained in fire smoke, with a history of myocardial infarction) proved that dia-resulting in increased levels of carboxyhemoglobin in the betics’ scores were closest to those achieved by the current blood. This in turn can lead to development of cardiovas-study participants. Therefore, firefighters-rescuers seem to cular diseases, and finally to cardiac death, a complication demonstrate fairly high control over negative emotions, but most frequent in older firefighters [20].

frequently at the price of health hazards typically associated with suppressing such emptions.

Illicit drug use and taking psychotropic medications were very rare occurrences in the examined group, with a prev-Furthermore, participants who rated their satisfaction with alence ranging from 1.2% to 2.4%. Presumably, this type of support as higher drank significantly less, confirming the risk behavior is the least likely to be accepted by the highly results of other researchers [22].

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No correlations were demonstrated between satisfaction impossible to exclude respondents fulfilling diagnostic cri-with received support and a tendency to use psychoactive teria for substance dependence that might influence the substances other than alcohol. It can be assumed that satis-results. Finally, the analysis of questionnaire data was per-faction with received support does not protect against the formed by the authors themselves, thus some degree of sub-use of drugs by professional firefighters-rescuers.

jectivity is inevitable.

The results indicate a significantly higher score in gener-To summarize, unhealthy behaviors in emergency servic-al avoidance style of coping with stress, as well as in the dis-es personnel may be considered a result of the mental and traction and social diversion subscales in firefighters who physical burden typically associated with their daily work drink compared to non-drinkers. It seems that firefighters and which is virtually impossible to eliminate [22]. An at-who are more likely to engage in actions distancing them tempt to minimize the consequences of stress and stress-re-from highly stressful situations are predisposed to drinking, lated risk behaviors in a group of professional firefighters is possibly as a way of coping with the negative consequences therefore not only in the interest of firefighters themselves of stress. Further analysis of the results confirmed that fire-and their relatives and supervisors, but also professionals fighters who drink alcohol are more likely than non-drink-such as psychiatrists and psychologists attempting to im-ers to fight negative emotions, spending time with their rel-prove intervention, prevention, and education programs, atives, visiting friends, making phone calls, and are more with a particular emphasis on the negative consequences often getting involved in activities like watching television, of alcohol and tobacco use [30].

overeating, thinking about pleasant things, and sleeping.

[23]. In another study on firefighters, police officers and conclusions

emergency workers [24], only emergency workers achieved scores comparable to the participants in our study on the The most common risk behaviors in the tested group were avoidance style of coping subscale [25]. The other 2 groups drinking alcohol and smoking tobacco, the prevalence of on average scored lower, proving they were less likely to which can be considered significant. Illicit drug use and demonstrate behaviors characteristic of this coping style.

taking psychotropic medications were the least frequent.

Alcohol consumption turned out to be associated with

The authors observed a correlation between anxiety as a avoidance-oriented coping with stress, as well as distrac-trait and the frequency of smoking, with regular (daily) to-tion. Firefighters who did not drink alcohol tended to have bacco smokers characterized by a lower average trait anxi-more control over negative emotions, including anger and ety compared to infrequent smokers. The character of the depression. Greater satisfaction with social support was ac-study makes this finding difficult to interpret, but it is be-companied by a reduction in alcohol drinking frequency.

lieved that smoking can affect anxiety as a trait, which of Firefighters who sporadically smoked tobacco were charac-course does not put into question all the medical and so-terized by higher anxiety and greater control over anxiety.

cial consequences of smoking, but may explain difficulties Further studies are warranted on the causal relationships in stopping [26].

between psychobiological and psychosocial factors and a tendency to manifest risk behaviors. The emphasis should Contrar

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y to the authors’ expectations, higher anxiety con-

be put on the problem of drinking alcohol and smoking trol appeared characteristic for sporadic smokers. People tobacco products in the group of professional firefighters-with higher anxiety control may not feel the urge to smoke rescuers and also on improvement of prevention programs.

more regularly because they probably have other ways to dis-charge negative emotions or they accumulate them inside Statement

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[27,28]. In another study carried out on a group of people practicing extreme sports [29], their average level of trait The authors declare no conflict of interest with respect to anxiety was comparable to our study group. It is reasonable any aspect of this study.

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