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First Responders and Substance Abuse

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Society relies on first responders, including police, Emergency Medical Technicians (EMTs), and firefighters, for safety on a daily basis. First responders are exposed to a unique combination of stressors that may place them at an increased risk of developing PTSD and substance use disorders compared to the general public.1 It is especially difficult to obtain statistics on addiction among first responders due to the stigma surrounding substance use among this population.1

Police

Police officers face stressful situations every day. They risk their lives while enforcing laws and arresting criminals. When they become officers, they take an oath to protect and serve the people they represent. In the line of duty, they place others above themselves and often witness horrific accidents and other tragic events. These stressful situations may cause police officers to turn to drugs or alcohol. Studies have provided various reasons for the use and abuse of drugs and alcohol among police officers:

  • Stress: Stress increases vulnerability to addiction.2 Police officers may face a variety of stressful situations and environments. This could include traumatic working situations, such as being shot at, having to shoot a suspect, or witnessing a horrific event. Some officers may drink to self-medicate after a particularly long or stressful day. Acute and chronic stress may lead officers to seek alternate, ongoing coping strategies to deal with the stress, including drugs and alcohol.2
  • Culture: In some instances, the stereotypical images of officers leaving work and heading to the bar to let off some steam commonly depicted on television and the movies may not be far from the reality of police culture. One study reports that police work is a culture that views at-risk drinking, such as heavy or binge drinking, as acceptable behavior.3 Heavy drinking is defined as a man consuming 15 or more drinks per week and a woman consuming 8 or more drinks per week.4 Binge drinking is classified as periods of drinking with the intention of becoming intoxicated. For men, binge drinking occurs when the user drinks 5 or more alcoholic beverages in 2 hours or less.5 For women, it is 4 or more drinks in 2 hours or less.5 For police officers, these behaviors may occur at work functions or after their shifts are over. Some officers may drink simply because the alcohol is available and drinking is considered an acceptable behavior.3
  • Peer pressure for female officers: Men and women deal with stressful situations differently, but when working as police officers, women may adapt to their primarily male-dominated workforce norms. This may include participating in unhealthy drinking behaviors.3 One study reports that female officers drink more than women in the general U.S. population.3 When compared to male officers, female officers were just as likely to have consumed alcohol in the past week and to have participated in binge drinking in the past 30 days.3 While statistics for the general population indicate men participate in heavy drinking and binge drinking behaviors more than women, the discrepancy doesn’t hold true for women in uniform.3

EMTs

Emergency Medical Technicians (EMTs) are relied upon to provide support and care during stressful, emergency situations but tend not to seek mental health support due to fear of stigmatization, confidentiality issues, or even damaging effects on their professional advancement.1 A variety of factors can contribute to EMTs developing substance use issues, including:1

  • Easy access to the drug supply.
  • Exposure to traumatic events.
  • Inherent stress of the job.
  • Long or irregular work shifts.
  • Mobile teams not having direct supervision.
  • Overnight shifts.
  • Physically demanding job duties that can lead to injuries.
  • Self-medicating to deal with distressing situations, such as being unable to save a patient, dealing with the sometimes gruesome scenes of accidents, etc.
  • Unwillingness to seek professional help to manage mental health issues, such as depression, post-traumatic stress disorder (PTSD), or anxiety.
  • Work environments that can be hazardous or volatile.

Firefighters

Firefighters function in dangerous and stressful work environments that raise their risk of physical injury and can increase the likelihood of developing mental health issues, including substance use disorders.1 Firefighters have higher rates of excessive or binge drinking than the general public.6 In one study, nearly 30% of male firefighters screened showed possible or likely issues with alcoholism.6 This can be attributed to a number of factors, such as:

  • Physical injuries: Firefighters are placed into dangerous situations as part of the job and can sustain painful or life-threatening injuries. This can make it more likely that pain medication is prescribed, which can develop into misuse or addiction to cope with physical or emotional pain.
  • Shift schedules: Most firefighters work 24-hour shifts for about 10 days each month, leaving a lot of downtime to engage in drinking or substance use.6
  • Social norms: Drinking is commonly used as a way to relieve stress or promote camaraderie and is often viewed as a normal behavior.6 Camaraderie can be a vital part of firefighting, since firefighters often rely on coworkers for safety and support. Firefighters also tend to see their drinking as similar to that of the general public, while studies show that alcohol use is higher among firefighters.6
  • Stress management: Firefighters are exposed to horrifying experiences, including having to run into dangerous situations, seeing others hurt or dying, and losing coworkers and friends. Alcohol or drugs can be an easy way to deal with stress or try to manage painful emotions.
  • Traditions: Firefighters commonly go out drinking after a shift ends to help unwind and strengthen peer relationships.6 Recreational alcohol use has often been looked at in a much more positive light than drug use. Historically, some firehouses even served as local pubs.6

