First responders include firefighters, paramedics, police, active duty military, corrections officers, and emergency medical technicians, among other rescue workers. Unfortunately, the incidents, images, and experiences encountered daily lead to numerous trauma-related problems. Misusing drugs, alcohol, or prescription medication becomes a way of coping with this trauma. The constant exposure to life-threatening situations, trauma, working long hours, sleep deprivation increases the risk of developing an addiction. Many of these problems often involve excessive alcohol use or prescription drugs.
Additionally, dealing with addiction is difficult for first responders because it is not easy to admit there is a problem. Much of the fear of admitting there is a problem stems from a stigma, which has begun to change. However, first responders are not often the first ones to admit they are struggling with addiction until it is too late. Substance abuse treatment for first responders is addiction services that address the specific problems or underlying issues. For example, this may include peer support or group therapy, individual counseling, and an application of different therapy models. Holistic approaches are also used to improve physical health. Treatment is essential because of the level of responsibility these jobs have.
Signs of Addiction Among First Responders
Noticing when someone struggles with addiction is not easy, but there are some red flags to look for. There are physical symptoms, external signals, and subtle psychological symptoms that help in identifying if someone is struggling with addiction. Some of the possible indicators for substance abuse include needle marks, burned fingers or lips, slurred speech, dilatated or constricted pupils, tremors, appearing lethargic, mood swings, and drastic changes in mood and behaviors.
Typically, among first responders, it is important to be aware of the behavioral indicators, especially after a significant incident or event. For example, this could include difficulty concentrating, focusing, or completing a task. The person may appear distracted or disorientated and begin to make inappropriate decisions or unreasonable choices. Also, they may struggle to make decisions, experience lapses in memory, or completely blacks out. Coworkers may notice the person is needing direction constantly, struggles to recall specific details, and needs assistance with basic tasks like filling out paperwork.
The physical and psychological demands of the job create circumstances where drugs and or alcohol could be used to cope. According to an article published in the American Journal of Addictions, in a large sample of urban police officers—approximately 18.1% of men and 15.9% of women reported experiencing adverse consequences from alcohol use. Also, about 7.8% of them met the criteria for lifetime alcohol abuse or dependence. The female police officers in the study had patterns of alcohol use similar to male police officers.
Many of the indicators of addiction begin with problems associated with post-traumatic stress. Per the journal article, among the general population and Americans with a history of PTSD, an estimated 52% of men and 28% of women have a history of co-morbidity. The evidence among police offers suggests alcohol abuse and dependence are a significant concern. Some studies have shown that up to 25% of police officers have serious problems with alcohol.
When Do Members of First Responders Need Substance Abuse Treatment?
When coworkers, family members, or friends begin to notice the signs of addiction, it is time to intervene and help. Most first responders are in a high-risk occupation group where it is possible for them to experience a wide range of physical and mental health consequences as a result of doing their job. For example, secondary traumatic stress is an emotional response to the duties of a first responder, and this often refers to the presence of PTSD symptoms. Unfortunately, drugs and alcohol have become an easy way to cope with these problems. Alcohol and prescription drug abuse are some of the most recognized issues.
Some of the signs of this stress include fear in situations that others would not find frightening, or the person is excessively worrying that something bad is going to happen to them, their loved ones, or coworkers. Someone struggling with a significant amount of stress becomes easily startled, feels jumpy, or is on-guard all the time. They would also become wary of situations at work, fearing for the worse. Some of the physical signs include a racing heart, shortness of breath, and increased tension headaches. Also, they may have a sense of being haunted by the things they have seen or experiences and have experienced a continuous sense of dread.
These are all serious issues that become progressively worse without help and contribute to the increased need to abuse drugs or alcohol. According to the Substance Abuse and Mental Health Services Administration, in a study investigating alcohol use in police officers following Hurricane Katrina, there was a significant association between hurricane relief efforts and hazardous alcohol drinking. Also, the lifetime prevalence of suicidal ideation in police officers was 25% in female officers and 23.1% in male officers. Another study found that career firefighters reported higher levels of problematic alcohol use and PTSD as compared to volunteer firefighters. Heavy or binge alcohol drinking was reported in approximately 50% of male firefighters.
