Firefighters, paramedics, and police officers are often the first on the scene of a traumatic event but too often. They are also often the last to heal. A career dedicated to protecting and serving others may leave minimal time for self-care in addition to being frequently exposed to trauma. The unique pressures experienced by these first responders lead to a high occurrence of substance use and mental health disorders. The physical and psychological injuries sustained on the job contribute to high levels of chronic stress, which may manifest as mental health disorders like depression and post-traumatic stress disorder (PTSD). These diagnoses are commonly associated with higher rates of substance use. While many first responders may not admit to substance use due to fear of being stigmatized or losing their career, there is likely a high percentage of substance use in this population. Some first responders may initially use substances such as alcohol as a means of relaxation or escape and over time have this habit turn into a problematic pattern of drinking. Other first responders may sustain a major injury on the job leading to the prescription of drugs such as opiates. Whether intentionally abused or taken as prescribed, these medications often lead to physical dependence during the normal course of use and, if not given appropriate attention, can lead to long-term substance use. First Responders and Addiction Identifying the true extent of substance use among first responders is a difficult task for many reasons. The stigma that first responders may associate with admitting a substance use problem can prevent people from seeking help or opening up to others about their difficulties. While there are only minimal studies of substance use disorders among first responders, especially law enforcement officers, the prevalence is likely to be much higher than reported. The most commonly used substances by first responders are likely alcohol and prescription drugs. Alcohol is a legal substance and does not carry the same negative connotation as drug use. For these reasons, first responders may feel less stigma if they drink excessively than they would if they used illegal drugs. Based on research concerning the correlation between substance use and the exposure to traumatic events as well as mental health disorders frequently experienced by first responders, it has been estimated that the prevalence of alcohol abuse by police officers is likely as high as twice that of the general population. First responders are exposed to physical hazards and may be injured on the job. As a result, well-intentioned doctors may provide prescriptions for pain medications. While these may be initially used responsibly, the potential for developing dependence is not lessened by the individual’s profession and carry the same abuse potential as these medications would if prescribed to any other group of people. One anonymous survey of police officers found that 9% of officers reported receiving legally prescribed medications, and 7% of these officers reported having used more of the medication than prescribed. Mental Health Disorders and First Responders Researchers have found a litany of possible negative health outcomes for first responders. In addition to physical health consequences, mental health hazards are also prevalent. Repeated exposure to trauma can lead to the development of many mental health concerns. While 20% of the general population will develop a mental health disorder at some point, this rate rises to 30% when limited to those employed as first responders. Some of the most commonly diagnosed conditions among first responders include: PTSD. First responders are frequently exposed either directly or indirectly to death, grief, loss, and pain as well as threats to physical safety and long work hours which often prevent a typical sleep pattern. Anxiety. This condition may develop due to experiencing chronic stress or from the high demands of the job. Feeling personally threatened may contribute to the development of anxiety. Depression. Depression commonly occurs for many of the same reasons as other common disorders among first responders. The severity of depression may vary based on the specific type of exposure to trauma that a person experiences. For example, a person who deals with serious injuries or deceased persons is more likely to develop more severe depression. Mental health resources for first responders are available but may be underused due to stigma or other barriers. For example, despite having health insurance, behavioral health programs are not always covered in full and may be too expensive for some first responders. Services may be available through a person’s employer, but first responders may not want others to view them as vulnerable and therefore choose to seek outside services. Organizations exist specifically for the purpose of promoting wellness among first responders, such as: The Code Green Campaign Reviving Responders The First Responder Center The Institute for Responder Wellness How to Identify Substance Abuse in First Responders If you suspect that a first responder is living with substance abuse, there are several common signs to look for, including: Changes in appearance, such as sudden weight gain or loss, extremely dilated or constricted pupils or sudden neglect of personal hygiene