First Responders & Substance Use Disorder

The high-stress nature of the jobs that first responders do can be a risk factor for mental health disorders and substance use disorders (SUD).

During their time of service, as many as a third of first responders (police officers, firefighters, paramedics, EMS workers) develop behavioral health issues such as PTSD (post-traumatic stress disorder), depression, or anxiety. Half of those with mental health disorders also develop SUDs.[1]

As many as one out of every four police officers has admitted to drug or alcohol misuse. Police officers may have substance use disorders at two to three times the rate of the general public — with rates as high as 20% to 30%.[2]

Similarly members of the U.S. Fire Service have some of the highest rates of binge and heavy drinking compared to other professions. [3]

EMS personnel also have higher rates of alcohol and drug misuse than the general public. Women first responders smoke, drink alcohol, and use drugs at as high as triple the rate of the general population.[4]

Paramedics and EMS personnel also have greater access to controlled substances, such as opioid and sedative drugs, which may elevate the risk for misusing these medications.

The Relationship Between Drug Misuse & First Responders

Substance misuse and SUD occur in first responders at higher rates than in the general population. This is likely due to the stressful nature of the job. First responders work in fast-paced, high-stress environments. They often face trauma on a daily basis. Alcohol and drug use is frequently a coping mechanism for trauma and stress. Stress, and especially chronic stress experienced by first responders, is a risk factor for SUD.[5]

In addition, first responders may have greater access to controlled substances. For example, paramedics may have access to benzodiazepines, sedatives or other anesthetics. Easy accessibility may increase the risk of misuse. 

Most Commonly Abused Substances 

These are some substances that are commonly misused by first responders:

‍Alcohol

Alcohol is one of the most misused substances by first responders. Surveys showed that around a third of police officers binge drank in the month leading up to a national survey. About 8% drank heavily, and 5.2% met criteria for an alcohol use disorder. [6]

Prescriptions Opioids

In the same survey as above, around 3.1% of police officers used illicit drugs or misused prescription drugs and 0.5% met criteria for a substance use disorder.

Police and firefighters may suffer on-the-job injuries that necessitate prescription opioid drugs to control pain. Law enforcement officers have a high rate of occupational injury. Between 65% and 85% of injury claims reported to workers’ compensation included a prescription for opioid medications. One out of every ten officers prescribed pain medications are still taking them a year later. Regular use of an opioid drug can lead to physical dependence, misuse or even a SUD. 

Commonly Misused Substances by Profession

Police Officers

Being a police officer is a high-stress job. Police officers may use alcohol as a coping mechanism or as a method to “unwind”. As many as 20% of police officers are problem drinkers.[7] In addition, injuries sustained on the job may require prescription opioid painkillers that can increase risk of dependency and even addiction. 

Firefighters

Similar to police officers, firefighters also work in a high-stress environment and see a wide variety of traumas on a regular basis. Firefighters may also drink alcohol to cope with the stress of the job. They also may have an office culture that encourages socialization with alcohol after work. According to some studies, firefighters may binge drink at rates double the general population.[8]

Paramedics/EMTs

Paramedics and EMTs have similar risk factors for SUD due to their high-stress jobs. Like police officers and firefighters, they may also use alcohol as a method of relieving stress. For some, easy access to certain controlled substance medications may put them at risk for substance misuse as well. Commonly misused substances can include not only alcohol but also opioids, benzodiazepines, or anesthetics such as ketamine or propofol.[9]

Warning Signs to Look Out For

Addiction and mental health issues can both lead to physical, social, psychological, and behavioral changes. Addiction and mental health issues often co-occur and can have overlapping symptoms.

Signs of a problem may include the following:

• Mood swings
• Changes in sleeping and eating habits and patterns
• Irritability
• Social withdrawal and isolation
• Being quick to anger
• Inability to stop using alcohol or drugs despite trying several times
• Drinking or using more at a time than intended
• Changes in social circles
• Inability to consistently fulfill work or home obligations
• Continuing to use substances despite negative consequences
• Risky behaviors, often including using substances in potentially dangerous situations
• Needing to take more drugs or drink more alcohol to have the same effects
• Withdrawal symptoms when alcohol or drugs wear off
• Feelings of hopelessness
• Sleep issues
• Suicidal ideation
• Lack of desire to engage in activities that were previously enjoyed

First Responders & Mental Health

The nature of high-stress, high-pressure jobs and trauma exposure can put first responders at a high risk for mental health issues as well as substance misuse. Mental health disorders and substance misuse often co-occur: about half of those who have a mental health disorder also develop SUD and vice versa.[10]

Substance misuse and mental health issues are often intertwined, and one can exacerbate the other. 

Depression

Police officers and firefighters experience high rates of depression. They are actually more likely to die from suicide than homicide or accident while in the line of duty.[11]

Depression is a mental health disorder defined by poor mood, feelings of helplessness, trouble feeling pleasure, sleep and appetite irregularities, and sometimes suicidal ideation. Regular exposure to trauma, high stress, and isolation from family and friends can increase rates of depression in first responders.

