A groundbreaking study by the University of the Western Cape (UWC) has uncovered a troubling link between psychological distress and harmful drinking among police officers and paramedics.

The research, which surveyed more than 400 experienced first responders – 309 police officers and 120 paramedics – found that those experiencing higher levels of stress and psychological distress were more likely to turn to alcohol as a coping mechanism.

Concerning patterns

Published in the Turkish Journal on Addictions, the study — entitled “Alcohol use in first responders in South Africa: Psychological distress factors related to harmful drinking and alcohol dependence” — identified anxiety, depersonalisation, fatigue and insomnia as significant predictors of alcohol use among these front-line workers.

The research defines harmful drinking as a pattern of alcohol consumption that causes physical or mental harm, often including binge drinking, consuming four or more drinks for women, or five or more for men, on a single occasion.

Prof Anita Padmanabhanunni, a psychologist and dean of the Faculty of Community and Health Sciences at UWC, said this was the first known study to examine the link between harmful alcohol use and psychological distress among South African first responders.

Unexpected findings on PTSD

Surprisingly, post-traumatic stress disorder (PTSD), which previous international research has linked to harmful drinking among police, did not emerge as a predictor of alcohol use in this study. PTSD is a mental health condition triggered by extremely traumatic events, with symptoms including flashbacks, nightmares, severe anxiety and intrusive thoughts.

The study found participants at risk of harmful drinking consistently reported higher levels of psychological distress across all measures, revealing a clear connection between mental health difficulties and alcohol use.

Barriers to seeking help

Padmanabhanunni, who conducted the research with Prof Tyrone Pretorius, UWC’s former rector and vice-chancellor, said protecting the mental health of first responders was “essential for sustaining emergency services and for ensuring that quality care is provided to communities.”

However, the researchers identified significant barriers preventing first responders from accessing mental health support. In South Africa, concerns about confidentiality, fear of being judged and broader barriers to accessing care may prevent many from seeking help. “This can allow distress to escalate and increase reliance on harmful coping strategies such as alcohol use,” Padmanabhanunni explained.

Culture of toughness creates additional challenges

A culture of toughness among first responders, where emotional control and self-reliance are seen as signs of competence, can discourage help-seeking behaviour.

“When emotional distress is treated as ‘weakness’ many first responders may feel compelled to push through rather than seek support. In this way constructions of masculinity can become a barrier to help-seeking,” Padmanabhanunni said.

Call for urgent intervention

The researchers emphasise that while support services exist in some South African settings, they are often not easily accessible, trusted, or well integrated into the workplace. Stigma around mental health and seeking help remains a major barrier.

The findings highlight an urgent need for interventions to support first responders’ mental health, including critical incident debriefing and mindfulness-based support programmes.

Police officers and paramedics are often the first on the scene when tragedy strikes, and the psychological toll of witnessing traumatic events may be pushing some towards increasing alcohol use as a way of coping with the emotional burden they carry, often in silence.