Poor short-term memory recall or inability to maintain focus on tasks at work Financial difficulties Reduced participation in social activities A decrease in work performance Sudden changes in behaviors, such as developing paranoia, becoming secretive, having mood swings or experiencing general irritability How to Help a First Responder Who’s Battling Mental Health Issues or Substance Abuse No matter what steps are taken to help a first responder who is currently experiencing difficulty, the most important thing to remember is to respond with empathy. Do your best to understand the extreme challenges faced by individuals in these professions. Do not judge a person’s response to these experiences, but instead provide support. Some initial steps in offering help include: Demonstrate a willingness to listen. Express your concerns respectfully and let the person know you are available to listen if they decide they are comfortable talking about their experiences. Remind the person that they experience extreme stressors daily to normalize their response. Ensure you are creating an environment of acceptance rather than judgment. Encourage professional help. You may offer to provide help to find resources, schedule appointments or give a ride to appointments to reduce the potential discomfort of seeking help alone. Treatment for First Responders Substance use and co-occurring disorder treatment for first responders is available. First responders who may worry about coming into contact with people from the community while seeking treatment may find that a full-service treatment center away from their home provides the provision of privacy they are seeking. Treatment programs which may be recommended include: Inpatient drug rehab, which refers to settings where patients live on campus or in near-by sober living facilities. These programs typically last approximately one month. Outpatient rehab refers to non-residential treatment programs and varies greatly in the level of intensity. In the case of intensive outpatient programs, a patient may engage in treatment services several times a week while in other situations, a person may go to individual therapy weekly or bi-weekly. Medical detox refers to facilities staffed by medical professionals who can provide treatment to ease a patient safely through the detoxification process. Some approaches which may be used in any of the above types of treatment programs include: Cognitive behavioral therapy (CBT), which focused on the relationships between a person’s thoughts, feelings and actions. CBT works to make changes in thinking patterns and behaviors with the intent of causing a change in emotional experience. 12-step models may be used as a framework for therapy as well as a complement to services. Most communities have some form of 12-step fellowship, which can provide peer support during and after treatment. Group therapy is commonly used and can help a person become more aware of their issues in an interpersonal context. Challenges For First Responders Seeking Treatment Many first responders may avoid seeking treatment for many reasons, such as: Fear of judgment Stigma on the job Real or imagined lack of access to treatment Financial concerns However, more organizations are recognizing these barriers and taking steps to make treatment more accessible while reducing stigma or other job-related concerns. The Police Executive Research Forum has published discussions between police chiefs regarding substance use by officers. While there are still very different perspectives on how to handle substance use and mental health disorders that develop due to on-the-job stress, these discussions show a significant shift towards the promotion of wellness. For example, The San Diego Police Department created an officer wellness program that has been reported as helpful in promoting awareness, wellness and resiliency in the agency. Treatment Facilities Specifically for First Responders There are even treatment options that cater specifically to first responders. For example, The IAFF Center of Excellence provides services specifically to firefighters experiencing substance use and co-occurring mental health concerns. Other programs may include some specialized therapy groups or other services for first responders. As a first responder, your job is to help others. Now is the time to help yourself. Substance use and co-occurring mental health conditions are treatable. Help is available, but you must take the first step. Contact a representative at The Recovery Village Palm Beach at Baptist Health today to learn more about our evidence-based treatment programs for addiction and co-occurring mental health conditions. SourcesGraves, Keith. “How Much Drug Use Occurs in Law Enforcement?” In Public Safety, September 11, 2017. Accessed August 30, 2019. Smith, Derek R., et al. “Alcohol and Tobacco Consumption among Police Officers.” The Kurume Medical Journal, February 2005. Accessed August 30, 2019. Samhsa.gov. “Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma.” May 2018. Accessed August 30, 2019. Community Oriented Policing Services. “The San Diego Police Department’s Officer Wellness Program.” June 2018. Accessed August 30, 2019. Police Executive Research Forum. “Police Chiefs Discuss a Tough Issue: Alcohol and Drug Abuse by Officers.” September/October 2012. Accessed August 30, 2019.