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First Responders and Substance Abuse: Stress and Trauma Responses

First responders are often exposed to high-stress situations as a part of their regular duties. Firefighters, paramedics, and police officers are often people who thrive under pressure and can perform tasks in harrowing situations. However, even gifted individuals can be put under tremendous strain by high-stress environments and traumatic events.

Unmanaged stress can lead to mental health problems and substance use disorders. A single traumatic event is enough to leave some people with post-traumatic stress and other mental and behavioral health problems. But first responders may experience many high-stress events throughout a single day. They may also experience traumatic events throughout their careers. 

Substance use disorders can come from poor coping mechanisms as a response to the high-stress environments first responders may find themselves in. Learn more about substance abuse among first responders and how it can be addressed.

First Responder Substance Use Disorder Statistics

First responders experience mental and behavioral health issues at rates that are higher than the average population. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 30 percent of first responders develop behavioral or mental health issues like depression and post-traumatic stress disorder (PTSD). Only 20 percent of the general public struggle with these issues. This suggests that first responders are more vulnerable to mental and behavioral health issues due to the nature of their job. 

Addiction is a behavioral issue commonly tied to trauma and other mental health issues. Alcohol is one of the most commonly misused substances in the United States. First responders are more likely to misuse alcohol, one of the most commonly misused substances in the United States,  over other substances, especially if they are tied to law enforcement or have a military background. Veterans tend to drink alcohol and misuse opioid prescriptions more often than civilians, but they misuse illicit drugs at the same rate as civilians. 

SAMHSA reports that 50 percent of male firefighters reported binge drinking in a 2017 study. Around 9 percent of male firefighters reported driving while intoxicated. Women only make up around 5.1 percent of firefighters, but 60 percent reported drinking more than recommended, and 39 percent engaged in binge drinking. Only 12 to 15 percent of women in the general population reported binge drinking.

Trauma and the development of post-traumatic stress disorder (PTSD) is a common link to substance use problems among first responders. PTSD is a mental health disorder characterized by anxiety, panic attacks, flashbacks, nightmares, and continuing to relive a traumatic event. PTSD is more prevalent among first responders than it is in the general population. A 2014 paper reported that first responders that respond to a critical incident could experience PTSD at a rate between 5.9 and 22 percent.

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Why Are First Responders Vulnerable to Substance Use Issues?

First responders have a greater risk of developing a mental health problem because of their high-risk and often traumatic duties. But what’s the link between mental health issues and substance misuse. Substance use disorders (SUD) and mental health problems are closely related, even in the general population. It’s estimated that around half of the people who seek treatment for a substance use disorder also struggle with a mental health problem at some point in their lifetime. These issues may also be bidirectional, which means each issue can worsen the other. 

The relationship between drugs and mental health is complicated. Does one cause the other? Are they caused by overlapping factors like genetics and environment? Both substance use problems and mental health disorders can be caused by several factors working together, so it can be challenging to pinpoint just one cause. Still, it’s likely that mental health problems increase your risk for substance use issues and vise versa. 

One clear link between SUDs and mental health problems among first responders is self-medication. Self-medication refers to the use of a psychoactive substance to manage uncomfortable mental health symptoms without consulting a professional. Alcohol is one of the most common substances involved in self-medication, but it can be done with prescriptions and illicit drugs as well. 

Drinking is a social activity, especially among coworkers. Social interaction with coworkers can be a good way to blow off steam, especially among first responders. However, using drinking as a response to negative emotions and trauma is common and accepted. You may commonly hear the phrase, “I need a drink,” in response to a difficult moment or event. Drinking can become problematic when it grows into physical or psychological dependence. Signs of self-medication can include using alone, using to mask feelings, and using at odd times, like first thing in the morning or in the middle of a workday. 

In many ways, addiction is an unhealthy coping response to normal negative emotions or symptoms of mental health issues. Addressing substance use problems often involves identifying internal and external triggers that may lead to drug or alcohol cravings.

First responders to the scene of an overdose

Treating a Substance Use Disorder

Substance use disorders are a significant problem in the United States, and first responders are at high risk. Addiction is a chronic, progressive disease that can get worse if it’s ignored, so it’s important to address these issues as soon as possible. Though it’s chronic, even severe addiction can be treated and managed, leading a productive life free from active addiction. 

Addressing addiction issues often requires help from medical or clinical professionals. Speaking to a doctor or clinician can be a good first step in seeking treatment. When you begin a treatment program, you’ll go through a process of assessment that’s designed to determine the right level of care for your needs. You’ll also make a personalized treatment plan based on those needs, with the help of a medical or clinical professional.

Addiction can affect your physical, psychological, and social health, so treatment often needs to address all of those factors. High-level physical needs may require medically managed or monitored services. For first responders, issues like PTSD, depression, and anxiety may need to be addressed alongside substance use issues. 

If those problems are ignored, success in addiction treatment will be limited. Individual and group therapy sessions may be helpful in addressing past traumas. Behavioral therapy may be used to help find positive coping responses to triggers and symptoms of mental health problems. 

Addressing Challenges to First Responders

Police, fire, and emergency departments are working to address problems related to high-stress work environments and substance use issues. In many departments, potentially traumatic events are followed by mandatory critical incident stress debriefings as a way to process events before they can lead to PTSD. However, while many first responders benefit from these debriefings, others find them invasive and unpleasant. Some prefer peer-to-peer processing sessions where they can talk about events with other first responders.

Sources

American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction

Flannery, R., Jr. (1999, January 01). Treating Psychological Trauma in First Responders: A Multi-Modal Paradigm. Retrieved from https://link.springer.com/article/10.1007/s11126-014-9329-z

National Institute on Drug Abuse. (2020, May 28). Part 1: The Connection Between Substance Use Disorders and Mental Illness. Retrieved from https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness

SAMHSA. (2018, May). First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. Retrieved from https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf

Teeters, J., Lancaster, C., Brown, D., & Back, S. (2017, August 30). Substance use disorders in military veterans: Prevalence and treatment challenges. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587184/

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