First Responders - Treatment Guide

Last Updated March 26, 2024

Elspeth has been a firefighter with the Chicago Fire Department since 2010. While she loves her job, she has witnessed many disturbing events, including people suffering from severe burns, lost limbs, and even several deaths. Some of these distressing experiences have left her with ongoing symptoms of post-traumatic stress disorder (PTSD).

Elspeth also works long shift hours and suffers from sleep disturbances. These factors have caused her to experience bouts of severe depression, for which she self-medicates with alcohol and anti-anxiety medications. Although her alcohol abuse and mental health conditions have worsened, Elspeth feels unable to speak to her colleagues out of fear of appearing incompetent or weak.

While the above story is fictional, it represents the predicament of many first responders who develop a problem with substance abuse. Not only do they experience troubling events as part of their job, but many find it difficult to seek help within their work environment.

However, there are ways for first responders to seek help if they’re struggling with addiction.

Who Are First Responders?

First responders play a vital role in society. They are responsible for attending to emergencies and are always the first on the scene of a disaster, crime, fire, or accident. First responders are typically the first person to encounter a situation that requires medical or law enforcement help. These roles include:

Police officers
Security guards
FBI agents
Sheriffs
TSA officers
Firefighters
Paramedics
Dispatchers
Lifeguards
Red Cross members
Fire Marshals
US Marshals

Prevalence and Causes of Addiction Among First Responders

According to the Clinical Psychology Associates of North Central Florida, 9% of first responders report heavy alcohol use in the past month.
The US Firefighters Association (USFA) has revealed that as many as 10% of firefighters are abusing drugs.
According to a University of Phoenix survey of first responders, 85% reported symptoms related to mental health issues; 27% were diagnosed with depression; and 10% were diagnosed with post-traumatic stress disorder (PTSD).
The National Survey on Drug Use and Health reports that roughly 29% of firefighters engage in alcohol abuse and 10% of those may be abusing prescription drugs.
According to the Substance Abuse and Mental Health Administration (SAMHSA), 36% of EMS workers suffer from depression, 72% suffer from sleep deprivation, and more than 20% suffer from PTSD.

Why Is Substance Abuse Common Among First Responders?

As the first ones to arrive to an emergency, disaster, or disturbing event, first responders face high amounts of stress. Not only are they exposed to the risk of violence, fires, or other dangers, but they also endure long work hours. First responders can experience emotional and physical trauma, so it’s no surprise that some turn to substance abuse in order to manage.

EMTs and Substance Abuse

Compared with other first responder groups, substance abuse is highest among paramedics and EMTs. While the causes are complex, some studies suggest that the nature of their work combined with easy access to prescription medications are contributing factors. The role of an EMT is also stressful, as they are required to make life or death decisions while dealing with peripheral risks and occupational hazards.

Due to the stress and emotional hardship that an EMT can experience, many individuals develop mental health conditions, such as depression, anxiety, and PTSD. Some studies have found that 69% of EMT personnel have not had enough time to recover from traumatic experiences. EMT staff have also reported a 7% rate of depression and a 10% rate of suicidal ideation.

Firefighters and Substance Abuse

Firefighters are also at risk of substance abuse, particularly when it comes to binge drinking. Some studies report that 50% of male firefighters and 40% of female firefighters engage in binge drinking. Alcohol consumption is also high among firefighters because it is promoted in fire-station culture (e.g., for camaraderie) and used to unwind and de-stress. A 2017 survey revealed that alcohol use was the second leading coping strategy by firefighters.

Like EMTs, many cases of substance abuse are connected to mental health conditions such as PTSD and depression that occur on the job. Firefighters are exposed to great physical risks as they deal with burning and collapsing buildings while trying to save civilian lives. Firefighters also work long shifts and endure continuous emergency calls. This causes many firefighters to develop sleep problems and mental health conditions. Therefore, many of them turn to drugs and alcohol to cope with depression, PTSD, and pain endured from burns or injuries.

Police Officers and Substance Abuse

Police officers are also no stranger when it comes to occupational stress and trauma. In fact, studies show that roughly 25% of police officers report experiencing depression, and 48% report both anxiety and depression. Due to the high levels of trauma that police officers face, such as exposure to domestic violence, murder, and suicide, many are at risk of substance abuse.

