Drug and Alcohol Abuse Among First Responders

Drug abuse prevention among first responders is possible if we take the necessary steps to help. 

What Do First Responders Do?

First responders put other lives ahead of their own, heading into dangerous situations to protect civilians at high personal costs. First responders are rightly glorified for their heroism but can face significant personal challenges due to their intense line of work.

Post-traumatic stress, job-related injuries, anxiety, and depression can all contribute to drug and alcohol abuse use among first responders. Fortunately, several programs and treatment protocols are available to help first responders with substance use disorders.

First responders are the first to arrive on the scene during emergencies. Whether that’s heading into a fire, providing emergency medical care for people with severe injuries, or heading to an active crime scene, first responders are there to help ensure the safety of the public and resolve crises. They willingly put themselves into the most demanding and intense human experiences to help.  


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What Does It Take to be a First Responder?

Types of First Responders

There are several types of first responders, each facing unique challenges. First responders include: 

Any one of these roles can be the first to respond to an emergency. 

Stresses of These Roles

The nature of working as a first responder means constantly exposing oneself to danger, stress, and potentially traumatic situations. People working as first responders choose to willingly enter situations that can be catastrophic for anybody, putting the needs of others above their own.

What’s more, they often work long hours and late shifts and are expected to rise to the call of duty despite personal circumstances. 

Why Is Drug and Alcohol Abuse Common With First Responders?

Drug abuse prevention

There’s no single reason why a first responder may become dependent on alcohol and abuse. Despite their glorification as heroes, first responders are regular people with real problems. Yet many of the stresses and hardships that come with a life of service can contribute to problematic drug or alcohol use, such as repeated exposure to traumatic events or simply work-related stress. 

Work-Related Stress

Typically, people who work as first responders work long hours with extended overtime and get repeated exposure to traumatic events. These can quickly compound and create an overwhelming amount of stress.

If this stress is not effectively managed through healthy coping mechanisms, self-care, and a commitment to work-life balance, it can lead to behavioral health problems. Thus, many first responders turn to substance use as a form of relief. 

Post-Traumatic Stress Disorder (PTSD)

PTSD affects first responders at a rate nearly five times as high as the general population. Police officers in particular face the highest rates of PTSD, with an estimated 35% of law enforcement officers receiving a diagnosis of PTSD in their lifetime. In comparison, only 6.8% of the general population will be diagnosed with PTSD.1

PTSD directly correlates with substance use disorder. In one national epidemiological study, 46.4% of people with a lifetime diagnosis of PTSD had co-occurring substance use disorder.2 People dealing with the after-effects of trauma will often turn to substances to cope with the crippling symptoms of PTSD, which can quickly turn into drug or alcohol addiction.

Defining PTSD

PTSD is a condition where exposure to traumatic events causes persistent challenges after the event has taken place. While 61% of all men and 51% of women will experience or witness a traumatic event in their lifetime, 80% of first responders will be exposed to traumatic events while on the job.3, 4 In addition, they are much more likely to have repeated exposure, increasing the likelihood that they will develop post-traumatic stress.

Exposure to trauma doesn’t always lead to PTSD. It’s completely natural to feel fear, exhaustion, anger, or even dissociation following a traumatic event. This isn’t a sign of personal weakness or mental illness—it is an adaptive survival mechanism designed to protect you from further danger.

Nonetheless, when these reactions to trauma continue long after the event has passed and begin to interfere with daily life, a person is considered to have PTSD.

Symptoms of PTSD 

According to the American Psychological Association’s Diagnostic and Statistical Manual, a person is diagnosed with PTSD if they experience several of the following symptoms:5

  • 1. Exposure to serious injury, sexual assault, or actual or threatened death
  • 2. Presence of intrusive symptoms, such as:
    • a. Repeated distressing memories of the traumatic event
    • b. Recurring dreams related to the traumatic event
    • c. Flashbacks
    • d. Distress at cues related to the event
    • e. Physiological reactions (e.g., increased heart rate, hyperventilation) in response to the cues associated with the event
  • 3. Avoidance of anything that reminds you of the traumatic event
  • 4. Alterations in mood and cognition, such as:
    • a. Persistent negative mood
    • b. Inability to experience positive emotions
    • c. Feeling estranged from others
    • d. Failure to remember portions of the traumatic event
  • 5. Increased reactivity
  • 6. Significant impairment in your daily life

The nature of PTSD means that many of these symptoms last for extended periods.

What is PTSD?

Challenges First Responders Face When Seeking Help

The most significant challenge that first responders face when seeking help comes from a culture that doesn’t like to acknowledge mental illness. Research from the University of Phoenix showed that 57% of first responders fear repercussions for seeking help from a mental health disorder, even though the vast majority agree that people who seek counseling would find recovery. 6

The same research also found that 71% would be encouraged to seek help if a leader in their organization spoke about their struggles with mental illness. Additionally, peer support for seeking help was shown to be more impactful, with 83% saying first responders would be encouraged if a trusted colleague or family member shared their struggles with behavioral health disorders. 6

This research shows an incredible opportunity for easing the challenges that first responders face by normalizing help-seeking behaviors from trusted leaders or friends.  

Substance Use and Police Officers

Police officers face particular struggles in their line of work, including frequent confrontation, a high risk of at-work injury, and regular exposure to violence. Any of these factors can lead to substance use to cope with stressful situations, which can impact their ability to serve the community and create great personal turmoil.

Since police officers are often the first to respond to any emergency, many repeatedly witness disturbing events or find themselves in dangerous situations.

These circumstances can lead police officers to feel the acute effects of trauma, such as hypervigilance or intense emotional swings. As a result, many turn to alcohol or substances to decompress after long, stressful days, increasing the risk of abuse and dependence. 

Statistics and Culture of Substance Use in Police Officers

A recent study looking at substance misuse in police officers showed that 28.8% engaged in binge drinking (defined as consuming five or more alcoholic drinks in a drinking session), 8% were classified as heavy drinkers, and 10% had used illicit drugs. A total of 7.8% of the population in this study met the criteria for alcohol use disorder, and 2.5% met the criteria for substance use disorders. 7

Besides work-related stressors, several other factors may contribute to these high levels of substance use. The first is a culture that generally accepts or even promotes alcohol use.

Many police officers frequently meet at bars and drink openly at work-related functions, and younger officers may feel pressured to partake to fit in. In addition, police are often repeatedly exposed to illicit drugs and have an easier time accessing them than other people, making drug abuse prevention all the more urgent for this demographic. 

Drug abuse prevention

Substance Use and Paramedics/EMTs

Emergency medical service (EMS) workers face significant mental health challenges due to the rapid pace of their work and constant exposure to extreme situations.

Paramedics and EMTs are frequently exposed to traumatic events. Research indicates that 69% of EMS workers do not have enough time to recover and process traumatic events before being sent back into the field. 8 This puts EMS workers at an increased risk for substance use disorders and developing other behavioral health problems.

The rate of serious mental health problems for paramedics and EMTs is nearly triple that of the general population, with PTSD and clinical depression being among the most common disorders. 9

In addition, EMS workers often have much higher levels of occupational stress than the general population, and occupational stress is associated with alcohol and substance use. EMS workers seeking relief from stress or attempting to self-medicate symptoms of underlying disorders can quickly develop a substance use disorder. 

Substance Use and Firefighters

Firefighters put their lives on the line in their work, charging into burning buildings to help save the people inside and protect their property. On-job injuries, a fire station culture that endorses alcohol use, and repeated exposure to trauma are all factors that can contribute to substance abuse in firefighters. It’s no wonder that many face challenges with their mental health after years of service. 

Statistics and Culture of Substance Use in Firefighters

In 2019, over sixty thousand firefighters were injured on the job. 10 Chronic injury and repeated manual labor can lead many firefighters to battle pain on a regular basis, and they may be prescribed prescription opioids to help manage their symptoms or turn to alcohol for relief.

Alcohol use is generally accepted as a way to decompress after stressful workdays, and fire department leaders may often silently support it. Fire station cultures often implicitly endorse heavy alcohol use, driving consumption rates among firefighters to much higher numbers than the general population. The prevalence of risky drinking behavior is astounding, with studies estimating that 58% of all firefighters are binge drinkers, and 17% meet the criteria for hazardous drinking. 1

In addition, firefighters face PTSD and depression rates at twice the general population level. 1 Volunteer firefighters are even more likely to be diagnosed with depression, possibly due to decreased access to mental health services, while career firefighters are more likely to develop alcoholism use disorders. 11  

Drug abuse prevention

Drug Abuse Prevention Methods

Drug abuse prevention is of paramount importance. Drug abuse prevention programs for first responders can go a long way towards alleviating the immense pressures from their line of work.

As we’ve seen, the academic research shows several potential strategies for first responders drug abuse prevention, such as an increased level of openness about mental health challenges from leadership. It’s also vital to teach first responders to support their colleagues seeking mental health treatment. The goal is to shift work cultures away from the implicit endorsement of alcohol use and create an open and accepting environment regarding treatment.

Of course, these changes would require significant structural shifts to long-standing traditions in first responder culture. Several other drug abuse prevention strategies could benefit first responders, such as lessons about healthy coping mechanisms. 

A Discussion on Drug Abuse Prevention

Coping Mechanisms for First Responders

Teaching first responders how to manage stress levels in a healthy manner can go a long way toward preventing addiction-related behavioral health problems, such as PTSD or depression. That’s why coping mechanisms are an excellent means of drug abuse prevention for first responders.

Listed below are various coping mechanisms that can help manage stress and improve well-being.

Healthy Work-Life Balance

Much of the stress from working as a first responder comes from a fast-paced schedule, with long hours and an expectation to work overtime.

Giving first responders a regular schedule with opportunities for extended leave or vacation gives them time to process the repeated traumatic events that they experience during work before diving back into the fray, preventing burnout. It also allows them to pursue activities that can foster their resilience, such as spending time with their families or engaging in hobbies or exercise.

Mindfulness Practices

Mindfulness is a scientifically validated tool for helping people manage their stress levels. It can break repetitive thought cycles associated with traumatic stress or depression and keep first responders working at their maximum capacity.

Healthy Sleep Habits

People who have sporadic sleeping habits, like those who do shift work, are at a higher risk for developing behavioral health problems. While the nature of working as a first responder means that they must be available twenty-four seven, a regular schedule that allows a comfortable sleep rhythm can go a long way towards maintaining their mental health.

Proper Nutrition

Eating well can stave off many of the physical effects of stress, such as cardiovascular damage or hypertension. These physiological consequences of working as a first responder only get worse if you aren’t eating a balanced diet.

All of these coping mechanisms serve to prevent the causes of stress for first responders before they can develop into a substance use disorder.

If a person is already dependent on alcohol or substances, they should be seeking professional addiction treatment services, such as detoxification or outpatient treatment.

Drug abuse prevention

Resources for First Responders

Fortunately, many resources exist for first responders struggling with mental health or substance use disorders. Although the challenges faced in these lines of work are substantial, recovery is possible.

Seeking help isn’t an indication of weakness or a lack of grit. Instead, it’s a way of showing commitment to the cause that they’re willing to improve themself. 

PTSD Foundation of America

The PTSD Foundation of America is dedicated to helping veterans recover from PTSD through evidence-based peer counseling. They focus specifically on combat trauma, but many first responders can benefit from their services. 12  

Alcoholics Anonymous

Alcoholics Anonymous (AA) has been helping people struggling with alcohol to recover for nearly a century. It is the first of the 12-step programs and has survived for so long precisely because it has proven beneficial for millions of people in recovery.13

AA groups are entirely free, anonymous, and available in nearly every city in the country, making it an excellent choice to help treat first responders with alcohol abuse.  

National Suicide Prevention Hotline

The National Suicide Prevention Hotline is open twenty-four seven at 1-800-273-8255. They provide compassionate and confidential support for people in distress and essential resources to first responders.14 

The Salvation Army

The Salvation Army is a Christian program dedicated to helping people overcome their personal challenges. They offer extensive substance use disorder treatment programs and serve over thirty million people in one hundred thirty-seven different countries.15  

Employee Assistance Programs

Employee Assistance Programs (EAP) are available to treat first responders with substance use disorder and make seeking recovery easier. EAP is offered through one’s employer, so first responders can reach out to the program to connect to treatment centers or licensed professionals and receive the help they need.

Working with EAP is an excellent way of maintaining a person’s career while taking time to care for themself. They will work with each individual to find accommodations that fit their particular needs. 

Final Outlook

Drug abuse among first responders is a significant issue, so drug abuse prevention must be the goal.

The particular circumstances of such demanding and self-sacrificing work can quickly lead to substance use and alcoholism treatment in first responders. Nevertheless, there is hope for recovery for those who are suffering.

Coping strategies for first responders can help them deal with work-related stress, PTSD, depression, or anxiety symptoms and can hopefully decrease the chance of substance use problems. Lastly, significant resources are available to help those in need.

First responders are real-life heroes, but they also have real-life problems. With increased awareness and changes in the culture of these professions, we can hopefully turn the tide of substance use for these indispensable workers.