Alcohol Use in First Responders in South Africa: Psychological Distress Factors Related to Harmful Drinking and Alcohol Dependence

First responders are frequently exposed to traumatic events and highly stressful situations due to the nature of their work. This enhances their vulnerability to psychological distress and the use of maladaptive strategies to cope. In South Africa, few studies have explored the relationship between alcohol use and mental health indicators among first responders. This study investigated the association between harmful drinking behaviors and post-traumatic stress disorder, depression, anxiety, emotional exhaustion, depersonalization, fatigue, and insomnia. A cross-sectional study was conducted with 429 first responders. The participants completed the Alcohol Use Identification Test, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Post-traumatic Stress Disorder Checklist for DSM-5, Maslach Burnout Inventory, Life Events Checklist, Chalder Fatigue Questionnaire, and Insomnia Severity Index. Higher levels of alcohol use were associated with higher levels of psychological distress. Specifically, anxiety, depersonalization, fatigue, and insomnia emerged as significant predictors of alcohol consumption. Participants classified as at risk for harmful alcohol use reported higher levels of psychological distress than those not at risk. Additionally, participants identified as having alcohol dependence reported higher levels of distress across all indicators than did those without alcohol dependence. These results underscore the need for integrated interventions that address both psychological distress and harmful drinking behaviors.