Background: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. Objectives: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. Method: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). Results: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. Conclusions: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.

1.
Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society.
J Clin Psychiatry
. 2000;61 Suppl 5:4–12.
2.
Gielen N, Havermans RC, Tekelenburg M, Jansen A. Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is.
Eur J Psychotraumatol
. 2012;3(1):1–9.
3.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.
Arch Gen Psychiatry
. 2005 Jun;62(6):593–602.
4.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey.
Arch Gen Psychiatry
. 1995 Dec;52(12):1048–60.
5.
Hingray C, Donné C, Martini H, Cohn A, El Hage W, Schwan R, et al. Description of type of trauma in alcohol-dependent women.
European Journal of Trauma & Dissociation
. 2018;2(3):153–6.
6.
McCauley JL, Killeen T, Gros DF, Brady KT, Back SE. Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment.
Clin Psychol (New York)
. 2012 Sep;19(3):283–304.
7.
Ouimette P, Read JP, Wade M, Tirone V. Modeling associations between posttraumatic stress symptoms and substance use.
Addict Behav
. 2010 Jan;35(1):64–7.
8.
Stewart SH, Pihl RO, Conrod PJ, Dongier M. Functional associations among trauma, PTSD, and substance-related disorders.
Addict Behav
. 1998 Nov-Dec;23(6):797–812.
9.
Dragan M, Lis-Turlejska M. Prevalence of posttraumatic stress disorder in alcohol dependent patients in Poland.
Addict Behav
. 2007 May;32(5):902–11.
10.
Petrakis IL, Simpson TL. Posttraumatic Stress Disorder and Alcohol Use Disorder: A Critical Review of Pharmacologic Treatments.
Alcohol Clin Exp Res
. 2017 Feb;41(2):226–37.
11.
Kelly MM, Jensen KP, Sofuoglu M. Co-occurring tobacco use and posttraumatic stress disorder: smoking cessation treatment implications.
Am J Addict
. 2015 Dec;24(8):695–704.
12.
Ledgerwood DM, Petry NM. Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers.
J Trauma Stress
. 2006 Jun;19(3):411–6.
13.
Chilcoat HD, Breslau N. Posttraumatic stress disorder and drug disorders: testing causal pathways.
Arch Gen Psychiatry
. 1998 Oct;55(10):913–7.
14.
Vujanovic AA, Marshall-Berenz EC, Zvolensky MJ. Posttraumatic Stress and Alcohol Use Motives: A Test of the Incremental and Mediating Role of Distress Tolerance.
J Cogn Psychother
. 2011;25(2):130–41.
15.
Najavits LM. Theoretical perspective on posttraumatic stress disorder and substance use disorder.
Aust Psychol
. 2005;40(2):118–26.
16.
Carlier IV, Lamberts RD, Gersons BP. Risk factors for posttraumatic stress symptomatology in police officers: a prospective analysis.
J Nerv Ment Dis
. 1997 Aug;185(8):498–506.
17.
Davidson AC, Moss SA. Examining the Trauma Disclosure of Police Officers to Their Partners and Officers’ Subsequent Adjustment.
J Lang Soc Psychol
. 2008;27(1):51–70.
18.
Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, et al. Predictors of posttraumatic stress in police and other first responders.
Ann N Y Acad Sci
. 2006 Jul;1071(1):1–18.
19.
Hartley TA, Violanti JM, Sarkisian K, Andrew ME, Burchfiel CM. PTSD symptoms among police officers: associations with frequency, recency, and types of traumatic events.
Int J Emerg Ment Health
. 2013;15(4):241–53.
20.
Ballenger JF, Best SR, Metzler TJ, Wasserman DA, Mohr DC, Liberman A, et al. Patterns and predictors of alcohol use in male and female urban police officers.
Am J Addict
. 2011 Jan-Feb;20(1):21–9.
21.
Leino T, Eskelinen K, Summala H, Virtanen M. Work-Related Violence, Debriefing and Increased Alcohol Consumption among Police Officers.
Int J Police Sci Manag
. 2011;13(2):149–57.
22.
Swatt ML, Gibson CL, Piquero NL. Exploring the utility of general strain theory in explaining problematic alcohol consumption by police officers.
J Crim Justice
. 2007;35(6):596–611.
23.
Ménard SK, Arter LM. Police Officer Alcohol Use and Trauma Symptoms: Associations With Critical Incidents, Coping, and Social Stressors.
Int J Stress Manag
. 2013;20(1):37–56.
24.
Philippe JM, Brahic O, Carli P, Tourtier JP, Riou B, Vallet B. French Ministry of Health’s response to Paris attacks of 13 November 2015.
Crit Care
. 2016 Apr;20(1):85.
25.
Proescholdt MG, Müller SE, Vogel M, Lang U, Wiesbeck GA, Breit W, et al. Early Screening for Posttraumatic Stress Disorder in Inpatient Detoxification and Motivation Treatment: results and Consequences.
Eur Addict Res
. 2018;24(3):128–36.
26.
Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM. The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov 2013.
27.
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation.
J Trauma Stress
. 2015 Dec;28(6):489–98.
28.
Ashbaugh AR, Houle-Johnson S, Herbert C, El-Hage W, Brunet A. Psychometric Validation of the English and French Versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5).
PLoS One
. 2016 Oct;11(10):e0161645.
29.
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II.
Addiction
. 1993 Jun;88(6):791–804.
30.
Gache P, Michaud P, Landry U, Accietto C, Arfaoui S, Wenger O, et al. The Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for excessive drinking in primary care: reliability and validity of a French version.
Alcohol Clin Exp Res
. 2005 Nov;29(11):2001–7.
31.
Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.
