Friday, February 2, 2024

Self-Medicating and Substance Use Disorders among First Responders


I’ve said it before in previous blogs, as well as in each of the books in the PTSD Recovery series, but it’s worth repeating:

Drug and alcohol abuse make a lot of sense in the context of PTSD. Criterion C of PTSD is avoidance, and drinking and drugging help us to avoid our feelings. Criterion D is all about changes in the way we think and feel, and alcohol and drugs can play a major role in this.

Now, self-medicating is a term used to describe individuals who turn to drugs or alcohol as a way to cope with overwhelming emotions and feelings that they are not ready or able to confront.

Alcohol, tobacco use, and excessive painkiller usage are common forms of self-medication.

According to the National Center for Injury Prevention and Control, CDC. Mental stress of the job can lead to substance and alcohol abuse as a way of coping with the stress.

Now let’s narrow the focus to first responders, who arguably have some of the highest stress jobs out there. It’s no surprise that they also show a higher rate of alcohol consumption when compared to the general population.

Chronic exposure to human suffering, tragic exposure to mangled bodies from an accident, the shrill cry of a mother screaming over her dying baby, being physically threatened while trying to save someone's life, having to deal with the gruesome reality of a drug overdose or suicide, going into a burning structure hoping to save those inside while knowing you are too late. Any one of those things could break the strongest person. But for first responders, this might be a single day's worth of emergency calls.

They’re trained for this, though, right?

Sure. But consider the constant pressure to remain composed during one crisis after another. We’ve mentioned cumulative trauma already and its effects. It’s common for first responders to develop co-occurring mental health and substance use disorders (SUDs). The long 24-hour shifts and traumatic calls lead countless first responders to develop mental health conditions such as acute stress disorder, depression, and post-traumatic stress disorder. Many individuals struggling with these issues turn to drugs and alcohol as a means of symptom relief. That’s Criterion D mentioned above.

While dealing with job stress is a factor, first responders may also turn to alcohol for other reasons. Sometimes, a cold beer (or a few) at the end of a tough day eases the tension. For others, maybe they need to take the edge off of their physical pain from injury or muscle strain and they grab their bottle of painkillers. No one likes to be in pain, whether mental or physical, so numbing it is one answer. And an easy habit to fall into.

Social drinking is also good for bonding with your peers. You’ve been through hell with your fellow first responders all day, and it would be a shame to miss some quality relaxation time with your pals once the shift ends. Problems related to substance abuse are easily hidden in a work culture where de-stressing with alcohol and comradery is normal.

The National Survey on Drug Use and Health revealed that up to 29% of firefighters engage in alcohol abuse, and as many as 10% of firefighters may be currently abusing prescription drugs.

Sometimes sleep or pain medication, while off-duty, is just the thing to help an aching first responder fall asleep after a crazy 24-hour day.

According to SAMHSA, 36% of EMS workers suffer from depression, 72% of EMTs suffer from sleep deprivation, and more than 20% of EMTs suffer from PTSD; all of which puts them at an increased risk of substance abuse.

Most people don't even realize they have an SUD until they try to cut down or face negative consequences from their self-medicating.

The good news is that substance use disorders are treatable. However, seeking help is often seen as a weakness in the first responder community, where being tough and resilient is essential.

It’s time to drop the stigma. When the work has begun to take a toll on mental and physical health, professional help is needed. That's the bottom line.

Seeking help is a necessary step towards healing. There are options available to use, and recovery is possible.


If you believe change is possible, you want to change, and you are willing to do the work, you absolutely CAN get your life back.”

Get your copy of The Soldier's Guide to PTSDThe Soldier's Workbook

or Acknowledge & Heal, A Women's-Focused Guide to PTSD

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