Substance abuse has no preferences in terms of race, gender, or profession. Everyone’s at risk of developing some form of addiction, even the people who do their best to keep us safe or take care of us in the moment of need. First responders often sacrifice their lives and safety to help their communities. Dealing with stress and facing danger or other unfortunate scenarios on a daily basis take their toll on mental health. All this could lead to the development of substance abuse. Unfortunately, the subject regarding substance abuse risk in first responders is often overlooked. The primary objective of this post is to provide more information on this topic. Scroll down to learn more.
In May 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report which focused on behavioral health and other concerns in first responders. The report included paramedics, police officers, and firefighters, so we’re going to refer to it several times through this post.
The biggest risk factor for the development of behavioral and other problems in first responders is the pace of their work. Since they’re facing risky and highly stressful calls, first responders can experience difficulties integrating work experiences. The report continues to say paramedics (emergency medical technicians or EMTs) have high rates of depression.
Indeed, a study from Prehospital Emergency Care found a high prevalence of stress, anxiety, and depression in paramedics. About 6.8% of paramedics were classified as depressed, 6% as anxious, and 5.9% as stressed. While these percentages may not seem that high to you, just keep in mind we’re talking about emergency medical technicians whose main job description is to be prepared for any scenario, answer any call, and provide an optimal level of care. Scientists confirmed it’s a statistically significant demographic, which requires further research.
The same journal also published a study that evaluated health outcomes in disaster situations. The paper reported 21.4% of medical workers responding to the East Japan earthquake in 2011 were diagnosed with clinical depression. Besides depression, emergency medical technicians also have a high prevalence of posttraumatic stress disorder (PTSD).
However, a study from the BMC Psychiatry shows psychological distress in paramedics is not just a result of exposure to traumatic events only. Instead, behavioral and psychological problems often arise from the problems at the managerial and organizational levels. These include work-related stress, lack of empathy from managers to problems paramedics face, a military-like environment that discourages emotional displays of stress. Other factors that lead to psychological distress in paramedics include:
- Lack of confidentiality
- Inappropriate therapies
- Inadequate return-to-work mechanisms
Emergency medical technicians believe they receive insufficient support from the organization to manage work-related stress, anxiety, burnout, or PTSD. Since they feel stigmatized, they’re reluctant to seek professional help for their psychological problems.
Despite high exposure to stressful and traumatic situations as well as organizational/managerial problems, substance abuse among EMTs is poorly explored, unfortunately. Evidence from a review of evidence on occupational stress exposure, PTSD, and high-risk alcohol and drug use among EMTs shows a big problem that needs to be addressed.
Results of the review showed 80% to 100% of EMTs were exposed to traumatic events. About >20% of paramedics had PTSD. The biggest revelation was that the prevalence of alcohol and drug use in EMTs was as high as 40%. Almost half of all paramedics from the reviewed evidence had substance abuse problems. That’s a staggering number!
Scientists behind this review showed there is a direct linkage between exposure to occupationally-related stress and high-risk alcohol and drug use. Substance abuse is a substantial risk for EMTs but also for patients they treat.
While studies focusing on paramedics and addiction are scarce and lacking, a growing body of evidence confirms depression, stress, and PTSD are all considered risk factors for substance abuse. Remember, all these problems are common in EMTs.
For instance, Current Opinion in Psychiatry published a paper that revealed almost one-third of patients with major depressive disorder also has substance use disorder. This comorbidity increases the risk of suicide and greater social or personal impairment.
Evidence confirms that mental health disorders, including different types of anxiety such as PTSD, are all associated with a higher risk of substance abuse. Again, while these studies didn’t focus on paramedics specifically, they do show a clear link between mental health or behavioral problems with a higher likelihood of developing a substance use disorder.
Further research on this subject is required, especially to focus specifically on EMTs and their risk of substance abuse, addiction, and recovery.
The SAMHSA’s report confirms police officers are at a higher risk of negative mental health outcomes primarily due to dangerous aspects of their jobs. Police officers are also more likely to experience critical incidence, environmental hazards, and traumatic events.
