First responders can include firefighters, paramedics, police, active duty military, corrections officers, emergency medical technicians (EMTs) and other rescue workers. Often, the images and situations they encounter during their day-to-day jobs can lead to an array of trauma related disorders including post-traumatic stress disorder (PTSD), acute stress disorder and other co-occurring disorders.

The constant exposure to potentially life-threatening situations, trauma, and the physical strain of working long hours with little sleep, can increase the risk of substance abuse and addiction as first responders may turn to drugs or alcohol as a coping mechanism.

Dealing with addiction and mental health issues can be difficult for firefighters and first responders, because it can be difficult to admit there is a problem. This is due to several different factors including operating in a culture that seeks to uphold an image of invincibility, fear that admitting an issue will make them seem unfit for the job and the negative stigma having a mental health issue may make them appear weaker or defective.

Prevalence Of Addiction Among Firefighters And First Responders

Although research is limited on drug or alcohol addiction among firefighters and first responders, some studies reflect that it is an issue. Typically, alcohol is the substance misused by first responders, however, there is a general relationship between stress, stressful occupations and other substance abuse disorders.

Approximately nine percent of first responders reported heavy alcohol use (five or more days of binge drinking) within the past month, according to the Clinical Psychology Associates of North Central Florida, P.A.

Firefighters and law enforcement personnel had the lowest rate of illicit drug use of any group of workers, with only one and a half percent reporting drug use in the past month. But, the US Firefighters Association (USFA) estimates that as many as 10 percent of firefighters may be abusing drugs.

First responders have a unique perspective on addiction. Their jobs may require them to see the same people, who are struggling with addiction, over and over and to witness the effects addiction has on bystanders such as children and elderly.

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Their jobs are often physically-demanding and carry risk of injury that may require opioid painkiller prescriptions. Though they see the effects these drugs can have first hand, no one is physically immune to the dependence that opioid drugs can create.

While alcohol and substance abuse are likely to cause problems with work performance, addiction to cigarette smoking is also taking a toll on firefighters lives. Firefighters who smoke are at an increased risk for heart and lung diseases, compared to firefighters that do not smoke. It is also common for it to take multiple attempts before quitting for good.

Though the number of firefighter fatalities has steadily decreased over the last 25 years, it still remains difficult to report an accurate number of deaths due to addiction and mental health disorders, according to the Clinical Psychology Associates of North Central Florida.

Mental Health Disorders In Firefighters And First Responders

A 2008 study examined the various resilience factors which protect the mental health of first responders, and found high level of compassion satisfaction and low levels of burnout and compassion fatigue. These findings were derived from an online survey for 961 first responders.

The survey asked questions that measured sense of community, collective efficiency, self-efficiency and work related mental health outcomes and found that these factors could be considered resilience factors which help preserve first responders’ work-related mental health.

According to 2017 study on the impact of European refugee crisis on first responders also found that those who perform rescue and recovery duties, as a part of their daily work activity, confront diverse and unpredictable stressors that can impact their overall mental state and well-being.

The study looked at the prevalence and factors associated with self-assessed PTSD, perceived well-being and burnout among rescue workers operating at Lesvos during the European refugee crisis. Of the 217 who participated in the study, 72 percent reported low levels of perceived well-being, 57 percent reported feeling burnt out, and 17 percent reported self-assessed PTSD.

A number of mental health predictors were also identified during this study including: family status, age, duration of shifts and the collection of dead adult or children bodies. The overall impact of the refugee crisis is visible on the rescue workers who offer rescue and first aid services.

The study also stated that there is an urgent need for the implementation of effective interventions, which focus on identifying problems to enhance the occupational, mental burden of first responders and rescue workers.

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This reflects that the severity of the situation to which first responders are responding to, will determine the risk level it has of affecting their personal mental state.

Due to the nature of their jobs, firefighters and first responders are at an increased risk for developing mental health disorders. A national survey from the University of Phoenix found mental health challenges are common among first responders, and even though helpful resources are generally available, they are not often used.

About 85 percent of first responders surveyed have experienced symptoms related to mental health issues, 34 percent had received a formal diagnosis with a mental disorder, more than a fourth had been diagnosed with depression, one in 10 with PTSD and 46 percent had experienced anxiety.

