First responders – police, firefighters, paramedics and corrections officers – protect and serve. Their dedication is heroic. Yet, who helps the first responders when they struggle? First responders are in crisis, facing higher rates of substance use disorder, mental illness and suicide than the general public. Like doctors, nurses and pilots, when it comes to addiction, first responders require specialized substance use disorder treatment that helps them manage their disease and, when appropriate, supports their safe return to work. The American Society for Addiction Medicine recommends that first responders require an addiction treatment program that addresses their unique needs. Specifically, first responders:
- Have responsibility to the public. First responders are in a position involving public safety; they should always be treated at a more restrictive level of care.
- Can access narcotics when they return to the workplace. Narcotics and other illicit substances are found in abundance in police work and other emergency situations. From Drug Take Back Boxes filled with narcotics in police department lobbies to medications in ambulances, there are many touch points where first responders have access to substances while out in the field.
- Have difficultly adopting the role of patient. First responders are the helpers, not the helped. They are trained to establish and maintain control of the most stressful situations. This training becomes instinctual and can make it difficult to transition to the role of patient. Treatment staff must be specially trained not only to be compassionate towards this characteristic but also accept it and use it as a strength in support of recovery.
- Do better in treatment with a group of their peers. Stigma is a barrier to treatment for most individuals. With first responders, the barrier is even greater. If they fear they’re going to be judged or information is going to get back to their department, they simply won’t share. Being with their peers establishes a level of trust that enables them to be honest, a basic tenet in recovery.
Normalized at-risk behavior
The “culture” surrounding first responders supports at-risk behavior around alcohol and drugs. It’s a strong drinking culture, and there is often an expectation to drink when there is something to celebrate (promotions, retirements), something to mourn (funerals, critical incident anniversaries, particularly disturbing calls) and just as part of the normal schedule (“second day work,” “choir practice,” first night off, union meetings, softball games, in the parking lot after a shift, etc.). While an individual’s alcohol consumption might not seem out of line when compared to peers, in reality it is much heavier than the that of the general population. Studies show that approximately 20% of any police department will have problematic alcohol consumption, and firefighters, likewise, have a higher likelihood of becoming addicted to opioids because of injuries that often result in chronic pain.
The insular nature and protective culture of first responders also makes the identification of substance use disorder more difficult. The average first responder comes into treatment significantly later in their addiction than those outside of the profession because they have been protected by their environment. Consider a police officer who is pulled over while under the influence. The police officer making the stop likely understands that a DUI could lead to a lost pension, harshly negative media attention, termination from not only their current department but an inability to continue in law enforcement as a career. The officer may also consider the impact a DUI charge on a fellow officer would have on their family and the reputation of the department. Many police officers catch breaks in these situations because of this fraternal bond. With the advent of bodycams, surveillance cameras and smart phones, this is changing. However, many other variations of this protection still exist, like firefighters and medics being given time to ‘sleep it off’ while on duty.
Using peer culture to cultivate recovery
As noted above, first responders are more likely to begin the recovery process in a group of their peers, especially when connected to a larger network of first responders who are also in recovery. Being with peers is perhaps one of the most critical parts of a successful treatment program. The bond that forms between the other first responders in treatment is unique, continuing long after treatment ends. The camaraderie fostered in programs like those in Caron’s program for First Responders is similar to the unit cohesion seen in the military or police and fire departments. It’s something that’s very special.
Some treatment centers might see this group cohesion as a negative. Caron, however, treats this as a positive and aims to nurture and encourage those strong bonds to form. We build on their strengths in order to facilitate recovery, not trying to change them. The clinical work is important, but without that peer support, they don’t have that part of their identity to take with them in their recovery. We also laugh a lot with our First Responders. There is a very distinct sense of humor that comes along with this culture, and it is something we see as a benefit in recovery.
Through peers, first responders learn they can go back to work in recovery and be better at their job. Through peer support, they see first responders who have been through it, and even thrived in their lives and careers coming out of treatment. It provides good role models. It’s not just clinicians telling them it will get better, they actually get to see the results in motion.
Caron’s peer network includes retired firefighters, police officers and military veterans who are themselves in recovery. In fact, our peers have collectively over 100 years of on the job experience and over 60 years in addiction recovery.
What to look for in treatment for first responders
In seeking help for alcohol and drug addiction, first responders should look for treatment programs with these characteristics:
- A peer network for support during treatment and in recovery. Peer support is crucial for successful long-term recovery. Too many first responders come out of treatment, only to relapse when they find themselves exposed to the pressures of the job. Having a peer support network, with people who have been in similar circumstances, can help make a difference.
- Separate living quarters, where first responders room together. This helps build peer connections and cohesion while eliminating a major barrier.
- Nonprofit. The mission and values of a nonprofit treatment center are aligned with those used to working in public service.
- Works with insurance to ensure the best possible treatment. Many people experience a constant struggle with their insurance companies, worrying about how many days of treatment they will be eligible to receive. Caron is unique in its value-based agreements with major insurance companies that remove this anxiety.
- Access to the full range of other evidence-based treatment modalities. Specialized treatment is necessary, but it is important to have other services available if needed. Addiction treatment should be individualized to the needs of the patient. For example, our first responders especially benefit from opioid and relapse specific programming, CPT for trauma, an immersive spirituality program and parenting groups organized by gender
Like other professions, first responders have unique challenges that require specialized treatment. Unfortunately, while doctors and nurses and pilots have very low relapse rates, first responders are much more likely to relapse. Other professions have licensing boards that closely monitor people who are in recovery to ensure strict compliance with professional guidelines. There is no uniform monitoring service for first responders. It’s not unusual to see first responders coming to treatment after relapsing. That is why it is important to seek a treatment program that not only specializes in the needs of first responders but also helps build the support needed to transition out of treatment and live, work, and thrive in recovery for life.