Mental health problems are common in police officers. For example, the June 2020 issue of Police Practice and Research published a study that focused on the mental health and needs of police staff in Scotland. Participants experienced high levels of occupational stress and anxiety (including PTSD) and depression. Subjects who reported depression connected their mental health problem to occupational stressors. A notable role in their depression belonged to a lack of feeling valued or appreciated.
Primary work-related stressors for police officers involved in the study were a job role, working hours, workload, and organizational culture. Their experience, personal background, and qualities influenced police officers’ reactions to work-related stressors. Unfortunately, police officers feel like they’re unable to be open about challenges they face due to the stigma linked with mental health in their workplace. Even though stigma isn’t as extreme as it was before, it’s still present and makes it difficult for affected police officers to be open about their struggles. Unfortunately, failure to seek support for mental health problems out of fear of being stigmatized only aggravates worsens their mental health.
The October 2020 issue of JAMA Network Open also published a study that focused on the mental health of police officers. More specifically, the main objective of the research was to evaluate the prevalence of mental illness and mental health care use among police officers in the large, urban police department. The study included 434 police officers. Results showed 12% of subjects were diagnosed with a mental health problem at some point in their lifetime, while 26% of police officers reported current symptoms of mental illness. Additionally, within the past 12 months, about 17% of police officers sought mental health care services.
Although 434 subjects may not seem like a large sample size, the study showed mental health is an occupational concern for police officers. Those with current symptoms of mental illness screened positive for PTSD, depression, anxiety, suicidal ideation, and self-harm. Mental health problems were particularly high in female police officers and officers who were widowed, divorced, separated, and those with military experience.
The most concerning discovery in this study was the fact police officers confessed they were accustomed to traumatic and stressful events so much they became numb to it. Why is this concerning? Simple – if a police officer is unaware of how work impacts their mental health, then they don’t know it’s time to seek treatment. In addition to the inability to identify mental health problems or realize they need help, police officers didn’t seek treatment for other reasons. These include:
- Concerns about confidentiality within the department
- Feeling unfit for duty
- Believing psychologists don’t understand their work and duty
Indeed, police officers face a great deal of trauma at work, but many of them fail to report it. A study of 575 police officers, published in Policing and Society, revealed many of them have experienced traumatic events at work, or they know a fellow officer who has. That being said, the police officers were reluctant to disclose traumatic experiences to their agencies. Additionally, many police officers refused to seek help within their agencies primarily due to the abovementioned stigma.
Probably the best way to understand the impact of police officer’s line of duty is to take the example of the 9/11 attack and how it affected their mental health. The American Journal of Industrial Medicine published a study that found 24.7% out of 1884 police-responders after the 9/11 attacks had depression. Moreover, 47.7% of subjects had both depression and anxiety. These results didn’t focus on mental health problems immediately after the traumatic event but 10 to 11 years later. Scientists also found PTSD with depression and anxiety was more pronounced in the presence of other factors such as:
- Having a Hispanic ethnicity
- Decrease in income
- Having experienced a physical injury on 9/11
- Having experienced traumatic/stressful events since 9/11
- Being unemployed
- Unable to work due to health
- Being retired
Police officers with comorbidity (PTSD and depression or anxiety and depression) were more likely to report more days of weak physical/mental health, reduced satisfaction with life, poor overall health, and unmet mental health needs than their fellow officers with only one of these conditions. Like in many other studies involving police officers, and the abovementioned paramedics, the biggest reason for failing to seek help are confidentiality concerns. Police officers were worried about losing their status among peers, being demoted to more restricted work status, and other problems at work that could arise due to violated confidentiality.
As seen throughout this section, police officers face many challenges and traumatic events that lead to mental health problems. Most of them don’t seek help due to a lack of trust, i.e., concerns about violating confidentiality. This only aggravates their mental health problem such as PTSD, depression, anxiety, or comorbidities. In other words, mental health issues and failing to seek help create a vicious cycle that only worsens a police officer’s symptoms and overall quality of life and general wellbeing.
