Firefighters accept a certain amount of risk as a part of the job they’re called to perform. They train hard so that they are prepared to handle the potentially dangerous events that the job puts in front of them, but there is another unseen risk that they might have to prepare for.
Firefighters are vulnerable to mental health and substance abuse issues. If left untreated, drug and alcohol abuse can affect multiple aspects of a firefighter’s life, threatening their health, relationships, and career.
Mental health risks can lead to alcohol or drug use as a coping response, which increases a person’s risk of developing a substance use disorder. Consequently, firefighters tend to have higher rates of substance misuse and mental health issues than the general population. However, addressing mental health issues in fire departments may also help curb the substance misuse rates among our first responders.
Learn more about why firefighters are vulnerable to addiction and how mental health risks can be addressed in fire departments.
Firefighters serve many functions in their communities. Of course, there is the matter of fighting fires, but they also respond to car accidents, chemical leaks, lost children, emergency medical service calls, natural disasters, search and rescue, and many other needs. As first responders, firefighters are vulnerable to many of the mental health problems that police and paramedics might suffer from.
Because of the harrowing things firefighters witness and perform, they often have higher rates of mental health and behavioral health problems than the general population. For instance, firefighters have higher rates of suicidal ideation and actions than the average person. A 2016 study found that firefighters with EMS duties had a sixfold increase in their likelihood of reporting a suicide attempt that first responders with firefighting duties alone. In fact, as many as 37 percent of EMS and firefighters have reported contemplating suicide, which is almost 10 times the rate of the average American.
SAMHSA reported that 50 percent of male firefighters reported recent binge drinking, and 9 percent reported drinking and driving while intoxicated. Among female firefighters, 39 percent reported recent binge drinking, which is higher than the general population.
Firefighters are exposed to several risk factors that may make them more vulnerable to mental health issues. As first responders, they are often witnesses of painful and harrowing events. Even if a responder’s life isn’t in danger, witnessing the aftermath of something like a deadly car accident can be a psychologically distressing experience.
However, firefighters are also called to put themselves directly into harm’s way when fighting fires and responding to emergencies during natural disasters. One event like the ones firefighters experience is enough to leave a person with trauma or other psychological problems. But firefighters may experience these events many times throughout their careers.
But what do trauma and mental health have to do with drug and alcohol abuse?
Addiction is commonly associated with other mental health issues like trauma, depression, and anxiety. According to the National Institute on Drug Abuse (NIDA), reports that multiple national surveys have found that as much as half of people that experience mental health issues in their lives also experience substance use problems.
People with ongoing mental health problems often seek out healthy and unhealthy ways to cope with it. Psychoactive substances are a popular unhealthy coping response, and using them to treat mental health issues is called self-medication.
In self-medication, a person uses drugs or alcohol to dull or distract from painful mental and emotional issues. For firefighters, police, and other first responders, this often starts through healthy activities like forming social bonds with colleagues and friends. Alcohol and even drugs are often used in social settings, but as you get used to coping with drugs or alcohol, you may start to self-medicate more often, even when you’re alone. Drinking and drug use outside of social settings to mask painful mental symptoms is a sign of self-medication.
Because firefighters are more vulnerable to mental health problems, they are also more likely to self-medicate, which can lead to substance use issues.
Addiction is a chronic disease that can get worse over time if left untreated or treated improperly. Addiction treatment can help avoid or address the more severe consequences of addiction. When you first enter a treatment program, you’ll go through an assessment process that’s designed to identify your needs and connect you with the best level of care for those needs.
If you have high-level medical needs, you might start with medical detox, especially if you’re likely to experience severe withdrawal symptoms. As you progress, you may move to inpatient treatment with medical monitoring or clinically managed care.
When you’re able to live on your own safely, without jeopardizing your sobriety, you may move on to outpatient treatment. Outpatient treatment is split into intensive outpatient treatment with more than nine hours of treatment each week and outpatient treatment with fewer than nine hours of treatment each week.
Through treatment, you may go through several different therapy options depending on your needs. Each week, your personalized treatment plan will be reassessed and altered depending on your progress. Firefighters and other first responders may go through therapy options that address past trauma and mental or emotional issues that might be caused by it. PTSD, depression, and anxiety issues are commonly treated alongside substance use disorder.
In fact, it’s important to address co-occurring issues alongside addiction or unaddressed problems that may trigger a relapse. On the other hand, addressing mental health issues that could feed a substance use problem may help improve outcomes of addiction treatment.
It’s important to address mental health needs and risks when addressing addiction among firefighters. One way to do this is to increase awareness of both the signs of mental health issues and the solutions that are available to address them. However, the Substance Abuse and Mental Health Services Administration highlights some risk and protective factors that can increase or decrease a firefighter’s likelihood of developing a mental health or substance use disorder.
Before an event, it’s important for firefighters to be well-trained, briefed, and prepared. First responders who feel unprepared for a high-stress situation or a traumatic incident are more likely to experience mental strain.
Personal life events that happen before an event could also affect a first responder during an event. During an event, the length of time a person is exposed to an event and the proximity to the epicenter of a disaster or tragedy also affected a person’s chance of experiencing trauma. Limiting hours at the site of a disaster, especially at the center of it, could help mitigate risk.
In some cases, experiencing a traumatic event is unavoidable, so post-event protective factors are important. Firefighters whose personal life is affected by a disaster may be more vulnerable to mental problems. Processing the disaster or event in a healthy way is key to mitigating mental health challenges. Post-event briefings like critical incident stress debriefings can be -helpful for some, but others find them invasive. For many firefighters and first responders, peer-to-peer processing is more effective and welcome.
American Psychiatric Association. (2017, January). What Is Addiction? from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
ASAM. (n.d.). What is the ASAM Criteria? from https://www.asam.org/resources/the-asam-criteria/about
National Institute of Mental Health. (2018, July). Anxiety Disorders. from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
National Institute on Drug Abuse. (2018, January). Principles of Effective Treatment. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
SAMHSA. (2018, May). Disaster Technical Assistance Center Supplemental Research Bulletin. from https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf