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First Responders & Substance Use Disorder

April 20, 2022

Table of Contents

The high-stress nature of the jobs that first responders do can be a risk factor for substance abuse, mental health disorders, and substance use disorder (SUD).

During their time of service, around a third of first responders (like police officers, firefighters, paramedics, and EMS workers) develop behavioral health issues, including PTSD (post-traumatic stress disorder), depression, and anxiety. Half of those with mental health disorders also develop SUD.[1]

As many as one out of every four police officers on duty has drug or alcohol abuse issues. They have substance use disorders at two to three times the rate of the general public — with rates of 20% to 30% as opposed to 10%.[2]

Similarly members of the U.S. Fire Service have some of the highest rates of binge and heavy drinking in the country — both of which are high risk factors for alcohol use disorder (AUD).[3]

EMS personnel have higher rates of alcohol and drug abuse than the general public. Women first responders smoke, drink alcohol, and use drugs at triple the rate of the general population.[4]

Paramedics and EMS personnel also have greater access to controlled substances, such as opioid and sedative drugs, which can elevate the risk for misusing these medications.

The Relationship Between Addiction & First Responders

Substance abuse and addiction occur in first responders at rates higher than in the general population. This is likely largely due to the stressful nature of the job, the trauma that comes with it, and the lack of processing time between calls or difficult situations.

First responders live in a fast-paced, high-stress environment. They often face trauma on a daily basis.

Alcohol and drug use is often a coping mechanism for trauma and stress. It can provide a temporary reprieve from difficult memories or feelings. Stress, and especially chronic stress such as that experienced by first responders, is a common risk factor for addiction.[5]

Stress and continual psychological pressure elevate the odds for developing a mental health disorder, which also raises the potential for problematic drug or alcohol use to self-medicate symptoms. A mental health disorder is also a risk factor for developing SUD.

he high-pressure nature of the job creates an insular culture where first responders tend to stick together and commiserate with each other, as they feel outsiders will not understand. This often occurs at bars or places where alcohol is commonly consumed.

First responders have greater access to controlled substances. This brings more potential to misuse drugs.

There is often stigma around seeking help for problematic alcohol or drug use, which can cause first responders to fear losing their jobs. When people don’t seek help, it compounds the problem.

Commonly Abused Substances

Alcohol is one of the most abused substances by first responders. It is easy to get, socially acceptable, inexpensive, and commonly used to cope with stress. There are often “cop bars” and local watering holes where police or firefighters will spend time after their shift blowing off steam.

Surveys showed that around a third of police officers binge drank in the month leading up to a national survey, about 8% of public protective services drank heavily, and 5.2% had an alcohol use disorder between 2010 and 2014.[6]

While first responders have access to both illicit and prescription drugs, many of these fields also require regular drug testing, which can be a deterrent for drug abuse. In the same survey, around 3.1% of public protective services used illicit drugs or misused prescription drugs and 0.5% had a drug use disorder.

In particular, police and firefighters commonly suffer on-the-job injuries that can necessitate prescription opioid drugs to control the pain. Law enforcement officers have one of the highest rates (sixth) of occupational injuries.

Between 65% and 85% of injury claims reported to workers’ compensation included a prescription for opioid medications. One out of every ten of these officers prescribed pain medications are still taking them nearly a year later. Regular use of an opioid drug can lead to physical dependence, misuse of these substances, and addiction.

Signs of Addiction & Mental Health Issues in First Responders

Addiction and mental health issues can both lead to physical, social, psychological, and behavioral changes. Addiction and mental health issues often co-occur and can have overlapping symptoms.

Signs of a problem may include the following:

  • Mood swings
  • Changes in sleeping and eating habits and patterns
  • Irritability
  • Social withdrawal and isolation
  • Being quick to anger
  • Inability to stop using alcohol or drugs despite trying several times
  • Drinking or using more at a time than intended
  • Changes in social circles
  • Inability to consistently fulfill work or home obligations
  • Continuing to use substances despite negative consequences
  • Risky behaviors, often including using substances in potentially dangerous situations
  • Needing to take more drugs or drink more alcohol to have the same effects
  • Withdrawal symptoms when alcohol or drugs wear off
  • Feelings of hopelessness
  • Sleep issues
  • Suicidal ideations
  • Lack of desire to engage in activities that were previously a priority

Stressors Per Profession

Certain first responder professions tend to use particular substances more. Specific stressors or job-related conditions can raise the risk for these issues.

Police officers

Being a police officer is a high-stress job with long hours. It requires quick decisions while bearing witness to trauma and tragedy on a regular basis. Add in the public perception of policing and police officers in general, and the stress rate goes up even further.

Police officers often use alcohol as a coping mechanism and a method to “unwind” after a particularly stressful shift. Drinking is also a big part of police culture, and police officers often gather together off shift and binge drink together. As many as 20% of police officers are problem drinkers.[7]

Police officers put themselves in danger and are often injured in the line of duty. This can result in the need to take prescription opioid painkillers.