Line of duty makes police officers susceptible to mental health problems, but they go beyond anxiety and depression. Behavioral and mental health problems of police officers extend to substance abuse, too.
For example, the International Journal of Emergency Mental Health published a study that examined the relationship between alcohol use and the level of involvement during Hurricane Katrina among law enforcement officers. According to results, heavy disaster exposure was strongly associated with hazardous alcohol use among police officers. First responders experienced a great deal of stress during the Hurricane Katrina disaster at work, but also in a personal aspect. Many of these police officers reported extreme damage to their homes. These personal or additional stressors only influence the scope of a traumatic event and negative outcomes.
That said, officers with low or moderate exposure to the Hurricane Katrina disaster didn’t have an increased score at a test suggesting alcohol use. These officers are able to recover from a disaster without hazardous alcohol consumption.
Research from the American Journal of Addictions found that out of 712 police officers who participated in the study, 11% of males and 16% of females reported at-risk levels of alcohol use the past week. More than one-third of male and female police officers engaged in binge drinking past month. Also, 16% of females and 18% of male police officers reported adverse consequences brought on by alcohol use. Data also suggested police officers were more likely to engage in binge-drinking episodes than the general public. In fact, female officers were two to three times as likely.
A major predictor of severity of alcohol use disorder among police officers is PTSD, evidence shows. Posttraumatic stress disorder is common in police officers hospitalized for alcohol and related to higher severity of addictive disorders, including tobacco use.
Research focusing on Australian police officers found the highest level of alcohol consumption was in the 18-to-25 age group. Additionally, around 25% of police officers reported drinking alcohol while on duty. An alarming 30% of police officers scored at risk harmful consumption on the AUDIT test, while 3% met the alcohol dependence score.
Dangers of alcohol use go beyond the risk of developing an addiction. Studies show alcohol use, especially when combined with PTSD, increases the risk of suicide ideation.
Bearing in mind, many police officers are reluctant to seek help for the trauma they experience, various substances serve as coping mechanisms. Police officers may decide to take a certain substance to slow down an overactive mind or to escape reality. In most cases, these substances include:
- Prescription painkillers
Consumption of these drugs puts a person at ease, i.e., allows them to feel relaxed. To a person who’s experienced a traumatic event or does so on a daily basis, these substances may seem like a good solution. But as it always happens, the intake becomes more compulsive. More of the drug is necessary to achieve the same effects, thus paving the way to dependence and addiction.
Like other first responders, firefighters are at the forefront in times of crises, disasters, and other types of danger. Repeated exposure to life-or-death scenarios has a major impact on their mental health and wellbeing. Demanding work schedules can harm their quality of sleep and thereby contribute to psychological symptoms.
Firefighter’s line of duty can take its toll on mental health and, probably, even more so among inexperienced individuals.
A study from Psychiatry Research examined mental health among career and volunteer firefighters and yielded interesting findings.
Researchers enrolled 525 firefighters, of whom 204 were volunteers and 321 career firefighters. Findings revealed volunteer firefighters reported significantly higher levels of depression, PTSD, and suicidal symptoms than their counterparts. On the other hand, career firefighters reported high levels of alcohol use.
Presumably, the biggest reason volunteer firefighters had more mental health problems is down to increased structural barriers to mental health care in terms of availability of resources and cost.
Other studies also pointed out volunteer firefighters had a higher prevalence of PTSD, which is greatly influenced by trauma load and sense of coherence (SoC). The term SoC refers to the firm belief in experiencing internal and external environment as predictable, related to the feeling of being prepared for what’s coming.
Evidence shows repeated exposure to trauma results in desensitization, flashbacks, and irritability in firefighters. Scientists explain it’s likely that the long-term impact of repeated exposure to traumatic events is closely intertwined with other mental health outcomes and poorer general wellbeing.
