In an emergency, every second counts. There is not a minute to spare and even less time to react. Being a first responder involves utilizing every skill ever learned, paired with the most complex measures of instinct and morality. Then, taking action at a moment’s notice. The most important characteristics of a first responder are their courage, bravery, and selflessness.
Those same characteristics, however, have suggested a lack of urgency in providing them adequate mental health and substance abuse resources. Many are expected to fend for themselves in terms of processing the emotional trauma experienced. This also includes managing immeasurable stress on their own time. All while upholding the expectation of their public image.
From the very first moment a 911 call is made, first responders jump into action. Before the line even connects to dispatch, the location is scanned, and accounts of available personnel are called to attention. Whether the need for rescue involves police, EMT’s, paramedics or firefighters, all are preparing themselves to rush to aid. Pushing their agendas and fears aside, these brave men and women respond to be first on the scene.
As rewarding of a career in any of these lifesaving departments can be, it does not come without challenge. It is extremely demanding, both physically and emotionally. While some recognize their actions as heroic, it is often a thankless job. Especially in the intensity of the moment, there is very little time to concern themselves with their wellbeing over the priority of the mission.
Unfortunately, once said task is complete, many find it difficult to readdress the trauma experienced, leading to difficulty coping.
The grueling work hours and, at times, horrific encounters can have detrimental effects on these essential workers. Many of our first responders have inadequate resources to process, which can lead to psychological conditions down the road. Unfortunately, and far too often, this can lead some to resort to substance abuse.
Regardless of department, those on the front lines deserve specialized and discrete care for their needs. This is especially important when mental health concerns and addiction are involved.
Staying informed of the risk associated with psychological illness in high-pressure careers allows for the best possible care. Everyone deserves a life free of substance abuse, and first responders, despite the stigma, are no exception.
This specific line of work is not possible without years, or even decades, of dedicated training. Many first responders have moved through the ranks, taking on more and more responsibility as time goes by. While the opportunity for advancement in the field is truly superior, so is the responsibility that builds along with it.
Some experience unavoidable encounters that can change a person on a fundamental level. Though adaptation to bearing witness to tragic events is often developed, utilizing safe and healthy coping mechanisms can lag.
It is at this point when substance use often becomes a norm and can quickly grow to dependency. Some of the most notable stressors that can lead to a first responder to turn to substance abuse are unavoidable. However, with proper outlets to manage difficult experiences, the likelihood is dramatically lessened.
Taking a closer look at the situations these valued professionals are subject to daily, provides insight into their humbling sacrifice. Many first responders often need to cope daily with many or even all of the following.
This is especially true for those within the police and fire department. When responding to a call, they all too often face mortal danger while performing essential tasks. Risks include being on the wrong end of a firearm or running into a burning building to save lives.
At the end of the day, if they are fortunate enough to make it that far, revisiting emotions isn’t easy. Each choice made, within every split second, is the difference between life and death. Knowing this reality is not only difficult for the officers themselves but extends to place stress within their families and friends.
Risking exposure to harmful chemicals or contracting an incurable/deadly disease has always been a known risk for first responders. However, this is especially true with Covid-19, where the world was subjected to a global pandemic.
First responders remain on duty, serving communities, despite health risks and regardless of circumstance. Police and firefighters put the lives of those in need before their own on each call. This is especially valid for those that serve as EMT and paramedic officers. The constant fear of contamination or contraction of a life-altering illness is a requirement, especially in these professions.
In each line of first responder professions, there is a required amount of gear worn at all times for everyone’s protection. Whether it is a utility belt, medical equipment, or protective gear to withstand heat, they are considered uniform. In no time at all, the load becomes increasingly heavy to bear while functioning.
When taking lifesaving action, the physical discomfort and strenuousness associated with wearing such eventually take a toll. Many require medication or physical therapy for injuries and strains done to the body over time. Unfortunately, some prescription medications are substances that have the potential for dependency and can lead to addiction.
