Drug And Alcohol Abuse Among First Responders

Medically Reviewed by Johnelle Smith, M.D. on July 14, 2021

Drug and alcohol abuse among first responders is often an overlooked issue. The unique challenges that first responders face on a daily basis contribute to problems with mental health and substance abuse that can be treated with several different programs.

Substance Abuse And Addiction Among First Responders

First responders such as police officers, firefighters, and emergency medical services (EMS) personnel play a crucial role in ensuring the safety of U.S. citizens.

However, the mental health of first responders is often overlooked. Understanding the causes of substance use disorders and mental illnesses is key in properly serving this demographic.

Treatment is available for first responders who struggle with addiction. Several programs can help first responders, such as support groups for individuals in the field.

Why Do First Responders Start Abusing Drugs And Alcohol?

Law enforcement officers, emergency medical technicians (EMT), and firefighters are routinely exposed to a range of traumatic and sometimes horrific scenes.

For those who risk their lives and work on the front lines to protect U.S. citizens, there are many emotions that come with experiencing traumatic events and highly stressful situations.

The difficult aspects of their work can contribute to larger issues of mental illness and substance abuse.

What We Know About The Mental Health Challenges First Responders Face

Mental illness is a major issue with first responders. There are many mental health challenges a first responder can face, but there are a few common issues.

The most common mental health challenges for first responders are:

Stress And Mental Illness

The mental issues listed above often come down to one common denominator: stress, which usually manifests as either acute or chronic stress.

Acute stress is caused by an isolated incident, and chronic stress is a build-up of day-to-day stress over time.

Both forms of stress have the potential to cause serious mental illnesses, including challenges such as PTSD, addiction, depression, and suicide.


According to the Journal of Emergency Medical Services (JEMS), first responders are at an increased risk of post-traumatic stress disorder (PTSD).

A first responder might feel any one of the following responses from PTSD:

  • reliving traumatic experiences
  • feeling an intense need to be aware of their surroundings
  • preparing for disaster
  • feeling guilt about the traumatic experience


Multiple factors might contribute to first responder depression, such as:

  • negative aspects of the work
  • lower levels of positive work factors
  • less support and focus on emotion-focused coping styles
  • a lack of awareness of the mental wellbeing of first responders
  • barriers to mental health care

One study found that volunteer firefighters tend to have higher levels of depression than career firefighters, which may be due to the lack of training on coping skills for volunteers.

Many people also have greater barriers to mental health care and treatment. This can greatly contribute to increasing cases of depression.

Substance Abuse

Substance abuse can have a causal relationship with many mental illnesses, including depression and PTSD.

As depression worsens, a first responder might turn to substances as a form of self-medication. And as the substance abuse worsens, so does the depression.

The same cycle of substance abuse and mental illness can occur with PTSD, other anxiety disorders, suicidal thoughts, bipolar disorder, and more.

In addition to the traumatic scenes first responders might face, there are several personal, genetic, and environmental factors that may also contribute to addiction.


A study published in the JEMS found that first responders are about 10 times more likely to have suicidal ideations and/or attempt suicide than the general public.

Of the people studied, firefighters were found to have the highest risk of suicidal thoughts and behaviors.

While first responder jobs can be dangerous in and of themselves, the Centers for Disease Control and Prevention (CDC) has found that people like police officers and firefighters are more likely to die by suicide than in the line of duty.

Some of the factors associated with higher potential for suicidal thoughts and actions are:

  • frequent emergency responses to suicide attempts
  • lower ranks
  • active military status
  • work environment
  • socio-economic status

Signs Of Drug Or Alcohol Abuse In First Responders

If you or someone you love is a first responder, it’s important to know the signs and symptoms of drug or alcohol abuse.

Mental illness and substance abuse can affect first responders in different ways. Be on the lookout for major changes in behavior, physical health, and other changes.

Physical Signs Of Addiction In First Responders

The first signs of addiction you see can be physical. First responders might go through rapid or gradual changes in their physical health, personal upkeep, and other changes.

Physical signs of drug or alcohol abuse in first responders are:

  • drastic health changes
  • changes in appearance
  • neglecting personal hygiene
  • finding drug paraphernalia
  • dilated pupils
  • skin manifestations (rashes, needle marks, red cheeks and nose)
  • over or under eating
  • changes in weight

Emotional And Mental Signs Of Addiction In First Responders

It’s also important to be aware of the emotional and mental signs of substance abuse. If someone you know is exhibiting any of the following signs, they may be struggling with an addiction.

Emotional and mental signs of substance use include:

  • loss of interest in hobbies or passions
  • memory loss
  • increased anxiety
  • depressive episodes
  • fluctuating energy levels
  • mood swings
  • irritability or aggravation
  • aggressive behavior
  • inability to cope with stress
  • confusion
  • defensiveness or denial
  • drug cravings

Behavioral Signs Of Addiction In First Responders

You may notice certain behavioral changes in a first responder who’s struggling with substance abuse.

Some of the behavioral signs of addiction include:

  • financial problems
  • withdrawal from friends, family, or social activities
  • frequently lying
  • changes in work performance
  • missing important meetings, gatherings, or events
  • legal issues
  • drinking alcohol more frequently or using drugs recreationally

Solutions To Help First Responders

There are many options for addiction treatment for first responders. If you or someone you love is struggling with addiction as a first responder, treatment is available.