Career firefighters and those with greater experience may have better resilience regarding the impact of trauma on their mental health. For instance, the January 2021 issue of Psychological Trauma found firefighter recruits (a total of 322) were exposed to about nine potentially traumatic events, and 66% of them occurred in the line of duty in the first year of service. Around 3% of participants developed PTSD, generalized anxiety disorder, and depression. Over time, distress stabilized among firefighters and wasn’t predicted by exposure to trauma.
The American Journal of Health Promotion featured a study that evaluated health outcomes among US firefighters, and their findings also confirmed this line of duty could lead to mental health problems. Repeated exposure to trauma and sleep disruptions are among the factors that impacted mental health within fire service organizations. Many organizations support the need for mental health services for firefighters, but there is an ongoing debate about the best treatment approach.
April 2020 issue of Brain and Behavior published research whose main objective was to investigate mental health and quality of life in firefighters in the capital area and growth promotion area of South Korea. A total of 206 firefighters participated in the study, of which 110 were from the capital area and the remaining 96 from the growth promotion area. Differences in mental health domains were significant between these groups. The only domain without differences was in the quality of life of firefighters. Firefighters from the capital area experienced more mental health problems than their counterparts. Despite a rather small sample size, the study goes to show the impact of firefighting services on mental health may depend on the location. Larger areas bring more traumatic events and may, thereby, negatively affect the psychological health and wellbeing of a firefighter.
According to a study from the March 2019 issue of the Journal of Nervous and Mental Disease, greater anxiety sensitivity and PTSD symptoms were linked with increased suicide risk among male firefighters. This relationship was strongly mediated by anxiety sensitivity cognitive concerns.
As mentioned above, career firefighters reported more alcohol use than their volunteer counterparts. In this section, we’re going to focus more on the subject of substance abuse in firefighters.
According to a study from Women’s Health Issues, recent or past month heavy/binge alcohol drinking was reported by about 50% of male firefighters. At the same time, 9% of firefighters reported driving while intoxicated. The same study showed the prevalence of alcohol use was high among female firefighters as well. About 40% out of 1913 female firefighters in the study reported binge drinking in the previous month. Moreover, 4.3% of female firefighters reported driving while intoxicated. Compared to their counterparts, problem drinkers were 2.5 times as likely to have been diagnosed with depression, have symptoms of PTSD, and were also 40% more likely to sustain an injury.
In a study from the Journal of Occupational and Environmental Medicine, alcohol and tobacco use were present among firefighters. While the sample size was small, it showed:
- 59% had sleep deprivation
- 58% engaged in binge drinking behavior
- 21% had poor mental wellbeing
- 20% reported current nicotine use
- 14% engaged in hazardous drinking behavior
- 11% had depression
- 8% experienced poor physical wellbeing
- 5% reported caffeine overuse
- 4% reported poor social bonding
The alcohol-tobacco relationship was found to be moderated by depressive symptoms in a study that assessed the use of these substances in firefighters during their first three years of service.
High rates of heavy and binge drinking among firefighters in the Central US were observed in a study featured in Occupational Medicine. The study included 656 firefighters from 11 career and 13 volunteer departments. According to results, career firefighters drank about ten days per month, and alcohol consumption was relatively heavy. Moreover, 58% of career firefighters and 40% of volunteers drank three or more drinks on average. Similar values were observed with binge drinking on days when they consumed alcohol. It’s also useful to mention that 9% of career firefighters and 10% of volunteer firefighters in this study reported driving while intoxicated within the last month.
A study from Comprehensive Psychiatry found latent alcohol dependence among firefighters was directly associated with latent suicide risk variables. That said, when scientists added PTSD and depression into the equation, alcohol dependence wasn’t linked with suicide risk any longer.
Despite the fact that firefighters, and other first responders, face dangerous and traumatic events on a daily basis, their mental health and substance abuse risk are still insufficiently studied. Most studies had a small sample size, or they focused on one aspect of substance abuse, usually alcohol or tobacco.