A 2010 study of police officers working in urban areas revealed that 11% of male officers and 16% of female officers also reported at-risk alcohol abuse. 25% of officers report “being part of the team” during social occasions as a contributing factor to high alcohol consumption. However, the biggest contributor is the stress and trauma that these officers face daily.

Substances Most Commonly Abused by First Responders

Alcohol

Alcohol is one of the most commonly abused substances among first responders. Because alcohol depresses the central nervous system, many individuals find relief in the way it causes relaxation and feelings of euphoria. Alcohol also creates a numbing effect, which is why people who have PTSD or depression use it to “forget about their troubles.” However, alcohol poses a high risk for abuse and tolerance. This can lead individuals down a path of addiction that can be difficult to break without treatment.

Stimulants

Stimulants are another commonly abused substance among first responders. While some start out using prescription stimulants like Adderall, others move on to harder drugs, such as cocaine and methamphetamine.

Whether it’s to stay awake or remain focused on the job, stimulants are a dangerous drug, as the side effects can include anxiety, paranoia, or even hallucinations (if taken at high doses and for long periods). Illicit stimulants like cocaine and crystal meth can also impair someone’s judgment and encourage risky behaviors. Long-term use can also damage a person’s cardiovascular health and respiratory system. This makes stimulants one of the more hazardous drugs, especially if they’re taken while a person is on duty.

Prescription Opioids

Prescription drugs such as opioid painkillers are another commonly used substance among first responders. Some first responders take these drugs to deal with injuries sustained on the job. Over time, they can develop a dependence on these medications, especially because they can produce euphoria and relaxation. While these drugs may provide short-term relief for pain and nervous tension, prescription opioids are notoriously addictive and should not be taken regularly. This is especially important for first responders who need to have their wits about them while attending to an emergency.

Tobacco

Tobacco is another highly abused drug among first responders. Nicotine is known for decreasing feelings of stress and tension; therefore, many individuals in this industry smoke to relax and cope with the stresses of the day. One study found that 18% of firefighters smoke, which is higher than any occupational group in the U.S.

Rates of smoking are also high among police officers, with 16% reporting usage, compared with 13% of the general population. While smoking is less hazardous to one’s cognitive capabilities, it poses long-term health risks and can decrease a person’s fitness and health, which can affect job performance.

Co-Occurring Disorders Among First Responders

Post-Traumatic Stress Disorder (PTSD)

The most common co-occurring disorder among the first responder population is post-traumatic stress disorder (PTSD). This mental health condition occurs after a person has experienced or witnessed a distressing event. According to some reports, first responders are twice as likely than the general population to develop PTSD. A Canadian report conducted by the Centre for Suicide Prevention, for example, indicates that over 17% of firefighters and paramedics struggle with PTSD. This is following repeated exposure to distressing and disturbing events while on duty.

Symptoms of PTSD vary but can include depression, anxiety, flashbacks of distressing events, nightmares, frightening thoughts, recurrent memories of the event, avoidance of places, events, or people that remind them of traumatic experiences, being easily startled, hypervigilance, and irritability, anger, or aggression. Due to the high rates of PTSD, it is no surprise that many first responders turn to alcohol and drugs. Research has shown that people with PTSD are more than 50% likely to develop a substance use problem.

Depression

Depression is also commonly reported in first responders. A case-control study of EMT professionals reveals that rates of severe depression were around 6.8%. Another study conducted on first responders after the East Japan earthquake indicated that 21.4% were diagnosed with clinical depression, while a German study reported that 3.1% of emergency physicians had clinical depression. While these rates vary depending on the profession and types of traumatic situations they experience on the job, what is clear is that first responders are at a moderate to high risk of developing depression due to the nature of their work.

Suicidal Ideation

Because of the traumatic events that are witnessed by first responders, suicide rates can also be high. Some research suggests that EMT personnel may be more likely than the general population to attempt (or consider) suicide. A 2016 study, for example, found a lifetime prevalence rate of 10.4% for suicidal ideation, and a 3.1% rate for a past suicide attempt.

In the same review, combined EMT and firefighting duties were associated with a sixfold increase in the likelihood of suicidal ideation compared with firefighting alone. Another study conducted in 2015 revealed that 37% of fire and EMT personnel have contemplated suicide, which is 10 times the rate of U.S. adults.