Dual Diagnosis Treatment

Those with PTSD are 2–4 times more likely than an individual without PTSD to have a substance use disorder.7 People with both PTSD and substance abuse disorders have more complex clinical needs when compared to those with either disorder alone.7 The potentially more complicated clinical course for first responders may involve the following issues:7

  • Increased chronic physical health problems
  • Poor social relationships
  • Higher rates of suicide attempts
  • More legal problems
  • Increased risk of violence
  • Higher likelihood of not following a prescribed treatment plan
  • Higher likelihood of dropping out of treatment
  • Less improvement during treatment

Treatment for first responders with a dual diagnosis of PTSD and a substance abuse disorder must start with a thorough assessment.7 Goals of the assessment include the following:7

  • Identifying the traumatic event
  • Identifying the problematic substance use disorder
  • Evaluating both problems
  • Assessing the severity of the symptoms throughout treatment

The first portion of the assessment is to identify PTSD through the use of screening tools to assist in diagnosing PTSD.7 The next step is to identify the substance or substances of abuse through blood or urinalysis testing. Once this is complete, the problems can be properly diagnosed and a treatment plan can be developed.7

Treatment may include both counseling and medications.7 There are two different schools of thought on how to approach treatment in a person with both PTSD and drug or alcohol abuse. The first focuses on addressing the substance abuse first. Once the user has been substance-free for a defined period of time, such as 3–6 months, trauma-focused treatment can begin. This method of treatment may require that the patient attend two separate treatment centers and have two different healthcare providers to complete the full course of treatment.7

The second method of treatment addresses both the PTSD and substance abuse issues at once. This model assumes such a close connection between the two diagnoses that they must be treated together in order for treatment to be successful. This method is often used when it is thought that the substance use disorder began after a traumatic event.7

Treatment of PTSD often occurs in a group therapy setting.7 This provides patients with a peer group that may better understand the symptoms they are experiencing, as well as the consuming effects of PTSD on everyday life. Focusing on the response to the traumatic event has been found to be more successful than revisiting the traumatic event during treatment.7

Treatment may include the following:7

  • Education for you and your support system on the connection between PTSD and substance abuse disorders
  • Exploration of the relationship between PTSD and substance abuse
  • Self-management of symptoms and negative emotions
  • Development of cognitive-behavioral coping skills, which may be effective in treating PTSD symptoms, such as depression, anxiety, anger, and sadness.

Sources

  1. Crowe, A., Glass, J.S., Lancaster, M.F., Raines, J.M., & Waggy, M.R. (2015). Mental illness stigma among first responders and the general population. Journal of Military and Government Counseling, 3(3), 132-149.
  2. Sinha, R. (2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences.
  3. Ballenger, J.F., Best, S.R., Metzler, M.A., Wasserman, D.A., Mohr, D.C., Liberman, A., … Marma, C.R. (2011). Patterns and Predictors of Alcohol Use in Male and Female Urban Police Officers. American Journal of Addictions.
  4. Centers for Disease Control and Prevention. (2016). Fact Sheets – Alcohol Use and Your Health.
  5. Centers for Disease Control and Prevention. (2017). Fact Sheets – Binge Drinking.
  6. Jahnke, S.A., Poston, W.S.C., & Haddock, C.K. (2014). Perceptions of alcohol use among US Firefighters. Journal of Substance Abuse and Alcoholism, 2(2).
  7. McCauley, J.L., Killeen, T., Gros, D.F., Brady, K.T., & Back, S.E. (2012). Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. Clinical Psychology, 19(3). 
  8. Myrick, H., & Anton, R.F. (1998). Treatment of Alcohol Withdrawal. Alcohol Health and Research World.
  9. U.S. National Library of Medicine. (2016). Opiate and Opioid Withdrawal.

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