The data indicates that the impact of PTSD and other mental health disorders, combined with an increased risk of alcohol use can lead to a ten-fold increased risk for suicide. A fire department is three times more likely to experience a suicide among its staff than a line-of-duty death, according to the National Fallen Firefighters Foundation.

Signs Of Addiction And Mental Health Issues In Firefighters And First Responders

There are various ways to tell if someone is struggling with addiction or mental health issues. Both physical, outward signals and more subtle psychological symptoms may help in identifying if someone is in trouble.

Possible Alcohol and Substance Abuse Indicators Include:

  • burned fingers or lips, or needle marks on arms
  • slurred speech, stuttering or incoherency
  • has trouble maintaining eye contact
  • has dilated or constricted pupils that do not change when exposed to light
  • tremors, shaking or twitching of hands and eyelids
  • hyperactivity or appearing overly energetic
  • appearing lethargic or falling asleep randomly
  • impaired coordination
  • speaking very slowly or very fast
  • extreme mood swings
  • appearing fearful or anxious or having panic attacks
  • increasingly angry or defiant
  • being impatient, irritated or highly irritable

Some Attitude or Behavioral Indicators of Substance Abuse Include:

  • difficulty concentrating, focusing or completing a task
  • appearing distracted or disoriented
  • making inappropriate or unreasonable choices
  • struggling to make decisions
  • experiencing lapses in memory or complete blackout of events
  • needing direction constantly
  • struggling to recall specific details
  • needing assistance with basic tasks like filling out paperwork

While the first responders are more likely to abuse alcohol, prescription drug abuse is also a major issue among firefighters and first responders. Due to the physical demands of their jobs, it is common for first responders to obtain prescriptions for addictive painkillers. There is also an increased availability for first responders to access medications on the course of their duties or on-the-scene.

Mental Health Spectrum Affecting Firefighters And First Responders

First responders and firefighters are considered a “high-risk” occupation group, in that it is possible for them to experience a wide range of physical and mental health consequences, as a result of doing their job.

Secondary traumatic stress can be an emotional response to the duties of a first responder. Secondary traumatic stress refers to the presence of PTSD symptoms caused by at least one indirect exposure to traumatic material. Some signs of secondary traumatic stress may include:

  • Fear in situations that others would not find frightening.
  • Excessive worrying that something bad is going to happen to yourself, loved ones or colleagues.
  • Easily startled, feeling “jumpy” or “on guard” all the time.
  • Wary of every situation, expecting a traumatic outcome.
  • Physical signs like a racing heart, shortness of breath and increased tension headaches.
  • Sense of being haunted by the troubles you see and hear from others and not being able to make them go away.
  • The feeling that others’ trauma is yours.

Other terms used to describe elements involved in secondary traumatic stress include, compassion fatigue, burnout and vicarious trauma, but they are not all interchangeable.

Compassion fatigue

Compassion fatigue is the result of hearing, seeing, or sympathizing the first-hand trauma experiences of another. Symptoms of compassion fatigue often mimic those of PTSD.

Those experiencing compassion fatigue may encounter changes in memory and perception, alterations in their sense of self-efficacy, a deletion of personal resources and disruptions in their perceptions of safety, trust and independence. They may also appear indifferent to the troubles of others.


Burnout is often characterized by emotional exhaustion, depersonalization and reduced feelings of personal accomplishment. While also work-related, burnout develops due to general occupational stress. Typically, this term is not used to describe the effects of indirect trauma exposure specifically.

Sometimes, people use burnout and compassion fatigue interchangeably, however, they are not the same. Compassion fatigue is a more severe indication that larger problems are present and are not being dealt with appropriately.

Although every individual will express burnout differently, some common signs and symptoms can include the following feelings:

  • as if nothing you can do will help
  • tired, or exhausted and overwhelmed
  • like a failure
  • as though you are not doing your job well
  • frustrated
  • cynical
  • disconnected from others, lacking feelings, indifference
  • depressed
  • feeling as if you need to use alcohol or other mind-altering substances to cope

Vicarious trauma

Vicarious trauma is a rare trauma condition that occurs when secondary trauma is not addressed. When the feelings associated with secondary trauma are experienced for a long time, a person can become so distressed that the way they view the world changes for the worse.

