Substance Abuse Among Firefighters

Firefighters spend their days braving burning buildings, responding to emergencies and saving lives. But between long shifts and traumatic calls, countless firefighters develop conditions like post-traumatic stress disorder (PTSD), acute stress disorder (ASD), anxiety and depression. Many men and women struggling with these issues turn to drugs and alcohol to cope with them. Because of the physically demanding nature of firefighting, firefighters are frequently injured on the job, and with each injury sustained there is a chance they may become addicted to painkillers during their recovery.

While the reality of firefighters’ behavioral health issues are difficult to face, the good news is that resources are available for those struggling with a disorder. Are you a firefighter grappling with addiction or mental health issues? Are you the friend or loved one of a firefighter who is? Information about risk factors, treatment options and the paths to recovery can be found below.

Why Do Firefighters Have a Higher Risk of Developing Addiction and Mental Health Struggles?

While no demographic is untouched by addiction or mental health challenges, firefighters are disproportionately more likely to develop these conditions than members of the general population. According to a 2012 study published in Occupational Medicine, 56 percent of firefighters were also past-month binge drinkers. According to the Fire Service Joint Labor Management Wellness-Fitness Initiative, alcohol is the most common substance abused among firefighters.  This is due to a variety of factors, including trauma, on-the-job injuries and fire station culture.

Trauma

Firefighters are often the first on the front lines of many accidents, including fires, car crashes and natural disasters. They witness life-altering injuries and senseless deaths. During some calls, their own lives may even be on the line. In the face of these challenges, many firefighters develop conditions like ASD and PTSD. Worse still, because of the extended shifts most firefighters work, they are often cut off from vital sources of familial support for long periods of time. This can make it even more difficult to process and bounce back from trauma, and may contribute to the development of severe mental health conditions in response to it.

On-the-Job Injuries

Workplace injuries are an inevitable fact of life for many firefighters. Sprains, strains and other muscle injuries are common because of the extremely physical nature of firefighter’s work. According to the National Fire Protection Association (NFPA), 62,085 firefighter injuries occurred in 2016. To help firefighters recover from these injuries, doctors will often prescribe opioid painkillers. While these substances can help relieve pain in the short-term, they can also lead to dependence and addiction if used in excess or over an extended period of time.

Fire Station Culture

While conditions have improved in some fire stations as awareness and knowledge about addiction and mental health risks increases, many stations still have a culture that encourages binge drinking. A recent study conducted by the American Heart Association found that male firefighters drink more on average than the general population. While only 23 percent of men in the general population reported binge drinking in the past month, nearly half of the firefighters surveyed did. Additionally, behavioral health issues are still stigmatized and ignored in some stations. This can be incredibly isolating for individuals struggling with a disorder, and makes it difficult to come forward and ask for help when it’s needed.

Co-Occurring Disorders Among Firefighters

Addiction rarely occurs in a vacuum. In most cases, an underlying behavioral health condition drives or influences substance use. This condition is referred to as a co-occurring disorder, because it has a direct relationship with an individual’s addiction. Co-occurring disorders can manifest in firefighters in a number of different ways. However, the most common mental health issues they struggle with are ASD, PTSD, anxiety and depression. 

Post-Traumatic Stress Disorder

Post-traumatic stress disorder can develop after a person sees or experiences a traumatic event. For firefighters, this may involve going on a risky, life-threatening call or witnessing the injury or death of victims or co-workers. 

Some of the most common symptoms of PTSD include: 

• Recurring, intrusive memories of the traumatic event that manifest as nightmares, flashbacks or disturbing thoughts
• Avoiding any reminders and feelings associated with the trauma
• Increased reactivity, irritability, anger, hypervigilance, aggression or fear
• Insomnia
• Negative changes in thoughts and moods 

These symptoms usually begin shortly after the traumatic event, and persist until a firefighter undergoes professional care. For an official PTSD diagnosis to be made, symptoms must remain for at least one full month. 

Acute Stress Disorder 

Much like PTSD, ASD is a condition that can develop after an individual is exposed to a traumatic event. In many cases, ASD is a precursor to PTSD. While the two conditions share symptoms, an ASD diagnosis can only be made if the symptoms last between three days and one month after the traumatic event. If symptoms for persist for longer than one month, a PTSD diagnosis may be made. 

Anxiety

While firefighters aren’t necessarily more likely than members of the general population to develop anxiety, the very stressful nature of their work can trigger this condition, or worsen it in those who already have it. 

Common symptoms of anxiety include:

• Excessive worrying
• Preoccupation with criticism or negative experiences
• Excessive sweating
• Headaches
• Nausea or stomach pain
• Rapid or irregular heart rate
• Sleep problems, including insomnia, nightmares or restlessness

Depression

While depression is a condition that can impact people from any occupation, it can be particularly difficult for firefighters to cope with in the wake of trauma and the daily demands of the job. 

Common symptoms of depression include: 

• Chronic feelings of sadness and emptiness
• Loss of appetite
• Weight loss
• Body aches
• Sleeping problems
• Decreased energy
• Trouble concentrating or remembering things
• Feelings of guilt or helplessness

Why Many Firefighters Don’t Seek Help

Seeking treatment for behavioral health issues can prove difficult for many people, including individuals outside the firefighting profession. However, in many cases involving firefighters, this hesitation goes beyond typical apprehension. Firefighters spend their days helping people in need. So what happens when firefighters themselves need help? Because the men and women in this profession are so used to being the ones who support others, it can be difficult for them to seek professional assistance when they struggle with behavioral health problems, like addiction, PTSD or depression.

While awareness about mental health struggles and addiction have gradually increased within the firefighting community in recent years, stigma surrounding speaking up about these issues still exists. Many firefighters fear that they will be labeled “weak” or “unfit for work” if they come forward or attempt to seek care. A recent study published in Psychiatric Services showed that 58 percent of firefighters reported that stigma was a significant barrier to seeking treatment. 

While stigma may not exist in all firehouses, many don’t discuss mental health issues at all. This can leave a firefighter who is struggling feel isolated and alone. If a firefighter doesn’t know anyone else dealing with these issues, they may blame themselves for their difficulties and suffer in silence. Perhaps this is why so many firefighters commit suicide. In 2017, 103 firefighters committed suicide, while 93 died in the line of duty.

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Helpful Resources for Firefighters

Addiction and behavioral health difficulties can seem like an uphill battle, especially when you feel like the world expects you to have everything under control. However, if you or a firefighter you know struggles with addiction or behavioral health difficulties, options are available for treatment. Rehabilitation centers across the country address addiction and co-occurring disorders, including The Recovery Village. If you’re seeking specialized care for firefighters and paramedics, you may want to consider reaching out to the IAFF Center of Excellence. Designed by firefighters, for firefighters, this Maryland center has already helped hundreds of firefighters find a path to hope and healing among peers who understand their struggle. Reach out today for more information.