Firefighter PTSD and Alcohol Abuse

Firefighters witness unimaginable events and scenes on a daily basis as they work to serve and protect all of us. Exposure to these traumatic situations can take a toll over time, leading to post-traumatic stress disorder (PTSD). Often, firefighters do not seek help for PTSD and turn to alcohol to ease their symptoms. This alcohol use may become alcohol abuse, leading to addiction.

Understanding PTSD in Firefighters

PTSD is a mental health disorder that develops after experiencing or witnessing some sort of traumatic event. It is characterized by intrusive thoughts and memories, nightmares, extreme anxiety, and severe reactions to reminders about the past trauma.

Firefighters are exposed to all sorts of trauma, including devastating fire scenes, fatal accidents, and a variety of medical emergencies. This repeated exposure not only can not only cause PTSD to develop but magnify its symptoms because of the continuous reminders of past traumas compounded by new traumas.

If the PTSD is not treated, it can become debilitating for the firefighter, affecting all aspects of their lives.

Why Firefighters May Turn to Alcohol

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. Overall, most studies indicate that around 30% of all first responders have a substance abuse disorder of some kind.

The high rate of alcohol abuse among firefighters is in part due to PTSD and other mental health disorders like anxiety and depression. Firefighters turn to alcohol as a coping tool for stress, sleep problems, and intrusive memories. This kind of alcohol misuse often turns into an addiction.

Social factors also contribute to alcohol abuse. Firefighters often drink together to bond, be part of the team, or blow off steam after a hard day or night. Some firefighters also feel pressure to “fit in” with their peers.

How PTSD and Alcohol Abuse Reinforce Each Other

For those firefighters who drink to cope, alcohol is only a short-term solution. Over time, both the symptoms of the mental health disorder and the alcohol addiction get worse. Chronic alcohol use can lead to sleep problems, mood disturbances, anxiety, and depression, which in turn lead to more alcohol use. It’s a vicious cycle.

Warning Signs to Watch For

It’s important to recognize the signs that alcohol abuse has become an addiction. The formal definition of an alcohol use disorder (AUD) according to the Statistical Manual of Mental Disorders specifies 11 criteria that determine whether an AUD is present.

1. Drinking more than intended or for longer than intended
2. Wanting to reduce or stop alcohol use but not being able to
3. Spending excessive amounts of time drinking or recovering from drinking
4. Feeling cravings for alcohol
5. Failing to live up to responsibilities due to alcohol use
6. Having relationship problems because of alcohol use
7. Giving up activities that you enjoy in order to drink instead
8. Engaging in risky behaviors like driving while drinking or under the influence
9. Continuing to drink in spite of negative consequences like health issues
10. Needing more alcohol to get the same effects
11. Having withdrawal symptoms when you are not drinking

Having two to three of these symptoms indicates a mild AUD, four to five is considered moderate, while six or more is severe.

Treatment Options for Co-Occurring PTSD and Alcohol Addiction

When someone has PTSD and an alcohol addiction, it is referred to as having co-occurring disorders. An integrated treatment approach must be used to treat both disorders at the same time. Treatment may begin with medication for the PTSD, followed by therapy for both the addiction and the PTSD.

Cognitive behavioral therapy (CBT) is the most commonly used treatment for co-occurring disorders and has proven results. In CBT, patients learn ways to cope with their mental PTSD without abusing alcohol, as well as strategies to control their harmful and negative thoughts and emotions.

Dialectical behavior therapy (DBT) may also be part of the treatment. It is similar to CBT, but also focuses on mindfulness and challenging intense emotions with rational thoughts.

Both therapies are generally used group therapy. Group therapy is critical to the treatment process, giving patients the opportunity to share emotions, experiences, and challenges with peers.

Treatment may be inpatient or outpatient, but a comprehensive treatment program is recommended, consisting of an inpatient program, followed by a partial hospitalization program (PHP), and an intensive outpatient program (IOP).

Note that some treatment facilities, such as Bridges of Hope, offer treatment that is specific to first responders.

Barriers to Treatment for Firefighters

Unfortunately, many firefighters don’t seek treatment for a variety of reasons.

Stigmas

A common stigma is that alcohol abusers are weak, which can be particularly hard for firefighters to deal with since they are supposed to be “tough”. This is also true of the underlying PTSD, which may be perceived as a weakness.

Career Risk

Firefighters may fear that they’ll lose their job if they admit to having an alcohol abuse problem that needs to be treated. However, generally this is not the case, with most fire departments now offering mental health resources for employees.

Fear of Community Perception

Firefighters may fear that the public will find out about their PTSD and alcohol abuse and view them as less competent or weak.

Belief that Treatment Won’t Work

Often, firefighters have no confidence that treatment will work and think that they can deal with it on their own.

Finances

Firefighters 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 firefighters covers care for issues that occur on or as a result of the job, including PTSD and alcohol use 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. However, with some homework and patience, treatment can be accessed and is worth the effort.

In Closing

Firefighters have one of the toughest jobs imaginable, and it often leads to PTSD and subsequent alcohol abuse. If you are a firefighter struggling with both, Bridges of Hope is here to help. We offer programs specifically designed for firefighters and other first responders that focus on your specific needs. We are committed to providing comprehensive, compassionate care that serves you just as you bravely serve our community. Give us a call today to learn more.