Compassion fatigue seems to be a growing epidemic among first responders, as more news stories report on the lack of compassion first responders feel towards calls for things like opioid overdoses. One EMT reported that he remembers feeling the hair on the back of his neck go up each time he’d respond to a call for opioid overdose, now it has become so commonplace, that no longer happens.

Due to the interaction first responders have with addiction, it can be hard not to internalize the scenes they take in daily. These situations do have an impact on their overall well-being and, without proper treatment, can lead to severe consequences.

Willingness to be first on the scene in many terrible situations is one of the things that make first responders seem trustworthy to survivors. Often, this means that as a first responder you are in the same environment that the people who need your help are in, and at times this can be tough.

As a first responder, there is potential to struggle with lack of privacy, disruptions during sleep, hectic work schedules and other various factors that affect overall physical health. It is also possible, overtime, to become more vulnerable to feeling the acute traumatic stress, sorrow and anger of the people you help.

At times, some first responders can feel guilty for having survived the disaster, and when this happens it can become difficult for them to understand risks to their own health and safety.

Self-Care Tips For First Responders And Firefighters

It is common for firefighters and first responders to be trained to screen survivors for negative behavioral health effects. Currently, the field is also focusing on identifying survivor resilience, fostering strengths and encouraging self-care. Just as they assist survivors in this process, they can also apply it to themselves.

By focusing on building strengths and carrying out self-care activities, first responders can positively contribute to their behavioral, cognitive, physical, spiritual and emotional resilience.

The SAMHSA Suggests The Following Strategies To Help Accomplish This:

  • Focus on the four core components of resilience: adequate sleep, good nutrition, regular physical activity and active relaxation (yoga or meditation.)
  • Get enough sleep, or at least rest.
  • Get enough fluids to stay hydrated and eat the best quality foods you can.
  • Complete basic hygiene tasks like combing your hair, brushing your teeth and changing you clothes. Wearing clean clothes can make you feel better.
  • Try to wash up when you leave work, even if it is just your hands and face. Think of it as a way to “wash away” the difficulties of the day.
  • Make time to learn about the people you work with. Taking time for conversations will help in developing positive feelings towards yourself and others.
  • Engage with your coworkers to celebrate success and mourn sorrows as a group.
  • Take time to be alone so you can reflect and rest.
  • Practice your spiritual beliefs or reach out to a faith leader for support.
  • Take time away from work, when possible. Removing yourself from the stress can help you remember that not every place is going through such hard times.
  • Try to find things to look forward to.
  • Communicate with friends and family as best you can.

When three or more of the above self-care practices are combined, they can help prevent compassion fatigue. Once they become a part of your routine, then you will have an overall prevention plan. Not only do these healthy habits strengthen the ability to cope while in the moment, they can also help your body remember how to bounce back to a healthier state.

Challenges Firefighters And First Responders Face When Seeking Help

Stigma surrounding mental health and addiction in the workplace, may be keeping first responders and firefighters from getting the help they need. Of those who reported being diagnosed with depression in the University of Phoenix survey, half cited incidents at work as a contributing cause.

The survey also reflected that the social stigmas associated with seeking mental health help on the job often has negative consequences. Some of these consequences include their supervisor treating them differently, co-workers perceiving them as weak and potentially being passed over for promotions.

Of those surveyed, 50 percent the respondents firmly believed that their supervisor would look at them differently, and 42 percent disagreed that their supervisor would be willing to openly discuss the importance of addressing mental health concerns.

A team environment is important especially in a first responder environment. You need to be able to count on your team for support and, with the added pressure of needing to seem invincible it can be difficult for first responders to not feel ashamed of their mental condition. They do not wish to be seen as the weakest link by their team, so they don’t openly talk about it.

Benefits Of Treatment For Addiction And Mental Health

There are various benefits first responders can receive from formal treatment for addiction and mental health disorders. Ignoring what you’re going through can cause an increase in stress levels and allow the problem to grow, and become more difficult to treat.

Specialized and confidential treatment for first responders does exist and it can help in a handful of ways. Treatment can help you understand that you are not alone, and that trauma is a normal human response to abnormal situations.

Learn more about dealing with addiction and mental health.