Many first responders experience problems with burnout, which also increases the risk of substance abuse where treatment is required. Burnout is usually characterized by emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment. These problems develop due to general, occupational stress, and everyone experiences it differently. Someone who is burnt out from work may misuse drugs or alcohol to cope. Some of the symptoms involve feeling as if you can do nothing to help or are always tired, exhausted, or overwhelmed. Also, there is feeling like a failure and as if you are noting doing your job well.
Additionally, there are feelings of being frustrated, cynical, disconnected from others, indifferent, lacking feelings, and always feeling depressed. The mixture of addiction and these continuing psychological problems increases the risk of overdose and or suicide. According to an article published on EMS1, problems with depression and PTSD affect an estimated 30% of the nation's first responders, compared to 20% of the general public. Approximately 3.7% of Americans have contemplated suicide, yet it jumps to 37% for fire and EMS professionals. Also, 0.5% of Americans attempt suicide, and 6.6% of fire and EMS professionals attempted suicide. These ongoing issues must be resolved with well-rounded evidence-based substance use treatment, counseling, and or therapy.
How Does Drug Rehabilitation for First Responders Operate?
The rehabilitation process is similar in many ways to other programs. However, there are usually internal support services and access to referrals to programs used by police departments, EMS, firefighters, etc. The first step should involve an assessment or at least confiding in someone that can guide you in the right direction. An assessment would determine what the extent of the problem is and what forms of help are available. Following an assessment, detox would be needed, especially if the addiction involves pain medication or other types of addictive prescription drugs. However, detox should not be considered the only approach because it will not address underlying issues or the reasons why.
Therapy and counseling for first responders would either be accessed through an internal program or external services. For example, it could involve outpatient counseling or treatment provided by the healthcare plan. It is not uncommon for first responders to attend residential rehabilitation and take a medical leave of absence. It is important to address the issues and receive proper counseling and aftercare support. Peer support groups are often excellent resources because it is made up of other first responders struggling with similar issues. Treatment should not be avoided because the problem does become worse.
According to research examining the assessment and treatment of traumatic stress in first responders, following the Boston Marathon bombing, the LEADER program was developed, which stands for Law Enforcement, Active Duty, Emergency Responder. The program offers services across multiple areas and levels of care that include inpatient or residential treatment, partial hospitalization, and outpatient programs. The treatment process involves an initial assessment, symptom stabilization, and skills training, trauma-focused processing, and consolidation, and aftercare.
However, the first step is asking for help, and this is not always easy. An article published on EMS1 highlighting what first responders need to know about asking for help and getting into treatment. The article notes there are real or perceived social, political, or systemic obstacles that exist, stopping an individual from asking for help. Also, there is a feeling of shame, fear, or appearing weak or concern about one's reputation. Countless first responders suffer in silence and never ask for help. A good place to seek help is through trusted coworkers or through a peer support team that is recognized for helping first responders.
However, there is a reluctance to attend support meetings. Some first responders choose to attend meetings in different cities or use virtual meetings to help. Outpatient counseling is a common option, but it should be a program where the professionals know how to work with first responders. Inpatient treatment could be needed, and many treatment centers provide specific services for first responders. However, there are some important questions to consider, like is a lower level of treatment necessary before insurance approves residential care. Also, does insurance cover inpatient treatment, what are the added costs, or could time be utilized under the Family and Medical Leave Act.
Alternatives to Treatment for First Responders and the Prevalence of Addiction and Substance Misuse
Overall, first responders can positively contribute to their behavioral, cognitive, spiritual, and emotional resilience. Taking a proactive approach to your physical and mental wellbeing within a high-stress job significantly reduces your chances of becoming addicted to drugs or alcohol. The Substance Abuse and Mental Health Services Administration outlines tips for disaster responders for preventing and managing stress, which also includes involving the family.
