Greater perceived stress and lower self-regulation associated with substance use behaviors in a national sample of United States emergency medical service clinicians.

backgroundEmergency medical service (EMS) clinicians are first responders who can experience work-related stressors. Substances can be used as a coping strategy to manage stress. The ability to self-regulate motivation, cognition, and emotions may protect against substance use. Our objective was to examine the associations among stress, self-regulation, and substance use in EMS clinicians to identify potential psychological targets for substance use prevention.

methodsWe invited a random sample of 19,000 full-time United States EMS clinicians from the largest national EMS database, of whom 1510 completed the survey. The online survey distributed by email included validated scales for perceived stress and self-regulation, as well as items assessing the number of days with binge drinking, cannabis use, and nicotine use in the prior month. We examined substance use outcomes using multivariable zero-inflated negative binomial models weighted to reflect population sociodemographic distributions.

resultsEach 1-point increase in perceived stress was associated with 21% more binge drinking days (aIRR=1.21 [1.05, 1.39]), 79% more cannabis use days (aIRR=1.79 [1.22, 2.61]), and 5% more nicotine use days (aIRR=1.05 [1.01, 1.10]). In contrast, each 1-point increase in self-regulation was associated with 97% lower odds of using cannabis at all (aOR=0.03 [0.01, 0.57]) and 33% fewer binge drinking days (aIRR=0.67 [0.51, 0.88]).

conclusionsIn this national cross-sectional study of full-time United States EMS clinicians, we identified stress and self-regulation as factors significantly associated with substance use. Future studies should determine whether workplace and individualized interventions targeting perceived stress and self-regulation help reduce substance use among EMS clinicians.