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First Responders Mental Health and Addiction Treatment

First responders face a number of unique mental, physical, and social stressors related to their work. In some cases, drug or alcohol use could be used as a way of coping with these challenges, stressors, and trauma. For these reasons, substance abuse in first responders may be more common than in the general population. But recovery is possible. Specialized first responder treatment programs can help address the unique needs of this population.

Who are First Responders?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), first responders include:1

  • Emergency public safety professionals.
  • Emergency medical services (EMS); this can include paramedics, emergency medical technicians (EMTs), and emergency dispatchers.
  • Firefighters.
  • Law enforcement personnel, such as police officers.

Mental Health Concerns Among First Responders

First responders face many unique occupational mental health risks. This may include, but is not limited to, post-traumatic stress disorder (PTSD), depression, fatigue, burnout (feeling extremely exhausted and overwhelmed), and increased suicide risk.1

Not everyone with risk factors will develop a mental health condition. General risk factors that can affect a first responder’s mental health can include:1

  • Challenging or dangerous work conditions.
  • Being faced with trauma, death, grief, injury, pain, or loss.
  • Dealing with disaster situations.
  • Fast-paced work environments.
  • Direct threats to personal safety.
  • Long or inconsistent working hours.
  • Poor sleep.
  • Relationship problems as a result of their work.
  • Being unwell or unfit for work.
  • Poor training.
  • Personal history of trauma.
  • Other negative experiences.

Specific risk factors for PTSD, stress, burnout, and depression in first responders can include but are not limited to:1

  • Being onsite or close to the epicenter of an event, especially for long periods of time.
  • Identification with trauma and disaster survivors.
  • Not having enough information at the event.
  • Feeling unsafe.
  • Having too many people to supervise.
  • Dealing with serious injuries or dead bodies.
  • Physical harm or severe trauma.
  • Being mental health workers.
  • Watching too much television reporting of the event.

Post-Traumatic Stress Disorder (PTSD)

A core risk factor for first responders developing mental health problems is the pace of their work, which often includes answering back-to-back high-stress (and sometimes high-risk) calls. This can result in not having enough downtime to process potentially traumatic or particularly stressful events.1

One study reports that more than 80% of first responders have had multiple trauma events at work and estimates that between 10 and 15% of first responders have been diagnosed with PTSD.5 Another study indicates that PTSD may be present in as high as 30% of first responders.6

First responder PTSD symptoms can include:4

  • Reliving the event through intrusive thoughts, memories, or flashbacks.
  • Avoiding reminders of the event that trigger distress.
  • Changed thinking and mood, which could mean being unable to remember the event, having increased negative thoughts or feelings, less interest in hobbies, feeling detached from others, or unable to feel happiness or other positive emotions.
  • Altered arousal and reactivity. You might feel like you easily fly off the handle for no apparent reason, be easily startled, or act in a reckless and self-destructive way.


First responders generally have high rates of depression. One study reports that 6.8% of EMS professionals experience depression.1 Another study indicates that volunteer firefighters have much higher levels of depression than career firefighters; 38.5% of female volunteer firefighters were deemed to be at risk of depression, compared to 22.2% of female career firefighters.1 And a study of police officers after the 9/11 attacks found that 24.7% experienced depression, and 47.7% struggled with both depression and anxiety.1

Symptoms of depression include:7

  • Feeling low or sad in mood.
  • A lack of interest in activities you once enjoyed.
  • Appetite changes.
  • Sleep problems.
  • A lack of energy or increased fatigue.
  • Feeling worthless or guilty.
  • Problems thinking or making decisions.
  • Suicidal thoughts or behaviors.


One study found that an overall 18% of EMS worker survey participants went through burnout, with EMS dispatchers having an especially high rate of 32%.9

Symptoms of burnout include:8

  • Sadness, depression, or apathy.
  • Feeling easily frustrated.
  • Blaming others.
  • Feeling indifferent.
  • Social isolation.
  • Poor hygiene (the way you take care of your health and personal grooming).
  • Feeling tired, overwhelmed, or exhausted.
  • Feeling like a failure or like you’re not doing your job well.
  • Needing alcohol or drugs to cope.


Suicide is another potential risk for first responders.6 One study showed that police officers with burnout have a 117% increased suicide risk compared to those without burnout.1 According to the Centers for Disease Control and Prevention (CDC), law enforcement officers and firefighters have an increased likelihood of dying by suicide than in the line of duty, and EMS workers are 1.39 times more likely to die by suicide than members of the general public.10 And as shocking as these numbers can be, scientists believe suicides are underreported, especially in firefighters.6

Substance Use in First Responders

Substance use in first responders may be common for a number of reasons. There is often a culture of camaraderie among first responders where teams may meet at bars or parties and drink to socialize.1 First responders may also use drugs or alcohol as a way of coping with stress, burnout, compassion fatigue, and trauma.11,12

One study shows 50% of male firefighters engaged in heavy binge drinking (5 or more drinks for men or 4 or more for women within 2 hours) or heavy alcohol use (binge drinking on 5 or more days in the past month), while 39.5% of female firefighters reported binge drinking (compared to 12 to 15% of women the general population).1,2 In another study of police officers, 18.1% of male and 15.9% of female police officers said that alcohol negatively impacted their lives, and 7.8% of these study participants met the criteria for alcohol use disorder (AUD), the clinical term for alcoholism.3

The Stigma First Responders Face

Perceived and actual stigma, combined with society viewing first responders as “strong” and innately resilient, may lead many first responders to cover up their problem or avoid seeking help. They might feel inadequate or “weak” for not being able to handle the stress associated with their jobs.13 Some may also fear that they will lose status at work if they admit they have a problem and need help.13 Still others might fear that their privacy won’t be protected, or that their career will be negatively impacted if they seek treatment.13

Finally, some first responders may struggle with multiple barriers to treatment, which could include factors such as poor access to treatment, insurance not covering certain costs, the cost of treatment, trouble getting time off, or a lack of transportation.1

How to Help a First Responder Facing Mental Health Issues or Substance Use

Loved ones can offer support and guidance to first responders facing mental health or substance use issues in a number of ways. Simply being there for the person and listening to them if they want to talk can be one of the most important things you can do.

Encourage them to get enough rest and to take good care of themselves by eating a healthy diet and getting enough exercise, even if that means just going for a walk after dinner. You can also urge your loved one to seek help—but don’t pressure them. You might suggest talking to their doctor; you could even offer to go with them to the appointment or help them look up first responder substance abuse treatment centers.14

Specialized First Responder Addiction Treatment Programs

First responders often have different recovery challenges than those of the general population and can be affected by many of the risk factors discussed earlier. Attending a detox or rehab can also be more challenging due to shift work, long or overnight hours, physical demands, fatigue, and other concerns. That’s where specialized first responder addiction treatment programs can help, because they are uniquely able to tend to all these concerns in addition to tackling mental health issues and substance use.

In these types of specialized programs, you will often be in the company of other first responders who are also struggling with the same issues. This may help you not only feel less alone, but studies show that strong social support helps build resiliency (ability to cope with and bounce back from negative events).15

Some other common features of first responder addiction treatment tracks can include specialized trauma treatment, resilience and stress management training, treatment for co-occurring disorders (meaning addiction and mental health conditions), and group and individual therapy that specifically addresses the unique challenges of first responders.6 American Addiction Centers (AAC) offers specialized treatment for first responders that can help address both your addiction and any mental health challenges you may be facing so you can start to heal.

Finding Addiction and PTSD Treatment for First Responders

You can find a specialized addiction treatment program for first responders by searching online, asking your doctor for a referral, or by calling American Addiction Centers (AAC). AAC offers free screenings and treatment for co-occurring disorders, such as PTSD and depression.

AAC is a leading provider of evidence-based first responder treatment that can help you regain control of your life. Our admissions team operates a confidential substance abuse hotline available 24/7 at or through text. You can also find out if your insurance covers treatment at American Addiction Centers online instantly before you call.

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