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First responders, including police officers, firefighters, and paramedics/EMTs, encounter situations every day that are unimaginably stressful and horrific. They are charged with protecting citizens and saving lives, which can be rewarding, but also a weight that can be difficult to bear.
This continuous stress can lead to mental health disorders, and unfortunately, a higher-than-average likelihood of substance abuse.
First Responder Substance Abuse Rates
Various studies have been conducted to determine the prevalence of substance abuse among first responders, and of each type of first responder.
Among police officers, alcohol abuse is the most common substance abuse problem. One study found that around 18% of male officers and 16% of female officers reported experiencing adverse consequences from alcohol use. Nearly 8% of all officers met the criteria for lifetime alcohol dependence. Fewer studies have been done about drug abuse among police officers, but estimates are that 20% – 30% of all police officers have a substance abuse disorder, whether alcohol or drug abuse.
Among firefighters, The National Survey on Drug Use and Health indicated that as many as 29% reported alcohol abuse and that 10% may abuse prescription drugs.
Among paramedics and EMTs, drug abuse numbers are estimated to be even higher than those of police officers and firefighters.
Overall, most studies show that around 30% of all first responders have a substance abuse disorder of some kind.
Factors Leading to Substance Abuse Among First Responders
Substance abuse causes differ from individual to individual, but several potential contributing factors have been identified.
PTSD and Other Mental Health Disorders
Substance abuse is often the result of underlying conditions including post traumatic stress disorder (PTSD) and depression, both of which are common among first responders. Substance abuse is a form of self-medication to combat the symptoms of these disorders.
The most common symptoms of PTSD include nightmares, flashbacks, anger and irritability, and sleep problems, as well as physical symptoms such as chronic pain, headaches, and chest pain. These symptoms can be quite distressing, but often go untreated by appropriate methods, which leads to substance abuse as a way to relieve the symptoms.
PTSD and other mental health disorders among first responders have a clear connection to the stressful and often sad situations these brave people endure every day. For police officers, the public perception of law enforcement of recent years is also likely a contributing factor. They live with a fear of public scrutiny or even disciplinary action over actions they take in the heat of the moment. Any mistake can have devastating consequences.
Sleep Deprivation
Sleep deprivation is a problem for many first responders due to working long or odd hours, as well as sleep difficulties due to stress. This lack of sleep can magnify the symptoms of underlying mental health issues, thus contributing to substance abuse issues. Many first responders also use alcohol or drugs to aid in falling asleep.
Sleep deprivation can also lead to physical issues such as pain and headaches, which some choose to self-medicate by abusing alcohol or drugs.
Social Factors
Social factors, particularly among police officers and firefighters, also contribute to alcohol abuse. These first responders drink together to bond, be part of the team, or blow off steam after a hard day or night. Some officers also feel pressure to “fit in” with their peers.
Access to Illegal Substances
Police officers are often involved in calls where illegal drugs are present, giving them access to substances they may be abusing. This access may contribute to starting substance abuse, or to maintaining their substance abuse.
Injuries
All first responders encounter situations that may be dangerous and lead to injuries. These injuries may require pain medications, such as opioids, which can lead to addiction in some individuals.
Health Care Workers and the Pandemic
Hospital health care workers, particularly doctors and nurses, should not be overlooked as first responders who deal with emergencies and other traumatic situations. Internally, it’s long been recognized that stress among these individuals is high due to high patient provider ratios, excessive workloads, and patient deaths, among other reasons.
These factors became an even more significant problem during the pandemic, but with the added fear of personal COVID-19 infection. Studies have suggested that during the pandemic, conditions like depression, anxiety, and PTSD increased in health care workers, leading to a greater level of substance abuse as a coping mechanism.
Additionally, what health care workers faced during the pandemic has been compared to combat stress, which research has long shown to be a factor contributing to substance abuse.
Treatment Barriers
Many first responders don’t seek treatment for a variety of reasons, most of which can also be attributed to members of the general population who don’t seek treatment.
Denial
The acceptance of having a substance abuse disorder can be overwhelming, considering the treatment that may be necessary in both the short and long-term. The easiest solution is simply denying the problem.
Stigmas
A common stigma is that substance abusers are weak, which can be particularly hard for police officers and firefighters to deal with since they are supposed to be “tough.” This is also true of underlying mental health disorders, which may be perceived as a weakness.
Job Risk
First responders may fear that they’ll lose their job if they admit to having a substance abuse problem that needs to be treated. However, this is generally not the case, with most emergency departments offering mental health resources for first responder employees.
Fear of Community Perception
First responders may fear that the public will find out about their mental health or substance issues and view them as less competent or weak. For police officers, they may feel that their authority will be undermined because of this perception.
“It Won’t Work”
Often, people have no confidence that treatment will work and that they can deal with it on their own. It’s an “I can stop anytime I want” perception, which ultimately is another form of denial.
Money
First responders may think that treatment, particularly in-patient treatment, will not be fully covered by their health insurance, which in some cases is true. However, most health insurance provided to first responders covers care for issues that occur on or as a result of the job, including mental health and substance abuse disorders.
Lack of Access to Treatment
Some perceive that there are few resources for help available or that they will be wait-listed. While there are resources available, they do often have waitlists for treatment, which is part of the overall mental health crisis in the U.S. However, actions are being taken to mitigate this issue, making more resources available, particularly for first responders.
In Closing
We all need to be aware of what first responders face, and the related issues that they may encounter. This awareness should inspire compassion, empathy, and respect rather than negative perceptions. A simple “thank you for your service” can go a long way. For first responders, it’s important to know that there are treatment options available. It’s also a much better alternative to making a critical mistake on the job due to impairment.
Treatment may not always be pleasant, but it can lead to a better, more fulfilling life. First responders can learn to cope with the stress and trauma that they endure and focus instead on the positive impact that they’re making in their community.