For first responders, being always on call is typically mandatory. Being overworked is common because these positions cannot be left short or unmanned. This leaves first responders with little time to themselves and their families.
Having an unknown schedule makes it incredibly difficult to maintain a healthy focus on their own needs. Void of time for healthy practices, such as utilizing a gym or alone time, it is beyond a fulltime job. Unfortunately, due to its availability, many instead opt for alcohol to unwind, which can quickly become an illness to address.
First responders, in any division, are burdened with enormous amounts of responsibility. A high moral standard is expected. This refers to maintaining a particularly chivalrous appearance and demeanor.
However, this can be discouraging. Many first responders would rather continue suffering from addiction in silence. The stigma that surrounds addiction is enough to encourage many first responders to conceal their need for rehab assistance. This work, where each relies on one another to perform at optimal levels, substance abuse can suggest a lack of dependability. Unfortunately, this alone can be life-threatening when dealing with an emergency, or as well contribute to job termination.
First responders deal with more than their fair share of trauma in the field. However, a trauma one experience is unarguably a worst-case scenario. This is the term used to define when a person is critically injured or deceased. Paramedics, EMTs, firefighters, and police are often the first officials to assess the situation in response to an emergency notification.
First responders, more than most, are left to deal with how these interactions affect them emotionally. The pressure of being unable to stabilize, revive, or rescue a person can lead to psychological disturbances. This is regardless of whether the incident occurred through no fault of their own.
If repressed or unaddressed, it is far too common to depend on drugs and alcohol for self-medication to cope. Realistically, some consider it an understandable outlet.
Through rigorous training, first responders learn how to deal with traumatic experiences on a professional level. However, on an instinctual level, the body will inevitably experience a physical reaction, commonly referred to as fight or flight. In truth, it can be a challenge to override nature’s primal design.
Despite elevated blood pressure and heart rate, first responders must push past instincts and make calculated decisions based on their training and education. However, overriding the natural reaction to a threatening situation does not come without consequence. Once the threat has been subdued, the psychological after-effects can lead to physical ailments.
It is at this point when instinct resumes once again to cope. Professional therapy, as well as substance abuse rehab centers, are trained to help manage the emotional risks associated with these professions. However, many are afflicted with the worry of being deemed unfit and refuse to seek treatment.
Aside from relying on substance abuse to cope, many first responders face issues working through nature’s defense mechanisms moving forward. The brain reacts in ways such as derealization and depersonalization. This reaction is similar to what’s observed in victims of a heinous crime. Similarly, if left untreated, they may be facing a long road of burn out, substance dependency, or PTSD.
Post-traumatic stress disorder, or PTSD, is a psychological condition that affects many first responders. PTSD is a state of mind that is triggered after a significant life-altering or threatening event.
PTSD is unique in the sense that it can remain unnoticed and asymptomatic for an extended amount of time. Though typically, symptoms begin to arise within a month of exposure to a traumatic event.
Compared to any other profession, firefighters, EMTs, police officers, and paramedics are 50% more likely to face mental health concerns, such as PTSD. Similarly, this may also be the reasoning behind the increased number of substance abuse within the community. Stigma, embarrassment, and pride most likely contribute to the silence. Increasing the likelihood of first responders to rely on harmful or illegal substances to self medicate.
Another theory regarding substance abuse in the workforce due to PTSD is that it often goes unrecognized. Among the different departments, as well as the uniqueness of each personality, this illness can present itself in different ways. Rehabs, as well as mental health professionals, determine the diagnosis based on four subgroups.
The specifics of each subgroup includes:
Coupled with self-treatment, through substance abuse and addiction, our most valued first responders could be facing a dual diagnosis. Suffering from one or more mental illnesses, individuals with dual diagnosis require professional care to overcome these hurdles. If you or a first responder that you love shows signs of PTSD and substance abuse, know that help is available.
Among the nation’s community of first responders, studies have shown that 84% may be suffering from an untreated psychological illness. This conclusion is due to their reporting on the effects of witnessing a traumatic event. The study reflects only slightly more than 30% have received proper treatment.