Recognizing the Signs and Symptoms of Addiction in First Responders

Substance misuse among first responders can come with an array of signs and symptoms, such as:

Health problems (from substance use).
Finding drug paraphernalia.
Declining work performance.
Memory loss or memory issues.
Social withdrawal.
Burned fingers or lips, or needle marks on arms.
Slurred speech, stuttering or incoherency.
Trouble maintaining eye contact.
Dilated or constricted pupils.
Tremors, shaking or twitching of hands and eyelids.
Hyperactivity or appearing overly energetic.
Lethargy or excessive sleepiness.
Impaired coordination.
Slow or rapid speech.
Mood swings.
Impatience or irritability.
Difficulty concentrating, focusing, or completing a task.
Appearing distracted or disoriented.
Making inappropriate or risky choices.
Struggling to make decisions.
Constantly needing direction.
Inability to recall specific details.
Requiring assistance with basic tasks, like filling out paperwork.
Financial issues or money troubles.

Professional Stigma Surrounding Addiction and Behavioral Health Issues

One of the barriers to getting help is the stigma around mental health and addiction in the workplace. Like other professions, many first responders avoid seeking help because they are unsure about how to access services and because they are worried about being perceived as weak.

For example, a University of Phoenix survey indicated that many first responders reported stigma in the workplace as a barrier to treatment. This included things such a supervisor treating them differently, co-workers perceiving them as soft/weak, and being passed over for promotions. Of those who were surveyed, 50% said they believed they would be treated differently if they sought help for their substance abuse.

While each case can vary, these responses indicate a hesitancy towards seeking mental health support because of how a person will be perceived and treated at work. Therefore, it is important for individuals to feel that they can seek help despite these perceived barriers. It’s also important that these first responder groups implement a supportive team environment so that their fellow workmates can feel safe about seeking help for their mental health.

Accessing Help

If you or someone you know is struggling with substance abuse, there are options. If discussing these issues within your workplace is not an option, there are mental health professionals and rehab centers that can provide confidential help. Some of the resources that first responders can refer themselves to include:

Employee Assistance Programs: these provide referrals and classes for people with stress and substance abuse issues.
Substance Abuse and Mental Health Services Administration (SAMHSA): provides a list of treatment provider locations.
PTSD Foundation of America: provides resources for first responders on their website.
Alcoholics Anonymous (AA): offers local meetings that cater to specific dem
The National Suicide Prevention Hotline: a toll-free number for individuals thinking of self-harm or suicide. They are available any time, day or night.
Salvation Army: offers a list of treatment centers that individuals can call for help with substance abuse and mental health issues.

Specialized Treatment Options for First Responders

Substance abuse treatment for first responders is similar to those in the general population. This can include a mixture of detox, individual and group therapies, 12-Step groups, nutritional therapy, family therapy, etc. Treatment has also been proven to be more effective when people are grouped with other individuals in similar occupations.

Traditional treatment options for first responders who are struggling with substance abuse include:

Residential or inpatient treatment
Partial hospitalization program (PHP)
Intensive outpatient programs (IOP)
Regular outpatient programs
Sober living

There are also specific therapies that are known to be effective for conditions like PTSD and substance abuse. These include:

Eye Movement Desensitization and Reprocessing (EMDR): this treatment is led by a therapist who guides an individual through a series of rapid eye movements to redirect traumatic memories.
Cognitive Behavioral Therapy (CBT): one of the hallmark therapies for substance abuse and mental health conditions. This type of therapy can help veterans change negative cycles of thinking into more positive and affirming ones.

Resources

If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

Butler Center for Research. (2015). Alcohol Abuse Among Law Enforcement Officers. hazeldenbettyford.org. https://www.hazeldenbettyford.org/education/bcr/addiction-research/alcohol-abuse-police-ru-716.

First Responders First. (2020). What Are the Most Common Sources of Substance Abuse Among First Responders? firstrespondersfirst.com. https://www.firstrespondersfirst.com/post/what-are-the-most-common-sources-of-substance-abuse-among-first-responders.

Phoenix.edu. (2017.) Majority Of First Responders Face Mental Health Challenges in The Workplace. Retrieved On December. https://www.projecthealingheroes.org/news/2019/1/22/uopx-majority-of-first-responders-face-mental-health-challenges-in-the-workplace.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2018). Disaster Technical Assistance Center Supplemental Research Bulletin. First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf.

Medical Disclaimer

At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on RehabAid.com.