Alcohol and drugs are common coping mechanisms for depression, but long term they can increase depressive symptoms and risk for suicide.

Anxiety

First responders can also be vulnerable to stress or trauma-related mental health conditions like anxiety. Occupational hazards of first responders include sleep problems, trouble focusing, difficulties regulating moods, irritability, and a higher rate of anxiety disorders.‍

PTSD

First responders often experience trauma in their line of work. Post-traumatic stress disorder, or PTSD, is common in people who have witnessed a trauma, death, or a near-death experience. This includes first responders.

It is hard to know exactly how common PTSD is among first responders because PTSD itself can be hard to define. Some estimates suggest rates of PTSD between 5.9% and 22% of first responders. [12] As many as 35% of police officers may have PTSD.[13]

In the short term, alcohol and drugs can seem to provide an escape from the intrusive thoughts or memories related to the trauma. However, long term, substances are poor coping tools, and can actually worsen the problem. 

Barriers to Seeking Help

First responders often do not get the help they need. They continue to show up to work and take care of others while either consciously or unconsciously ignoring their own mental health needs. This can lead to substance misuse as a method of coping.

First responders often face barriers when it comes to seeking help for mental health and substance use disorders. 

First, they may experience stigma from their peers or employers, or they may fear the loss of employment. Strength and self-reliance are highly esteemed in the culture of first responders, which can be barriers to seeking help for mental health disorders.[14] Finally, it may be hard for first responders to find time in their work schedules to get regular, consistent medical care and/or treatment for a SUD. 

Treatment Options for First Responders 

There are various treatment options available to first responders, and there are even specific treatment programs that are tailored directly to first responders. These include inpatient and outpatient programs as well as peer support and community services.

Inpatient, or residential, treatment programs typically have the first responder stay on site and receive structured programming with constant supervision and support full time for a period of days or weeks. 

Outpatient programs are more flexible, allowing a person to continue living at home, often still going to work, while attending sessions on a weekly or biweekly basis. 

Treatment modalities within different models can include the following:

• Individual therapy and counseling: First responders can receive specific support and learn tools and coping mechanisms while learning the root causes of mental health and substance abuse concerns.
• Group therapy and counseling: Group sessions can build on positive habits and life skills for managing stressors and the intense work environments of first responders.
• Cognitive behavioral therapy (CBT): CBT helps to identify how emotions and thoughts impact actions. It aims to modify negative patterns into more healthy ones with a mindfulness approach.
• Dialectical behavior therapy (DBT): Another form of behavioral therapy, DBT works to foster understanding and acceptance of intense feelings and teaches methods for living with these emotions.
• Dual diagnosis treatment: When a mental health disorder and SUD co-occur, both disorders will need to be treated simultaneously in an integrated fashion through dual diagnosis treatment methods.
• Life skills programs: These workshops can help to teach management skills and methods for coping with the stresses of the job and daily life.
• Educational programming: Learning about mental health, stigma, and problematic substance use can help to overcome barriers to care and ongoing recovery.
• Family support services: Services for family members or other support persons of the first responder. 
• Peer support groups: Meetings with other first responders can be an ideal outlet to help this community feel less isolated and form positive sober connections.
• Medication for Addiction Treatment (MAT): MAT can be helpful for opioid use disorder (OUD). Many individuals may benefit from medication in combination with therapy for treatment of SUD. 

Self-Care Tips for First Responders

First responders have particularly stressful jobs that require a regimen of self care to prevent burnout, stress and risk for mental health and/or substance use disorders. 

‍Self-care techniques for first responders can include the following:[15]

• Practice relaxation and breathing techniques or a mindfulness practice 
• Get enough exercise.
• Eat a healthy diet.
• Get enough sleep.
• Limit work hours and make sure you are ending shifts on time. 
• Consider writing in a journal regularly.
• Consider having a regular counselor or therapist 
• Talk to friends, family members, and coworkers about experiences and feelings.
• Limit caffeine and alcohol intake.
• Remember that your needs are just as important as the people you help.
• Take breaks when needed.
• Work in teams and have coworkers you feel comfortable speaking to
• Set healthy boundaries; it is okay to say “no.”

The most important thing is to remember to seek help when things feel overwhelming or out of control. Any mental health or substance use concerns can benefit from professional help.

Resources for First Responders

• SAMHSA’s National Helpline: This line provides treatment and referral information 24/7, free and confidentially. [16]
• National Alliance on Mental Illness (NAMI): NAMI provides a host of mental health resources for public safety professionals. [17]
• First Responder Center for Excellence (FRCE): FRCE offers behavioral health resources for first responders.[18]
• First Responder Support Network (FRSN): This network is staffed by first responders to help first responders with a variety of resources.[19]
• Responder Strong: This organization offers educational and wellness resources for first responders.[20]
• CopLine: This hotline for law enforcement officers provides peer support.[21]
• National Suicide Prevention Lifeline: This hotline offers crisis resources and support. It is free and confidential 24 hours a day, 7 days a week. [23]