Police officers are already at a high risk for misusing controlled substances due to high levels of daily stress and potential mental health issues as well. Taking an addictive substance, such as an opioid, can lead to abuse and the potential for an opioid use disorder (OUD).

Firefighters

Similar to police officers, firefighters also work in a high-stress environment and see a wide variety of traumas on a repetitive basis. Firefighters commonly drink alcohol to cope with the stress of the job.

They also have a culture that holds alcohol consumption and binge drinking as normal behaviors. Firefighters drink and binge drink at rates double the general population.[8]

Paramedics/EMTs

Paramedics and EMTs have similar risk factors and high-stress jobs. Like police officers and firefighters, they also use alcohol as a method of relieving stress with coworkers after their shifts.

EMS workers, however, generally abuse drugs at higher rates than police officers and firefighters do. This could be related to their continued and easy access to controlled substances as well as an effort to self-medicate underlying mental health issues and stress.

Commonly abused substances can include not only alcohol and tobacco but also non-medical use of marijuana, opioids, benzodiazepines, or anesthetics, such as ketamine or propofol.[9]

Mental Health, First Responders & Substance Abuse

The nature of high-stress, high-pressure jobs, as well as the propensity for danger and repeated proximity to trauma, violence, and tragedy, can put first responders at a high risk for mental health issues as well as problematic substance abuse. Mental health disorders and substance abuse often co-occur, as about half of those who have a mental health disorder will also develop SUD and vice versa.[10]

Substance abuse and mental health issues are often complexly intertwined, and both can be a risk factor for exacerbating, complicating, and compounding the other. Trauma and stress-related mental health disorders, including depression, anxiety, and PTSD, are common in first responders.

Depression

Police officers and firefighters are more likely to die from suicide than homicide or accident while in the line of duty.[11] Occupational stress coupled with barriers to behavioral health services and relationship issues that can be caused by intense work hours and shift times can all contribute to mental health issues, such as depression, which can increase the risk for suicide.

Depression is a mental health disorder indicated by low moods, feelings of helplessness, trouble feeling pleasure, sleep and appetite issues, and potentially suicidal ideations. Regular exposure to trauma, high stress, and isolation from family and friends can increase rates of depression in first responders.

Alcohol and drugs are common coping mechanisms for depression, but they can increase low feelings and the risk for suicide.

Anxiety

The job and lifestyle of a first responder can also make them vulnerable to developing a stress or trauma-related mental health condition like anxiety. Anxiety disorders can be triggered by high and chronic levels of stress.

First responders face all kinds of dangers and difficult scenes in their line of work, which can cause sleep problems, trouble focusing, difficulties regulating moods, irritability, and a higher rate of anxiety disorders.

PTSD

Responding to critical incidents, such as accidents, fires and violent crimes, can result in trauma for first responders. Post-traumatic stress disorder, or PTSD, is common in people who have witnessed a trauma, death, or a near-death experience.

First responders who have responded to critical incidents develop PTSD or psychological trauma related to this exposure between 5.9% and 22% of the time.[12] As many as 35% of police officers have PTSD.[13]

First responders often do not get the help they need. They continue to show up to work and take care of others, frequently making their own trauma and stress disorder worse. This can lead to substance abuse as a method of coping.

In the short term, alcohol and drugs can seem to provide an escape from the intrusive thoughts or memories, but the low following the “crash” can be even more pronounced. Substance abuse can make PTSD worse, and the opposite is also true.

Barriers for Seeking Help

First responders often face barriers when it comes to seeking help for mental health concerns and substance abuse issues. A lot of this is due to the stigma surrounding these conditions and the idea that a job might be lost over admitting to problematic drug or alcohol use or mental health issues.

The police force and firefighters are often considered a brotherhood. The idea is that these first responders are meant to be strong, and asking for help can be perceived as weak. Strength and self-reliance are highly esteemed in the culture of first responders, which can be barriers to seeking help for mental health disorders.[14]

First responders may have scheduling issues related to demanding, long, and odd work hours.

Another potential barrier to treatment is not knowing where or what to look for. Education can play a big role here. First responders who better understand mental health issues and how and where to seek help are more likely to get what they need.

Treatment Options

There are various treatment options available to first responders who need support for mental health issues and substance abuse concerns. Treatment models need to take into account the unique stressors first responders face and the nature of their job.

There are specific treatment programs that are tailored directly to first responders. These include inpatient and outpatient programs as well as peer support and community services.

Inpatient, or residential, treatment programs typically have the first responder go to a program, often to locations outside of their own local area, where they will stay on site and receive structured programming with constant supervision and support. Outpatient programs are more flexible allowing a person to continue living at home, often still going to work, while attending workshops and sessions around their schedule.

