High-stress environments can put psychological and emotional strain on people. First-responders are in professions that often put them in high-stress situations on a regular basis. Police, firefighters, and paramedics are required to run into situations where instincts might tell everyone else to run away or escape. Some people are gifted with the ability to thrive in stressful situations, but even they may be vulnerable to some of the psychological pitfalls of a stressful career.
First-responders may have an increased risk of developing problems that are associated with high-stress situations, including psychological trauma, anxiety, depression, and substance use disorders. In fact, a single event that might trigger post-traumatic stress and other mental health problems in an average person may happen many times throughout the career of a first responder.
Drug and alcohol use is often the result of poor coping mechanisms for mental health problems, and once addiction takes hold, it becomes a serious problem itself. First responders face many challenges when it comes to mental health and addiction, but seeking treatment may be the first step in recovery.
In 2018, SAMHSA reported, “It is estimated that 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and posttraumatic stress disorder (PTSD).” The general population experiences these issues at a rate of about 20 percent, showing a significant increase in the frequency of mental health issues among first responders.
Addiction is among these behavioral issues, and it can often occur at the same time as another problem like anxiety or depression. For instance, one 2017 survey found that as much as 50 percent of firefighters reported binge drinking within the past month. Nine percent reported driving while intoxicated.
Post-traumatic stress disorder (PTSD) is often linked to an increased risk of developing a substance use disorder. PTSD is a mental health issue that is caused by traumatic events that cause recurring episodes of anxiety related to reliving the event. It’s common among people that experience traumatic accidents, attacks, and injuries. A 2014 paper published in Psychiatric Quarterly reported that first responders to critical incidents may cause PTSD in between 5.9 and 22 percent of cases. Considering that first responders may be involved in multiple critical incidents during the course of their careers, they may be even more likely to experience PTSD.
First responders also experience higher rates of suicidal ideation and actions. An estimated 125 to 300 police officers commit suicide every year. One study mentioned in the SAMHSA report found that 37 percent of emergency medical service professionals contemplated suicide, which is 10 times the rate of the general population. Around 46 percent of firefighters have experienced suicidal thoughts, 19 percent planned suicide, and 15 percent attempted suicide. Again, these rates are significantly higher than the general population.
First responders are exposed to harrowing events, and that can cause some mental health issues in the form of trauma. Repeated exposure may lead to anxiety and depression issues, as well. But what’s the link between these mental health problems and substance use issues. There are several potential explanations for the fact that addiction and mental health problems often go hand-in-hand. It’s possible that one causes the other or that they have overlapping risk factors that lead people to develop both problems. It seems clear that mental health issues and substance use problems worsen each other, and they often need to be treated simultaneously for treatment to be effective.
One way mental health problems may lead to substance use issues is through self-medication. Self-medication is a term that refers to the use of psychoactive substances to cope with problems without consulting a medical or clinical professional. Alcohol use is a common and culturally acceptable form of self-medication. Even characters in movies and TV often say, “I need a drink,” in response to something disturbing or stressing in a way that normalizes using alcohol to cope with stress and negative feelings.
Drinking and even drug use often start as a social bonding experience, and it has had that place in human culture for thousands of years. However, as first responders blow off steam with alcohol, substance use problems may be recognized when drinking or drug use leaves the arena of social bonding and starts to become a need. A person may start drinking by themselves or at odd times, like first thing in the morning. When substance use is no longer being used as a social or recreational activity, and you use substances just to feel normal, it’s a sign of dependence or addiction. The line between self-medication and socialization can be difficult to notice, and drug use may quickly become a first-responders go-to method for dealing with trauma.
Substance use issues may also be associated with severe incidents that are out of the ordinary, even for first responders. For instance, disasters like Hurricane Katrina were shown to have an impact on relief workers. Police officers involved in Hurricane Katrina relief efforts showed an increase in hazardous drinking, and the average number of drinks increased from two to seven per day.
Coping with drugs and alcohol may dull painful emotions temporarily, but a substance use disorder can severely worsen medical, psychological, and social problems.
A substance use disorder is a disease that primarily affects the reward center of your brain. It’s a chronic disease, and there is no known cure, but it can be treated effectively, leading to lasting recovery. If addiction is left untreated, it can slowly start to take over multiple aspects of your life, including your health, finances, and relationships. Active addiction can increase your risk of a dangerous overdose, long term health issues like liver disease, and the inability to maintain employment. Many people avoid addressing a substance use disorder for fear that it might affect their career or relationships, but an untreated addiction usually starts to affect those things anyway. Treating the problem may be the best way to safeguard your health, relationships, and career.
To combat mental and behavioral health challenges that first-responders face, people in first-response fields are encouraged to take mental health seriously. SAMHSA highlights some risk and prevention factors that may be helpful for first-responders and their employers to understand. Adequate training and realistic expectations from authority figures can help better prepare emergency workers to handle disasters or events. Likewise, poor training can lead to mental and emotional strain. Other preventive, protective factors include getting enough sleep, limiting work hours, and taking vacations or career breaks to avoid burnout.
During an event, limiting exposure to traumatic circumstances as much as possible may help protect against mental health issues. In disaster relief workers, the time on the site of the disaster and the proximity to the epicenter of the disaster are associated with more mental health risks. First responders that spend long hours at disaster sites may be at greater risk than workers that are relieved. Safety and perceived safety are also important factors.
SAMHSA reported that reminders of a disaster by media coverage may increase stress and mental health risk. But, at the same time, avoiding thoughts or the event may also be distressing. Instead, processing the event in healthy ways may be more helpful. Examples include critical incident stress debriefing (CISD) involving interviews with professional mental health counselors after an event. However, others find support from their peers more helpful. Either way, it’s important to avoid unhealthy methods of coping like self-medication with alcohol.
American Psychiatric Association. (2017, January). What Is Addiction? from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
Psychiatric Quarterly. (1999, January 01). Treating Psychological Trauma in First Responders: A Multi-Modal Paradigm.Flannery, R. B. from https://link.springer.com/article/10.1007/s11126-014-9329-z
The Guardian. (2018, September 01). 10,000 years of cheers: Why social drinking is an ancient ritual. McKie, R. from https://www.theguardian.com/society/2018/sep/01/social-drinking-moderation-health-risks
National Institute on Drug Abuse. (2018, July). Treatment and Recovery. from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
SAMHSA. (2018, May). Disaster Technical Assistance Center Supplemental Research Bulletin. from https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf