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The Mental Health Needs of First Responders

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Our firefighters, police officers, and paramedics deal with stress levels the average citizen can’t relate to in their ordinary lives. At a certain point, you have to stop and wonder, what happens when the individuals who run to our rescue are the ones that need to be rescued? Our first responders choose to handle dangerous events each day for our society’s well-being, but the rigors of the job can quickly damage their mental health. Unfortunately, these mental health conditions can lead to alcohol and drug use to mask their pain. The first responder culture and stigma attached to mental health needs or addiction cause reluctance to get the help they need. 

The mental health needs of first responders are not something we always consider, but those on the frontlines commonly use alcohol to escape their stress. Firefighters, paramedics, and police officers use alcohol as a way to unwind from a traumatic situation or a way to promote social interaction. The combination of alcohol and socialization only increases the odds of first responders of developing substance use issues. Below we will discuss the issues our first responder’s face and their mental health needs. 

The Rate of Alcohol and Drug Use Among First Responders

Emergency medical responders are at a much higher risk of use alcohol, and reports mention that EMTs have much higher levels of post-traumatic stress disorder (PTSD). Even if the first responder wasn’t personally threatened, symptoms of PTSD could develop. Those who witness severe or traumatic events increase the chances of developing the condition. 

Untreated PTSD is a contributing factor relating to alcohol and drug use or other mental health issues like depression. An estimated 20 percent of paramedics and firefighters reported PTSD, which is much higher than that of the general population of 3.5 percent. According to other estimates, 40 percent of paramedics engage in drug and alcohol use.

Studies have shown that a police officer’s risk of developing a substance use disorder (SUD) will increase the longer they’re on the force. The study released by the University of Arizona found that addiction rates increased the longer the participant was a police officer, and after two years, 27 percent of rookies will develop an alcohol use disorder (AUD). After two more years on the force, that number increases to 36 percent. The study goes on to mention that alcohol is deeply ingrained in police culture. 

Firefighters also report higher levels of drug use, and a staggering ten percent of all firefighters currently use drugs. The findings suggest 29 percent of firefighters use alcohol, compared to 6.6 percent of the general population. 

How Are First Responders Affected by Mental Health Disorders?

First responders rank exceptionally high when it comes to suffering stress-related mental health disorders. Unfortunately, various kinds of trauma-related and stress conditions exist in the world, but first responders are most likely to develop acute stress disorder or PTSD. Acute stress disorder can only be diagnosed when the individual displays PTSD symptoms for a month or less following a traumatic event, while PTSD is a chronic response to stress or trauma.

The symptoms of acute stress disorder typically resolve within a month, but signs of PTSD will linger. Despite its severity, PTSD is a rational response to an abnormal event, and in some cases, it will cause a person to use alcohol or binge drink. Although they may not go on to develop an alcohol use disorder, it’s still a cause for concern. In a lot of cases, the symptoms of acute dress disorder will not fade over time. Keep in mind – an individual does not have to be exposed directly to a traumatic event to develop post-traumatic stress disorder.

The most common stressful and traumatic events that first responders encounter include:

  • Mass shootings or terrorist attacks.
  • Accidents involving vehicles or mass transportation, such as trains or airplanes.
  • Witnessing social conflicts, such as acts or war or riots.
  • Personally witnessing sexual abuse or severe violence.
  • Natural disasters, such as the aftermath of tornadoes, fires, earthquakes, or hurricanes.

How Is PTSD Diagnosed?

An official PTSD diagnosis can only be made by a trained medical professional. The condition follows a cluster of symptoms that will lead to a diagnosis, and signs must be present for more than four weeks and severely affect the individual’s quality of life. Untreated PTSD may lead to instances of alcohol or drug use to mask the symptoms. It may also cause depressive episodes that lead to suicidal thoughts or actions. Symptoms consist of the following:

  • Experiencing anxiety symptoms when confronted with places, people, or things that remind the individual of the traumatic event.
  • Reliving the past traumatic event through recurring dreams, vivid memories, or flashbacks.
  • Going out of your way to avoid anything that reminds the person of the traumatic event.
  • Experiencing symptoms of depression, such as loss of motivation, anxiety, or social isolation.
  • Hypervigilance of similar events.
  • Feeling detached from others or reality.
  • Issues with focus and memory.
  • Committing self-harming behaviors or failing to perform self-care.
  • Self-destructive behavior that includes binge drinking or substance use
  • Feeling hopeless and pessimistic.

A common misconception about PTSD is that it occurs immediately after the event – this is false. In some cases, symptoms of the condition won’t present themselves for weeks, months, or even years after the trauma. It is especially true in the case of first responders because the events have a cumulative effect. First responders experience various types of stressful events over the years. In some cases, it won’t be until the first responder encounters their 20th domestic violence case that they go on to develop PTSD, causing them to experience flashbacks of other events that transpired over the years.

The Mental Health Needs and Help For First Responders 

Fortunately, thousands of treatment facilities exist across the nation that caters to the mental health needs of first responders. These treatments are tailored around the individual to overcome substance use issues or co-occurring disorders. If the person exhibits drug or alcohol addiction in conjunction with a mental health condition, both disorders must be treated to be effective. Failure to treat PTSD will lead to relapse in the future. When both needs are addressed and treated together, it’s known as an integrated treatment program. These combine drug counselors and mental health professionals from various backgrounds to treat the client.

Trained psychologists and physicians will assess the client at all levels, leading to a diagnosis that will help develop a customized treatment plan. During their stint in treatment, professionals will document the client’s progress and make adjustments as needed. The integrated treatment plan is a part of a long-term commitment from the client to manage their mental health needs.

First responders entering this type of program who experience PTSD and drug use must undergo medical detox to clear their bodies of any drugs or alcohol. Once they’ve completed this portion of the program, they will be moved into an inpatient program to focus on their PTSD, depression, or mental health condition. It will consist of cognitive-behavioral therapy (CBT) sessions to help them through some of their post-acute withdrawal symptoms (PAWS).

If you’re struggling with drug or alcohol use or your mental health as a first responder, you must take the necessary steps to get help. You should never worry about the stigma attached when it comes to your life. 

Sources

NIMH (October 2020) Post-Traumatic Stress Disorder. from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Military Health Careers & Education (N.D.) Mental Health Awareness: Military & First Responders. from https://mhce.us/mental-health-awareness-military-and-first-responders/

NIAAA (October 2020) Alcohol Use Disorder. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders

Clinical Psychology Associates (N.D.) Firefighter and First Responder Alcohol and Drug Issues. from http://cpancf.com/articles_files/Firstresponderfirefighteralcoholdrugs1.html

EMS1 (August 2016) New Study Estimates 20 Percent of Firefighters, Paramedics Have PTSD. from https://www.ems1.com/health-and-wellness/articles/new-study-estimates-20-percent-of-firefighters-paramedics-have-ptsd-f9wM7jSLwhNCjRXy/#:~:text=Almost%2020%20percent%20of%20firefighters,population%2C%20according%20to%20the%20report

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