However, the disease of addiction was not included in the study and remains underreported, therefore inconclusive. This suggests that many more may be dealing with dual diagnosis, and have not sought out lifesaving treatment for themselves.
The reasoning behind the lack of treatment and therapy is due to denial or lack of awareness. Though, a shocking 39% of first responders confessed that they believed there would be unfavorable consequences upon seeking treatment. Those that have come forward did provide specifics within this inquiry, including the following reasons:
While some concerns may be understandable by the majority, they are based on the stigma associated, and not on fact. The refusal or denial of help for addiction and mental illness will only make things worse in the long run. Realistically, left untreated, it can lead to far worse, such as job performance issues, and can even cost a life.
The emotionally demanding responsibility of our first responders needs to be met with compassion and care, as well as understanding. Far too many are dealing with depression and anxiety without the necessary treatment. However, within the last decade, some first responders have opened up about the stressors of the job, and have utilized treatment facilities.
More than 30% of all EMS/EMT professionals, and over 24% of police officers, suffer from depression. Studies performed post-September 11, 2001, showed that almost 50% of police personnel struggle daily with both depression and anxiety.
Among fire department staff, specifically those trained to perform emergency medicine, the likelihood of a suicide attempt is alarming. They are six times more likely to be hospitalized after attempting to take their own lives. All presumably deriving from the trauma they’ve witnessed or stress from inadequate coping mechanisms.
Resorting to dangerous thoughts, behaviors, or substance abuse is an unfortunate, yet treatable problem faced by our valued first responders. In 2016, over 106 police officers took their own lives. Additionally, in that same one year, 115 paramedics, firefighters, and EMTs lost their battle with mental illness, committing suicide.
As saddening as those numbers are, thousands more battle their mental illness in silence and solidarity. Unfortunately, the correlation between addiction and mental health among first responders only adds to the mounting concern. Rehabilitation resources are available to receive help, restoring the quality of life for you or your loved one.
Many first responders consider it a courtesy to spare the ones they love from the details of their stressful encounters. It is important to respect the boundaries they have set. Although, it is also of interest to observe that they are managing their stress safely and responsibly.
One day in the life of a first responder may be more difficult than the next. So allowing proper time to cope is acceptable. However, many in the line of duty are reluctant to show vulnerability except to those closest to them. Others depend heavily on the security that their loved ones provide. Too much one way or the other can lead to codependency and should be discussed with professional care in mind.
It may be up to those closest to them to intervene when something just isn’t quite right. Learn how to identify if a first responder in your life is suffering from addiction.
If you notice one of these signs is beginning to occur more and more often, open up and discuss addiction treatment options. Chemical dependency can slowly eat away at a person’s over health with time.
Along with the responsibility of a high-pressure situation on the job, the combination is cause for serious concern. While not all occasional behaviors are cause for concern, it is better to be safe over sorry. Life may depend on it.
EMTs, paramedics, firefighters, and police may find it difficult to speak openly about facing difficulty coping with traumatic experiences. If someone has confided in you, be open and receptive to helping them get back on track. Turning to drugs and alcohol is only a bandaid that can and will make matters worse down the road. That is if it hasn’t already.
If you are a first responder in need of guidance when it comes to dealing with stress, professional help is available. If addiction has made its way into your coping routine, you are not alone. Reach out to discuss your rehab and recovery needs. Assistance and the road to recovery is only a call away.
Trained professionals at addiction treatment centers understand what you are going through. We complete evaluations daily to address all types of mental illnesses that hinder health and well-being. Let rehab specialists answer your call for a change. Help is one the way.
Dr. Richard Crabbe joined our team in 2019 as our psychiatrist and medical director. He attended the University of Ghana Medical School where he became a Medical Doctor in 1977. From 1978 through 1984, he was a medical officer in the Ghana Navy and provided a variety of services from general medicine to surgeries. He received his Certificate in General Psychology from the American Board of Psychology and Neurology in 2002.