The level of care needed is specific to each individual and the severity of the mental health and/or substance use disorders.

Treatment modalities within different models can include the following:

  • Individual therapy and counseling: First responders can receive specific support and learn tools and coping mechanisms while learning the root causes of mental health and substance abuse concerns.
  • Group therapy and counseling: Group sessions can build on positive habits and life skills for managing stressors and the intense work environments of first responders.
  • Cognitive behavioral therapy (CBT): CBT helps to identify how emotions and thoughts impact actions. It aims to modify negative patterns into more healthy ones with a mindfulness approach.
  • Dialectical behavior therapy (DBT): Another form of behavioral therapy, DBT works to foster understanding and acceptance of intense feelings and teaches methods for living with these emotions.
  • Dual diagnosis treatment: When a mental health disorder and SUD co-occur, both disorders will need to be treated simultaneously in an integrated fashion through dual diagnosis treatment methods.
  • Life skills programs: These workshops can help to teach management skills and methods for coping with the stresses of the job and daily life.
  • Educational programming: Learning about mental health, stigma, and problematic substance use can help to overcome barriers to care and ongoing recovery.
  • Family support services: For first responders, it is often even more important to involve the family in treatment programs through therapy, counseling and education. This can leverage more support at home. First responders often feel like they have to solve problems on their own, but through these services, they can build a support system.
  • Peer support groups: Meetings with other first responders can be an ideal outlet to help this community feel less isolated and form positive sober connections.
  • Medication for Addiction Treatment (MAT): MAT can be helpful for opioid use disorder (OUD). It works to keep discomfort to a minimum while reducing problematic drug use.

Help for a Functional Alcoholic or Addict

Nearly 20% of people struggling with an alcohol use disorder are classified as functional alcoholics.[15] A functional alcoholic, or addict, is typically middle-aged and well-educated with a stable home life and job. This can commonly apply to first responders.

First responders are often able to perform their job duties and manage their lives while still struggling with problematic substance use. From the outside, it can look like everything is fine.

A functional alcohol or addict still needs help for addiction. Drinking or drug use usually becomes an even bigger problem eventually.

One of the most important things for a family member of a functional alcohol or addict to do is to stop enabling them. Family members and coworkers often make excuses for these individuals and in a sense “clean up their messes.” This allows them to keep drinking or doing drugs to excess.

A structured intervention with a trained professional can help to facilitate a conversation with a loved one and help to get them into a treatment program.

Self-Care Tips for First Responders

First responders require a special level of self-care to balance mental health and reduce the temptation to use drugs or alcohol as coping mechanisms. It can be helpful to prepare for difficult calls ahead of time as much as possible and have realistic expectations to keep the pressure manageable.

During a call, it is helpful to work in teams instead of alone. Keep an eye on signs of burnout and secondary stress. Work out a buddy system with coworkers to support each other and watch out for signs of stress.

Self-care techniques for first responders can include the following:[16]

  • Practice relaxation and breathing techniques.
  • Get enough exercise.
  • Eat a healthy and nutritious diet.
  • Get enough sleep.
  • Limit work hours to no more than 12-hour shifts.
  • Consider writing in a journal regularly.
  • Talk to friends, family members, and coworkers about experiences and feelings.
  • Limit caffeine and alcohol intake.
  • Remember that your needs are just as important as the people you help.
  • Take breaks when needed.
  • Work in teams and limit time spent working alone.
  • Remember there are others to help too.
  • Set healthy boundaries; it is okay to say “no.”

The most important thing is to remember to seek help when things feel overwhelming or out of control. Any mental health or substance use concerns can benefit from professional help.

Resources for First Responders

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Citations

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  7. They Drink When They’re Blue: Stress, Peer Pressure Contribute to Police’s Alcohol Culture. The Dallas Morning Newshttps://www.dallasnews.com/news/investigations/2012/01/16/they-drink-when-theyre-blue-stress-peer-pressure-contribute-to-polices-alcohol-culture/. January 2012. Accessed February 2022.
  8. Firefighters and Alcohol: What the Data Says. FireRescue1.  https://www.firerescue1.com/fire-chief/articles/firefighters-and-alcohol-what-the-data-says-EEmQCV9ztxdv60BH/. April 2015. Accessed February 2022.
  9. We Need to Change Our Approach to Substance Abuse in EMS. Journal of Emergency Medical Services (JEMS). https://www.jems.com/operations/we-need-to-change-our-approach-to-substance-abuse-in-ems/. October 2017. Accessed February 2022.
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  11. Study: Police Officers and Firefighters Are More Likely to Die By Suicide Than in the Line of Duty. Ruderman Family Foundation. https://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/. Accessed February 2022.
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  15. Researchers Identify Alcoholism Subtypes. National Institutes of Health (NIH) https://www.nih.gov/news-events/news-releases/researchers-identify-alcoholism-subtypes. June 2007. Accessed February 2022.
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