Some of the core strategies or components involve adequate sleep, good nutrition, regular physical activity, and active relaxations, like yoga or meditation. It is essential to get enough sleep or at least rest and consume enough fluids to stay hydrated while also eating healthy foods. Simple things like completing basic hygiene tasks as wearing clean clothes or cleaning up before you leave work. It is also important to make time to learn about the people you work with and having conversations that contribute to developing positive feelings towards yourself and others.
It is a good habit to engage with your coworkers to celebrate success and mourn sorrows as a group, and also take time to be alone so you can reflect and rest. Many first responders practice spiritual beliefs and reach out to spiritual leaders for support. Also, take time away from work when possible and spend time with family and friends removing the stress. Most importantly, communicate with friends, family, and coworkers.
Unfortunately, these issues extend across the United States. According to an article available in the National Library of Medicine, a survey was done to examine alcohol use patterns among career and volunteer firefighters. The results of the survey indicated that career firefighters drank approximately ten days per month and drank relatively heavily on those days. Approximately 58% of career firefighters reported binge drinking on days they consumed alcohol.
Additionally, another article outlining the occupational risk factors in emergency medical services suggests that EMT's are at a greater risk of developing physical and mental stress-related disorders. Exposure to traumatic events was reported to be between 80% and 100% among EMTs. High-risk alcohol and drug use rates among other emergency response professionals were reported to be as high as 40%. Historically, these problems are nothing new and have affected first responders for generations.
The US Firefighters Association estimated that around 10% of firefighters might be abusing drugs. It also estimated that the threat of alcohol abuse among firefighters is more than double than that of the general population. Studies done in the early 1990s found there is a general relationship between stress, stressful occupations, and substance abuse. Information taken from the Firefighter and First Responder Alcohol and Drug Issues Part I found that 40% of firefighters were experiencing psychological distress, and 30% experienced problems with alcohol abuse.
Common Terminology with First Responders and Substance Use Treatment
| Term | Definition |
|---|---|
| First Responders | these are individuals with specialized training who are among the first to arrive and provide assistance at the scene of an emergency. For example, these are police, firefighters, EMTs, military, and paramedics, etc. |
| Trauma | is either physical or psychological. Psychological trauma is damage to the mind that occurs as a result of a distressing event. Trauma is often the result of an overwhelming amount of stress that exceeds one's ability to cope. Trauma could involve acute trauma, chronic trauma, or complex trauma. |
| Stressors | a stressor could be a chemical or biological agent, environment condition, external stimulus, or an event seen as causing stress to an individual. For first responders, these are events or environments that are considered to be demanding, challenging, and or threatening the individual's life or safety. |
| Post-Traumatic Stress Disorder | PTSD is a problem that occurs when someone has experienced or witnessed a traumatic event such as a natural disaster, serious accident, a terrorist attack, war or combat, or a violent crime. First responders often witness traumatic events daily depending on the job, and drugs and alcohol become an unhealthy way to cope. |
| Burnout | is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Burnout frequently occurs among first responders because of long hours experiencing traumatic situations. |
| Compassion Fatigue | is characterized by emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others. |
| Vicarious Trauma | is a transformation in the self of a trauma worker or helper that results from empathic engagement with traumatized clients and their reports of traumatic experiences. The individual begins to feel like they are experiencing trauma from working with trauma victims. |
| Stress Management and Prevention | is a wide spectrum of techniques and psychotherapies or holistic practices aimed at controlling and managing a person's level of stress, especially chronic stress. Most first responders use different stress management techniques to cope with difficult parts of the job. |
| Self-Care | is any necessary human regulatory function within is under individual control, deliberate and self-initiated. For example, eating healthy, exercise, and personal hygiene. |
| Self-Awareness | the experience of one's own personality or individuality and being aware of your environment or personal struggle and feelings, for example. |