Addict Behav
. 1978;3(3-4):235–41.
32.
Etter JF, Duc TV, Perneger TV. Validity of the Fagerström test for nicotine dependence and of the Heaviness of Smoking Index among relatively light smokers.
Addiction
. 1999 Feb;94(2):269–81.
33.
Legleye S, Kraus L, Piontek D, Phan O, Jouanne C. Validation of the Cannabis Abuse Screening Test in a sample of cannabis inpatients.
Eur Addict Res
. 2012;18(4):193–200.
34.
Ferris J, Wynne H.
The Canadian Problem Gambling Inventory
. Canadian Consortium for Gambling Research; 2001. pp. 1–59.
35.
Caillon J, Grall-Bronnec M, Hardouin JB, Venisse JL, Challet-Bouju G. Online gambling’s moderators: how effective? Study protocol for a randomized controlled trial.
BMC Public Health
. 2015 May;15(1):519.
36.
Norman SB, Haller M, Hamblen JL, Southwick SM, Pietrzak RH. The burden of co-occurring alcohol use disorder and PTSD in U.S. Military veterans: Comorbidities, functioning, and suicidality.
Psychol Addict Behav
. 2018 Mar;32(2):224–9.
37.
Evren C, Sar V, Dalbudak E, Cetin R, Durkaya M, Evren B, et al. Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation.
Psychiatry Res
. 2011 Mar;186(1):85–90.
38.
Hingray C, Cohn A, Martini H, Donné C, El-Hage W, Schwan R, et al. Impact of trauma on addiction and psychopathology profile in alcohol-dependent women.
European Journal of Trauma & Dissociation
. 2018;2(2):101–7.
39.
Kachadourian LK, Gandelman E, Ralevski E, Petrakis IL. Suicidal ideation in military veterans with alcohol dependence and PTSD: the role of hostility.
Am J Addict
. 2018 Mar;27(2):124–30.
40.
McFall ME, Mackay PW, Donovan DM. Combat-related posttraumatic stress disorder and severity of substance abuse in Vietnam veterans.
J Stud Alcohol
. 1992 Jul;53(4):357–63.
41.
Walton JL, Raines AM, Cuccurullo LJ, Vidaurri DN, Villarosa-Hurlocker MC, Franklin CL. The relationship between DSM-5 PTSD symptom clusters and alcohol misuse among military veterans.
Am J Addict
. 2018 Jan;27(1):23–8.
42.
Hruska B, Pacella ML, George RL, Delahanty DL. The association between daily PTSD symptom severity and alcohol-related outcomes in recent traumatic injury victims.
Psychol Addict Behav
. 2017 May;31(3):326–35.
43.
Waldrop AE, Cohen BE. Trauma exposure predicts alcohol, nicotine, and drug problems beyond the contribution of PTSD and depression in patients with cardiovascular disease: data from the Heart and Soul Study.
Am J Addict
. 2014 Jan-Feb;23(1):53–61.
44.
Walsh K, Elliott JC, Shmulewitz D, Aharonovich E, Strous R, Frisch A, et al. Trauma exposure, posttraumatic stress disorder and risk for alcohol, nicotine, and marijuana dependence in Israel.
Compr Psychiatry
. 2014 Apr;55(3):621–30.
45.
Bonn-Miller MO, Vujanovic AA, Boden MT, Gross JJ. Posttraumatic stress, difficulties in emotion regulation, and coping-oriented marijuana use.
Cogn Behav Ther
. 2011;40(1):34–44.
46.
Bremner JD, Southwick SM, Darnell A, Charney DS. Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse.
Am J Psychiatry
. 1996 Mar;153(3):369–75.
47.
Bujarski SJ, Feldner MT, Lewis SF, Babson KA, Trainor CD, Leen-Feldner E, et al. Marijuana use among traumatic event-exposed adolescents: posttraumatic stress symptom frequency predicts coping motivations for use.
Addict Behav
. 2012 Jan;37(1):53–9.
48.
Steenkamp MM, Blessing EM, Galatzer-Levy IR, Hollahan LC, Anderson WT. Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review.
Depress Anxiety
. 2017 Mar;34(3):207–16.
49.
Bouju G, Grall-Bronnec M, Landreat-Guillou M, Venisse JL. Jeu pathologique : facteurs impliqués.
Encephale
. 2011 Sep;37(4):322–31.
50.
Del Pino-Gutiérrez A, Fernández-Aranda F, Granero R, Tárrega S, Valdepérez A, Agüera Z, et al. Impact of alcohol consumption on clinical aspects of gambling disorder.
Int J Ment Health Nurs
. 2017 Apr;26(2):121–8.
51.
Konkolÿ Thege B, Hodgins DC, Wild TC. Co-occurring substance-related and behavioral addiction problems: A person-centered, lay epidemiology approach.
J Behav Addict
. 2016 Dec;5(4):614–22.
52.
Brunault P, Salamé E, Jaafari N, Courtois R, Réveillère C, Silvain C, et al. Why do liver transplant patients so often become obese? The addiction transfer hypothesis.
Med Hypotheses
. 2015 Jul;85(1):68–75.
53.
Steffen KJ, Engel SG, Wonderlich JA, Pollert GA, Sondag C. Alcohol and other addictive disorders following bariatric surgery: prevalence, risk factors and possible etiologies.
Eur Eat Disord Rev
. 2015 Nov;23(6):442–50.
54.
Schäfer I, Chuey-Ferrer L, Hofmann A, Lieberman P, Mainusch G, Lotzin A. Effectiveness of EMDR in patients with substance use disorder and comorbid PTSD: study protocol for a randomized controlled trial.
BMC Psychiatry
. 2017 Mar;17(1):95.
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