Evaluating an Individual’s Treatment Needs
Addiction among Police & Firefighters
Based on the bulk of the available empirical evidence, including information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), the United States Firefighters Association (USFA), the American Journal of Addiction, and the Journal of Criminal Justice, several conclusions regarding substance abuse and firefighters, police officers, and other emergency service workers can be made.
- Law enforcement officers and firefighters have low rates of illicit drug use compared to most other occupations where the average is typically around 8-9 percent; the rate is as low as 1.5 percent for law enforcement officers and firefighters in some studies.
- The rates of alcohol abuse among firefighters may be more than double that of the general population; the rate in the general population is often quoted to be a bit over 6 percent to about 9 percent.
- An article in the American Journal of Addiction estimated that the rate of alcohol abuse in law enforcement officers is approximately 7.8 percent, but an article in the Journal of Criminal Justice estimated that nearly 38 percent of police officers in a large study had at least one problematic drinking behavior.
- Other individuals employed in emergency services and as first responders would be expected to follow similar patterns. This is because drug testing is common in these fields, and this often limits the use of illicit drugs; however, the use of alcohol is more acceptable in these fields as it is legal. Unless there are functional issues associated with alcohol use on a job, individuals working in these occupations who drink alcohol heavily are often not sanctioned.
Thus, based on the most reliable available evidence, it appears that the primary drug of abuse associated with individuals who work in emergency services (e.g., law enforcement, firefighters, and other first responders) is alcohol, and the potential for development of alcohol abuse issues is quite salient. However, it should be noted that according to the above cited sources, there is actually a paucity of research regarding illicit drug use and substance abuse in many factions of the emergency services industry.
Issues with Substance Abuse in Emergency Services Workers
According to the book Substance Abuse: A Comprehensive Textbook, the abuse of alcohol or other substances in professions such as law enforcement, firefighters, and other emergency services workers is often complicated by strong feelings and identification of the brotherhood of the profession, codes of silence, and attitudes that individuals in these professions support one another by not openly discussing such issues with their supervisors. It is often the case that individuals with significant substance abuse issues in these professions are not identified until there are some serious functional issues associated with their alcohol or drug abuse. The general signs and symptoms that occur when individuals in these professions are abusing alcohol or other drugs include:
- A blatant disregard for protocol
- Excessive absences, frequent use of medical leave, or constant tardiness to meetings or roll call
- Significant declines in the performance of an individual at work
- Issues with other employees or the use of excessive force with other individuals
- Difficulty accepting responsibility for one’s own actions
- Numerous attempts to get coworkers to assume the individual’s duties
- Disobedience of direct orders or rules
- Significant issues submitting reports or paperwork
- Physical signs of substance abuse and/or withdrawal, such as trembling or shaking, excessive perspiration, flushed bloodshot eyes, skin, complaints of nausea, headaches, issues with anxiety, frequent vomiting, etc.
The American Psychiatric Association (APA) is responsible for the development of the formal diagnostic criteria for any substance use disorder. Only a trained mental health professional can formally diagnose a substance use disorder. Any individual exhibiting two or more of the above signs may have an issue with substance abuse, so it is important to have them formally assessed.
Risk Factors for Addiction
APA and the American Society of Addiction Medicine (ASAM) have identified numerous risk factors associated with the development of addiction. It should be understood that one’s occupation should not be considered to be a potential causal factor associated with the development of any mental health disorder. Instead, features associated with certain occupations may make individuals more vulnerable to developing these disorders, including addiction. Some of the general risk factors associated with the development of substance use disorders that are applicable to individuals employed in emergency services include:
- The experience of trauma: One of the most important risk factors associated with the vulnerability to develop issues with substance abuse in emergency service workers is the experience of a perceived traumatic event. According to APA and other sources, first responders are at a significantly increased risk for the development of trauma and stressor-related disorders due to the nature of their work. The development of a trauma and stressor-related disorder, such as acute stress disorder or post-traumatic stress disorder, is also associated with increased risk for the development of substance abuse. For instance, a study in the journal Comprehensive Psychiatry documented the potential relationship between perceived trauma, suicidality, and alcohol use and abuse in firefighters.
- The co-occurrence of some other mental health disorder: Individuals employed as first responders are vulnerable to the development of other types of psychiatric disorders, including depression. A diagnosis of depression increases one’s vulnerability to substance abuse and to issues with suicide. For instance, an article in the journal Forensic Examiner reported that 95 percent of police suicides are associated with alcohol use/abuse. A study reported in the Journal of Emergency Medical Services investigated the association between stress and suicidality in individuals employed in the emergency services industry. The findings indicated that 37 percent of these individuals contemplated committing suicide (compared to 3.7 percent of the population) and 6.5 percent of these individuals actually made a suicide attempt (compared to 0.5 percent of the general population).
- Peer pressure: Individuals working in an environment where alcohol use is relatively common often feel pressure to engage in alcohol use themselves. This includes drinking alcohol when socializing with others with whom one works. The research from APA generally finds that peer associations and peer pressure are significant factors in predicting alcohol abuse among all individuals.
- Other stressors: Exposure to perceived traumatic events is only one form of stress. Emergency service workers have unique sources of stress that may increase their vulnerability to substance abuse. These can include issues with supervisors, routine, pressure to perform on the job, family issues at home, and the development of a belief system where one views alcohol or drug use as an appropriate measure to cope.
- Family history: Having a family member who struggles with addiction increases the chances of a person also developing an issue with addiction. Emergency service workers who have a family history of substance abuse are at increased risk to develop substance use disorders as a result of multiple interacting risk factors.
- The drug of choice: Using or abusing substances that have a high potential for the development of physical dependence or abuse is associated with an increased vulnerability to developing an addiction. Alcohol is a significant drug of abuse and also has a significant potential for the development of physical dependence in individuals who chronically abuse it.
Treatment for Emergency Service Professionals
For the most part, people employed in emergency service professions, such as firefighters, are often very close to one another. Fostering awareness of the signs and symptoms of substance abuse in these professions may be an important factor in identifying these issues early.
The general protocol to treat issues with substance use disorders would not be altered significantly; however, the use of social support groups should be emphasized, as this could capitalize on the close ties that individuals in these occupations have with one another. The use of group therapy for these individuals might be advantageous if the groups contain other individuals from these occupations.
It is important to remember that there is a formal blueprint that is generally followed in the treatment of any substance use disorder; however, the blueprint is often individualized to meet the needs of the particular person in treatment. Some other considerations for treatment might include:
- Strong use of peer support services
- Intensive psychoeducation regarding signs of substance abuse
- The increased availability of support groups, such as Alcoholics Anonymous
- The use of specific clinics or therapists who have experience treating individuals in the emergency services occupation
- Employee Assistance Programs: Most police departments, fire departments, and other emergency service departments have Employee Assistance Programs (EAPs), and these should be utilized when available.
- Peer support groups: Narcotics Anonymous and Alcoholics Anonymous (AA) are national support groups that can be very useful for those dealing with issues with substance abuse. The anonymous nature of these groups can be very appealing to those in emergency services who are worried about stigma associated with addiction issues.
- SAMHSA: The Substance Abuse and Mental Health Services Administration offers a national Treatment Services Locator.
- NIDA: The National Institute on Drug Abuse offers very useful information for those struggling with substance abuse issues, including specifics on what to look for in a treatment provider.