First responders can find help through opening up about their challenges, seeking professional help, finding support groups, and more.

Opening Up About The Mental Effects Of First Responder Work

The first step to seeing better mental health among first responders is opening up. No solution can be found without first speaking on the real hardships and challenges of first responder work.

If you or someone you love is a responder, encourage yourself or them to speak up about their work. Eliminate the stigma surrounding first responder mental health by talking about it.

This means speaking up in the workplace among others who might understand the challenges, talking to friends and family members, and being open and honest with yourself.

Seeking Professional Help

First responders may find it hard to reach out for help when they’re struggling with their mental health.

One survey from the University of Phoenix revealed that over half (57%) of first responders believe that there would be negative repercussions if they were to seek professional help.

Of that 57%, many thought that if they were to get help, they’d receive different treatment from their superiors and be perceived as weak by their coworkers.

But professional counseling can help, and it begins with the leaders of these organizations and other first responders around them.

The survey found that 71% of first responders would be encouraged to seek professional counseling if a leader of their organization was willing to speak on their own experience.

If you’re a first responder dealing with an addiction, or someone you know is, find professional help.

You might choose a program like:

  • group, individual, or family therapy
  • drug and alcohol rehab
  • hospital programs, such as detox or outpatient treatment

The more people that face the issues of substance misuse and mental health, the better help first responders can get.

Finding Support Groups For First Responders

First responders are more likely to get help if they’re surrounded by others who know what they’re going through.

Support groups can be a great option for first responders who want a community of peers they can turn to.

Most cities across the nation have support groups such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), and many have support groups specifically for first responders.

Practicing Self-Care

Substance abuse may come from a desire to escape and self-medicate after witnessing a difficult scene on the job or struggling with the day-to-day work of being a first responder.

Self-care is an important aspect of finding healthier coping mechanisms for first responders. Getting quality sleep and eating well can be critical in maintaining self-care as well.

For first responders, self-care might look like:

  • taking days off work
  • allowing time for breaks
  • spending time in nature
  • going to sleep early to have a full night of rest
  • enjoying quality time with friends and family
  • making time for hobbies and interests outside of first responder work

These components of self-care are meant to replenish the energy that can be depleted when working as a first responder.

Being Mindful Of Burnout

One of the biggest issues first responders often face is burnout, a form of work-related stress that comes with a state of physical or emotional exhaustion.

First responders are more prone to burnout because they’re constantly at risk, working long hours, feeling misunderstood and underappreciated, and getting little time to decompress.

Signs of burnout for first responders include:

  • exhaustion
  • aggravation
  • blaming others
  • feeling sad or depressed
  • isolating yourself
  • poor hygiene

When the symptoms of burnout set in, it’s important to take time to heal yourself and spend quality time on self-care.

Speak with other first responders about burnout and take time to focus on your physical and emotional wellbeing.

Remind yourself that:

  • there are other first responders who can respond to crises
  • it’s ok to take breaks during the day
  • it’s ok to take time off
  • your own health is just as important as the health and safety of others
  • you are more than your work
  • pushing yourself past your limits doesn’t always provide the best results

Treatment To Help First Responders

There are several treatment options for first responders who want to begin recovering from addiction.

Many of these programs are part-time, so first responders can continue to live at home and remain employed throughout treatment if needed.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) programs combine addiction medications with behavioral therapies to take a whole-patient approach to recovery.

With MAT, a first responder can participate in counseling, peer support groups, and other programs while receiving medications to ease the symptoms of withdrawal.

Outpatient Rehab

Outpatient rehab is a part-time treatment option for first responders who want to remain employed and live in their own homes during treatment.

This is one of the more affordable treatment options and can be customized to the specific schedule and recovery needs of the individual.

Inpatient Rehab

Here, a first responder can stay at a rehab center for a given period of time. Inpatient rehab programs can last between 28 days and six months.

Inpatient rehab might be the right option for first responders who need 24-hour care and a longer break from work.

It can be especially helpful in providing distance from the emotionally and physically stressful work of being a police officer, firefighter, or EMT.


Depending on the substance and severity of the addiction, detox programs can last a few days or weeks. This is a 24-hour treatment program in which a person lives in the rehab center.

A detox program might be a good choice for first responders who can’t commit to a long-term program. There are many three- to seven-day detox programs that can treat withdrawal safely.

Job Security And Addiction Treatment For First Responders

Many first responders fear that if they’re honest about their problems, they could face judgment from coworkers or lose their job.

But substance abuse can lead to poor work performance and larger issues down the road, so addressing the addiction earlier is beneficial to both the worker and the employer.

The Americans with Disabilities Act

The Americans with Disabilities Act (ADA) protects people with disabilities who need to get treatment. This includes people recovering from opioid and substance use disorders.

The act requires employers to work with the employee to get the treatment that they need for addiction.

This might look like allowing a first responder to arrive late to work, take time off for rehab, or some other accommodation.

Resources For First Responders

Here is a compilation of resources for first responders or their loved ones:

This page does not provide medical advice. See more

Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.

These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.

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Medically Reviewed by
Johnelle Smith, M.D. on July 14, 2021
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