First Responders: Risk of Substance Abuse and Addiction

Last Updated on February 18, 2022

Emergency responders are the first, heroic individuals who arrive at many dangerous situations to help by providing medical assistance and other emergency services. As important as this role is, it comes with many physical and psychological strains that can negatively affect a person’s well-being. Emergency responders do incredible work, but they are people too. As a result, the risk of substance abuse and addiction among first responders is high.

Related post: Substance Abuse and Addiction Among Lawyers

How prevalent is substance abuse and addiction among first responders?

First responders can include people who are: 

  • Paramedics
  • Firefighters
  • Police officers
  • Active duty military 
  • Emergency medical technicians (EMTs)
  • Corrections officers
  • Other rescue workers

Although many of the individuals that work these jobs care for people who are struggling with addiction, substance abuse in these professions may be more common than you might think.

Substance abuse in firefighters

Recently, the National Survey on Drug Use and Health revealed that about 29% of firefighters abuse alcohol up to 10% may be currently misusing prescription medications.1 An study from the Journal of Substance Abuse & Alcoholism also highlighted high rates of binge drinking among firefighters, as well as high rates of possible or probable problems with alcohol use.2

Substance abuse in emergency medical services (EMS) workers

According to SAMHSA, 36% of EMS workers suffer from depression, 72% of EMTS suffer from sleep deprivation, and more than 20% of EMTs suffer from PTSD.1 These factors all increase their risk for developing substance use disorders.

Substance abuse in police officers

One study of urban police officers found that 11% of male officers and 16% of female officers reported “at-risk” alcohol use levels.3 Additionally, another survey on American police officers found that nearly 40% endorsed one or more problematic drinking behaviors.4

What are common risk factors for addiction among first responders?

First, due to the nature of their jobs, emergency responders like police officers, EMS workers, and firefighters, are consistently exposed to life-threatening situations and trauma. They frequently find themselves face-to-face with death, grief, injury, pain, or loss, and many of these instances come with direct exposure to their own personal safety. 

Equally important, first responders also tend to work long, hard hours, with frequent or back-to-back overnight shifts. This can lead to problems like poor sleep, physical problems, and poor mental health. Insomnia and other sleep disturbances can increase emotional reactivity and cause problems with emotional regulation, which can increase the risk of depression.

Additionally, the physically-demanding job of an emergency responder  may contribute to injury that could require the use of prescription opioid painkillers. Although first responders frequently see the risks of misusing prescription opioids, they are still not immune to the substance abuse problems and addiction they can cause.

How common are mental health disorders in first responders?

The unique risk factors that first responders face also contribute to heightened rates of mental health disorders, a key contributing factor for addiction.

Mental health issues among firefighters

According to SAMHSA, depression is commonly reported among firefighters. For example, one study found elevated levels of depression among volunteer firefighters (16.85 ratio) compared to career firefighters (13.06 ratio).1 This difference could be explained by the cost and availability of mental health care and the fact that volunteer firefighters also have separate jobs, which contributes to additional stress. 

Further, 22.2 percent of female career firefighters were at risk of depression, while 38.5 percent of the female volunteer firefighters were at risk of depression. Both volunteer and career firefighters report elevated levels of posttraumatic stress and PTSD.1

Consequently, suicide attempts and suicidal ideation rates among firefighters are also higher than the general population, with one study revealing the following data:6

  • Prevalence among current firefighters:
    • Suicidal ideation: 46.8%
    • Suicide plans: 19.2%
    • Suicide attempts: 15.5%
  • Prevalence among the general U.S. population:
    • Suicidal ideation: 13.5%
    • Suicide plans: 3.9%
    • Suicide attemps: 4.6%

Mental health issues in emergency medical services (EMS) workers

Depression is frequently reported among certified EMS professionals and they experience higher levels of stress and PTSD than the general population. For example, based on the findings concluded from one study:6

  • 28% of EMS workers felt like life was not worth living
  • 10.4% of EMS workers experienced serious suicidal ideation
  • 3.1% of EMS workers had attempted suicide in the past

Mental health issues in police officers

In the same way, police officers also have an increased risk of experiencing negative mental health effects due to the nature of their jobs. Many officers demonstrate strong psychological resilience due to the type of training they receive. However, consistent exposure to traumatic events can contribute to the development of serious mental health issues.

For example, one study found that after the World Trade Center Attack, 11% of police officers reported experiencing PTSD, with rates being higher among female officers (15.5%) than male officers (10.3%).7

What are signs of addiction and mental health issues in first responders?

While gathering for a drink with coworkers after a long and tiring shift isn’t necessarily a bad thing, binge drinking is absolutely harmful. Likewise, relying on illegal or prescription drugs to cope with psychological or physical work-related issues is extremely problematic.

Wheras indicators of mental health problems are not always easy to spot, signs of addiction among first responders commonly include:

  • Slurred speech
  • Dilated pupils
  • Impaired coordination
  • Lethargy or falling asleep randomly and suddenly
  • Speaking very quickly or slowly
  • Extreme mood swings
  • Having panic attacks
  • Uncharacteristic and extreme impatience or irritability
  • Tremors (shaky hands or twitching eyelids)
  • Difficulty maintaining eye contact
  • Trouble concentrating, focusing, or completing tasks
  • Lapses in memory, brownouts,  or blackouts
  • Inability to complete basic tasks, like filling out paperwork
  • Being very distracted or disoriented
  • Making inappropriate choices or decisions that don’t make sense

What stigma and challenges do first responders face when seeking help?

Unfortunately, the stigma surrounding addiction and mental health can sometimes prevent emergency responders from getting help for these issues. For example, many first responders may experience some of the following concerns when seeking mental health treatment or addiction treatment on the job:

  • Being treated differently by peers or superiors at work
  • Being perceived as “weak”
  • Not getting promotions
  • Believing a supervisor would not be willing to openly communicate about mental health issues in the workplace
  • Feeling ashamed of their condition

Related post: Addiction Among Medical Professionals

Addiction treatment and recovery for first responders

In conclusion, ignoring substance abuse problems or mental health conditions will only cause them to grow. The best way to get relief and help for these serious-life threatening issues is to get individualized treatment and care through a doctor, psychologist, and/or an addiction treatment center.

Notably, since emergency responders are more prone to experiencing mental health issues like PTSD, burnout, and compassion fatigue, it’s important for these professionals to get help at an addiction treatment facility that addresses co-occurring disorders. As a result, these individuals will receive well-rounded care that addresses all their unique treatment needs. Drug and alcohol rehab programs for first responders should also consist of trauma-informed treatment. This will provide clients with a culture of understanding, trust, and partnership in rehab.

If you or a loved one is an emergency responder that needs help to overcome addiction and mental health issues, the caring professionals at Nova Recovery Center can help. We offer individualized and trauma-informed treatment to address all aspects of addiction, including contributing mental health issues. We also work with EAP representatives to make substance abuse and mental health treatment more accessible for those that need it most. 

To learn more about our drug rehab Austin, TX, please call (888) 427-4932 to speak with an admissions representative at Nova Recovery Center or contact us online and we’ll reach out to you shortly.


  1. https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf
  2. https://www.jscimedcentral.com/SubstanceAbuse/substanceabuse-2-1012.pdf 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3592498/ 
  4. https://www.ojp.gov/ncjrs/virtual-library/abstracts/exploring-utility-general-strain-theory-explaining-problematic 
  5. https://doi.apa.org/doiLanding?doi=10.1037%2Fpro0000192 
  6. https://pubmed.ncbi.nlm.nih.gov/26719976/ 
  7. https://pubmed.ncbi.nlm.nih.gov/25851164/ 

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