Addiction Treatment for First Responders

You run toward other people's emergencies, and you are afraid that asking for help will cost the badge, the shift, or the trust of the crew. A hard shift is not a diagnosis. If drinking or drug use is how you come down, tell a clinician. Before you tell a supervisor, ask the program what it will release and to whom. Do not use a day off to stop heavy drinking or a benzodiazepine on your own.

If a coworker will not wake, is not breathing, or is seizing, call 911. For a mental health crisis, call or text 988. Do not wait until the shift ends.

The jobs the review actually covers

The work itself, including exposure to death, injury, long hours, and threats to personal safety, puts police, firefighters, and emergency medical workers at risk for stress, post-traumatic stress, depression, substance use, and thoughts of suicide. The bulletin is a review of studies. It covers emergency medical services, firefighters, and police officers. It sets military trauma aside because the training and the dangers differ. A dispatcher or a hospital nurse may face overlapping stress. Clinicians in health care are on a separate page, healthcare workers.

One estimate in the review says 30 percent of first responders develop behavioral health conditions, including depression and post-traumatic stress disorder, compared with 20 percent in the general population. That figure is an estimate from one source. It is not a prediction for a person on a particular shift. Some of the suicide research used convenience samples. A number here is a study finding, not a census of departments.

Stigma, cost, and the fear of the job

Firefighters face barriers that include stigma and the cost of treatment. Volunteer firefighters had greater structural barriers to mental health services than career firefighters, including cost, inadequate transportation, difficulty getting time off, and whether resources are available. Volunteers also carry a separate job. Those competing demands are a source of stress.

Peer programs have been used in part as a way through stigma, lack of time, poor access to providers, lack of trust, and fear of job repercussions. Asking for an assessment fits that. What your department's fitness-for-duty policy actually says is a question for the policy, a union representative, or a lawyer. Time off, when the federal leave rules apply, is in work leave.

Alcohol showed up in the studies as one way strain was measured. The percentages belong to those samples, not to every firehouse. One finding is worth keeping in view: drinking to sleep after a shift is a reason to talk to a clinician, including when the week was ordinary and not a disaster deployment. What withdrawal from alcohol can look like is in alcohol withdrawal. A sudden stop after chronic heavy drinking can be life-threatening. Stopping benzodiazepines abruptly can cause seizures that can be life-threatening.

Care without a special directory

Search FindTreatment.gov by place. How to read a listing is in how to find treatment. No facility is named here, and a program marketed only to police or fire is not automatically the right clinical fit.

Before you tell a supervisor, read privacy and confidentiality. Many substance use records from federally assisted programs have limits on disclosure. Those limits do not rewrite a department drug-testing policy. Ask the program, in plain words, what it will release and to whom.

Trauma and substance use often travel together in this work. What trauma-informed care asks of a program is in trauma and addiction. The bulletin notes that some firefighters found critical-incident debriefing helpful and others found it intrusive. One model is not required. If opioids are involved, naloxone and the emergency signs are in overdose signs. Carry it the way you carry other rescue tools, and still get emergency care.

Call or text (800) 653-9376 if you want help asking about programs and about confidentiality before you give a name.

Additional Resources

Sources cited on this page:

• SAMHSA DTAC Supplemental Research Bulletin: First Responders (May 2018)
• SAMHSA FindTreatment.gov
• NIAAA Core Resource: Alcohol Use Disorder, From Risk to Diagnosis to Recovery
• FDA: Boxed warning to improve safe use of benzodiazepines
• 988 Suicide & Crisis Lifeline

Common Questions