First responders face a number of stressors and traumatic situations in their work. Chronic exposure to trauma, job stress, and burnout (extreme exhaustion and overwhelm) can increase first responders’ risk of substance use, depression, post-traumatic stress disorder (PTSD), and other negative outcomes.1,2

For the purposes of this article, first responders include:

  • Firefighters.
  • Emergency medical services (EMS), which includes paramedics, 911 dispatchers, and EMTs.
  • Police officers and other law enforcement personnel.

The link between the trauma experiences of first responders and substance use is clear. For example, research shows that being involved in disaster response, such as helping in Hurricane Katrina, contributed to hazardous drinking among police officers, with the average number of alcoholic drinks increasing from 2 to 7 per day.1

First Responders and Addiction

First responders share similar experiences through their work on the front lines. Through these shared experiences, they form a connection with one another, creating a type of family bond that becomes a source of strength and support.2 The family bonds that develop can be an outlet for decompressing and processing traumatic experiences.

However, they can also lead to unhealthy coping mechanisms. For example, teams of first responders may find it appealing to decompress over drinks at bars or parties.1 Further, alcohol can be used as a way of trying to numb or blunt the negative emotions and symptoms of mental health disorders such as PTSD and depression.1

The Stigma First Responders Face

Actual and perceived stigma—negative or discriminating attitudes and behaviors based on certain personal traits—may prevent many first responders from seeking the treatment they need for an alcohol use disorder (AUD). Many first responders highly value being able to tolerate physical and mental trauma, so they may avoid asking for help because they feel like it will make them seem weak.2

Another barrier to getting help is the “suck it up” mentality that is sometimes reinforced among first responders and by their job. For example, it is a common expectation for officers involved in “shots fired” situations to return to work after 3 days off (if there is no injury).2

Further, the inherent nature of their line of work leaves little room for downtime in between traumatic events. This can make it especially hard to effectively work through and process any work-related traumas.1

Other barriers to treatment may include:1

  • Cost of care.
  • Insurance not covering certain costs.
  • Lack of transportation.
  • Trouble getting time off work.
  • Poor access to treatment.
  • Fear of employment repercussions.
  • Lack of trust and privacy concerns.

First Responders and Co-Occurring Disorders

As previously mentioned, first responders face unique occupational mental health risks that other occupations may not. This puts them at a higher risk of developing PTSD, depression, substance use disorders, and other behavioral disorders.1 When a mental health disorder and a substance use disorder occur at the same time, it is considered a co-occurring disorder.5

Research shows a connection between mental health and substance use disorders. In fact, people with mental health disorders are more likely to develop a substance use disorder than those who don’t experience mental illness.5 A 2015 study estimated that roughly 30% of first responders develop behavioral health disorders, such as PTSD or depression, compared to 20% of the general population.2

PTSD

Symptoms of PTSD can range in severity; some common symptoms include:2

  • Intrusive and distressing memories of traumatic events.
  • Changes in mood and thoughts, including feelings of shame, guilt, or overwhelm.
  • Changes in behavior, including aggressive and self-destructive behavior.
  • Changes in physical and emotional reactions, including an increase in angry outbursts and irritability.
  • Feeling “on guard.”
  • Problems sleeping or concentrating.
  • Becoming easily startled or scared.
  • Nightmares.

Depression

Depression is a disorder that impacts many people, and like PTSD symptoms, the symptoms of depression can range in severity. These symptoms may include:3

  • Feeling hopeless, sad, or anxious.
  • Sleep problems.
  • Fatigue and loss of energy.
  • Suicidal thoughts and behaviors.
  • Feeling guilty, worthless, or helpless.
  • Appetite or weight changes.
  • Decrease in psychomotor activity (talking, walking, moving).
  • Physical aches and pains.
  • Digestion issues.
  • Irritability.

Fatigue, Burnout, and Suicide

First responders are also at risk for fatigue and burnout, and the two concepts are interrelated. Burnout happens when intense stress leads to feelings of fatigue, exhaustion, and trouble coping.4

Occupational burnout has also been linked to an increase in suicide risk. One study shows that police officers with occupational burnout were 117% more likely to have suicidal thoughts than those who didn’t report feeling burnout.1

Another study found that 37% of firefighters and EMS workers had considered suicide; this is almost 10 times the rate of the general adult population.1

If you or someone you love is thinking of hurting themselves, please reach out for help. The National Suicide Prevention Lifeline has trained counselors ready to help 24/7 at 1-800-273-8255.

How to Help a First Responder with Addiction

There are a number of ways you can offer support and guidance to first responders facing alcohol addiction. When trying to support a loved one, remember it is important to communicate from a loving, non-judgmental place. Addiction strategies to help support a loved one include:6

  • Ask questions, actively listen, and engage in a conversation when they want to talk.
  • Communicate with empathy, compassion, and respect.
  • Ask if your loved one is getting care already. If not, remind them that help is available, but don’t pressure them. You might suggest going with them to a doctor or helping them research treatment options.
  • Reassure your loved one that you care.
  • Offer to help with daily tasks and responsibilities.

Also, keep in mind that change takes time; it is not instantaneous. Be patient with your loved one as they work through their challenges.

Finding First Responder Addiction Treatment

Effective treatment must address all aspects of a person, and for first responders, this means addressing factors unique to them such as exposure to trauma and other factors listed above.7 These factors, such as long work hours and physical demands of the job, may add recovery challenges for first responders that the general population may not have to address.

The good news is that specialized treatment programs exist to help first responders tackle these challenges. American Addiction Centers (AAC) offers first responder rehab programs where you will be in the company of other first responders who understand what you are going through.

If you or a loved one are a first responder struggling with addiction, know that you don’t have to go through this alone. Call 1-888-685-5770 or get a text any time, day or night, to learn about your treatment options.

Sources
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  1. Substance Abuse and Mental Health Services Administration. (2018, May). Disaster technical assistance center supplemental research bulletin- First responders: behavioral health concerns, emergency response, and trauma.
  2. Substance Abuse and Mental Health Services Administration. (2018). A quarterly technical assistance journal on disaster behavior health produced by the SAMHSA disaster technical assistant center.
  3. National Institute of Mental Health. (2018, February). Depression.
  4. InformedHealth.org (2020, June 18). Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: What is burnout?
  5. Substance Abuse & Mental Health Services Administration. (2022, April 21). Co-occurring disorders and other health conditions.
  6. U.S. Department of Health and Human Services. (2020, December 22). For friends and family members.
  7. National Institute on Drug Abuse. (2018, January). Principles of effective treatment.
  8. Boland, L. L., Kinzy, T. G., Myers, R. N., Fernstrom, K. M., Kamrud, J. W., Mink, P. J., & Stevens, A. C. (2018). Burnout and exposure to critical incidents in a cohort of emergency medical services workers from Minnesota. The Western Journal of Emergency Medicine, 19(6), 987–995.