Reasons a firefighter may engage in substance abuse are not the same for every person. But they usually involve around:
- Traumatic events, life-or-death situations
- On-the-job injuries
- Fire station culture were engaging in heavy drinking sessions is normalized
Similar to other first responders, firefighters may struggle with mental health problems, including depression, PTSD, acute stress disorder, and anxiety. As seen throughout this post, psychological problems can increase the risk of substance abuse. For many persons drinking alcohol is a coping mechanism to numb their feelings or make unpleasant thoughts go away.
So why don’t they seek help?
Stigma is the central theme in addiction and mental health problems surrounding first responders, including firefighters. The presence of these problems in firefighters is stigmatized by the general public, but also by fellow firefighters. The fear of being perceived as weak often prevents a person in need from seeking much-needed help and support. Times are changing, and stigma isn’t as strong as it used to be, but it’s still present in some fire stations. Moreover, while some fire stations have mental health services and encourage firefighters to discuss their traumas or stress, others do not. Lack of sources to get help is often considered as lack of support where an affected firefighter is left without options, especially if their income is low and they may not afford to pay for a therapy session.
First responders deal with numerous stressors that increase the risk of mental health and behavioral problems, including substance abuse. While they are dedicated to protecting and serving, police officers, paramedics, and firefighters need help as well. That’s where proper addiction treatment at the drug rehab center in Texas steps in. However, the importance of specialized treatment is often underestimated, but it can mean a huge difference in the recovery process of men and women who work in emergency services.
Why first responders need a specialized treatment program? The answer is simple – the treatment program needs to address their unique needs and challenges they encounter at the workplace. These needs and challenges are:
- The high degree of responsibility – everything first responders does affect their performance at work. Since their work is public service-related, the level of care for first responders with substance abuse needs to be advanced so they can recover successfully.
- Not the best patients – they say doctors are the worst patients, and we can apply this saying to first responders. Since it’s in their job description to treat, help, and protect others, first respondents find it difficult to adapt to the role of a patient where they are at receiving end of help.
- Easy access to illicit drugs and other substances – first responders have relatively easy access to narcotics which needs to be taken into consideration when treating police officers, paramedics, or firefighters with substance abuse.
- Stigma – public perception of first responders is often faulty. People somehow believe first responders should be there to help everyone, which is why they should never be in such a condition that requires someone’s help. Substance abuse is often perceived as a character flaw that makes a “regular” person conclude a police officer/paramedic/firefighter is unfit to do their job, even after a successful recovery. Stigma surrounding addiction among first respondents often complicates the treatment. First responders may be less likely to open up in group therapies out of fear of being judged. For that reason, they do better and benefit more from groups where their peers are present.
All these challenges only confirm the importance of specialized addiction treatment for first responders. The ideal inpatient residential treatment center for addiction program creates an environment where police officers, firefighters, and paramedics feel free to talk about their addiction without fear of being judged. Moreover, specialized addiction program for these patients focuses on helping them cope with everyday stressors and easy access to narcotics. Peer help and guidance play an important role here, as well.
Above all, confidentiality is crucial. A first responder with substance abuse needs the opportunity to recover in a supportive and encouraging environment without fear of their confidentiality being violated.
First responders dedicate their lives to save us in times of need, protect us from danger, and take care of us should we need urgent assistance. They serve their society with pride. We think of them as saviors who are both physically and mentally strong. While those things are true, we also need to acknowledge first responders go through trauma, highly stressful situations, and other scenarios that take their toll on their mental health. All this is aggravated by managerial and organizational problems. Many first responders have a high substance abuse risk, especially in terms of alcohol consumption. Unfortunately, stigma and lack of confidentiality prevent affected persons from getting much-needed help. All this only confirms the need for high-quality programs that would provide mental health support and addiction treatment when necessary.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction & pharmacology of drugs. He hopes to bolster Stonegate Center to the forefront of addiction medicine through bold, innovative content. He is currently pursuing his MBA in Finance from Texas Christian University.