The Firefighter’s Guide to Addiction and Mental Health Help

When a person spends the majority of their week responding to emergencies, putting out fires and rescuing people from near-death situations, that can have a mental health impact and may even trigger addiction issues. Whereas most people in this country have never had to make a life-or-death decision, firefighters routinely face high-stakes choices. If it is not another person’s life that weighs in the balance, it is their own.

When your full-time responsibility is saving lives, it is not uncommon to carry that stress home to family. When you operate in crisis mode so much of the time, recognizing that each call may bring unknown dangers and life-threatening situations, you may begin to live all of life on high alert. You may have seen every manner of fire and catastrophe, so you know what can happen. That can give rise to anxiety and worry. Maybe you worry about your loved ones. Maybe you worry about your fellow firefighters. Maybe you worry about having to drag another dead body from a fire.

Sadly, the mental health of firefighters is often downplayed or misunderstood. As with other first responders, the mental health of firefighters can further suffer from stigma, societal depictions of firefighters as “superheroes” and the cultural norms of firefighters themselves. This guide can help firefighters and their families better understand firefighter’s susceptibility to drug abuse, alcohol addiction, and mental health issues, and how the unique stressors that they face play a role. You will also learn about common mental health issues that affect firefighters, barriers to treatment and how to get help when you need it.

What are the Firefighter Addiction and Mental Health Statistics?

Depression is the most commonly reported mental health issue among firefighters in the U.S., according to a report by the Substance Abuse and Mental Health Services Administration. Here are some other addiction and mental health statistics cited by SAMSHA:

• Nearly 23 percent of female career firefighters report feeling depressed
• 38 percent of female volunteer firefighters are depressed
• 50 percent of firefighter deaths are due to the physical and mental consequences of long-term exhaustion and stress (heart attacks, suicides, strokes, etc)
• More career firefighters are diagnosed with post-traumatic stress disorder (PTSD) than volunteer firefighters
• Career firefighters are much more likely to have alcohol and drug use disorders than volunteer firefighters
• Some studies indicate that as many as 50 percent of male firefighters engage in binge drinking while nine percent drive while intoxicated
• Suicide ideation in male and female firefighters occurs at higher rates compared to the general population

Being injured on the job may also contribute to firefighter mental illness and addiction. The National Fire Protection Association’s latest numbers on firefighter injuries show that over 58,000 firefighters suffered at least one injury in 2018 while on a call. Injuries can range from chronic back sprains, lacerations, burns and other painful injuries that take time to heal. Consequently, some firefighters may take pain pills to deal with a painful recovery, which can lead to firefighters drug abuse and addiction to opioids.

Why are Firefighters Often Resistant to Getting Help?

One reason that a firefighter may resist getting help for addiction or other mental health issues may be their workplace culture. Researchers have found there is a “fire station culture” that encourages binge drinking and subtly stigmatizes firefighters who are depressed, anxious or have symptoms of PTSD.

When firefighters with mental health or addiction problems think no one will take them seriously or that they will be told to simply “hang in there” or “tough it out,” most won’t seek professional help. Instead, their depression and substance abuse may only worsen as they try to cope with severe psychological issues alone. Moreover, male firefighters with families to support will feel even more pressure to keep their depression, anxiety and PTSD symptoms to themselves.

What are the Different Levels of Stress and Their Impact on Firefighter’s Mental Health?

Everybody experiences various degrees of day-to-day stress involving family, work, social and/or personal life. Firefighters have two additional types of stress to contend with on top of these daily stressors: chronic (cumulative) stress and critical incident stress.

Examples of common chronic stressors endured by firefighters include:

• Living in fire stations for long hours away from family
• Going out on every new call and not knowing what to expect
• Dealing with the complexity of friendships with other firefighters
• Listening to traumatic stories
• Compassion fatigue (feeling emotionally burned out, exhausted and unenthusiastic about work)
• Local, county and state funding obstacles (possible lay-offs, reduced hours, decreased pay)

While cumulative stress is the leading cause of anxiety and depression in firefighters, it is the consequences of critical incident stress that often leads to symptoms of post-traumatic stress disorder. Examples of critical incident stress include: rescuing severely burned individuals, finding dead individuals in a burning home and learning that someone they rescued died later at the hospital. When children are involved in a call, that can be especially traumatic.

How Does Post-Traumatic Stress Disorder (PTSD) Affect Firefighters?

According to the International Fire Fighters Association, 20 percent of firefighters suffer from PTSD, compared to the general population rate of four percent. This rate is comparable to the rate of PTSD in combat veterans.

Signs of PTSD often begin within several weeks of experiencing a traumatic event. These symptoms include:

• Recurring nightmares, intrusive thoughts, or memories (flashbacks) about the event.
• Panic attacks.
• Insomnia/frequent awakening during the night due to anxiety or nightmares.
• Overreacting to statements or situations that are not really threatening or critical.
• An increase in aggressive, sometimes irrational behavior.
• Avoiding things that are reminders of the event. (For example, if a firefighter rushed into a burning home and found a deceased child clutching a stuffed teddy bear, the firefighter may go to great lengths to avoid stuffed teddy bears)

PTSD can also manifest physically in firefighters as:

• Migraines
• Recurring nausea/abdominal pain with no apparent medical reason
• Rapid heartbeat (tachychardia)
• Heart palpitations
• High blood pressure
• Increase in cholesterol or blood sugar levels (diabetes)
• Weight gain
• Back/joint pain

Instead of seeking therapy and counseling for depression or PTSD, firefighters may resort to self-medicating with drugs or alcohol. Alcohol is the most frequently abused substance among firefighters, followed by marijuana and pain medications.

A study published in the Journal of Substance Abuse and Alcoholism found that 70 percent of volunteer firefighters and 85 percent of career firefighters reported drinking alcohol in the past 30 days. Another 45 percent of volunteer firefighters and 56 percent of career firefighters reported binge-drinking in the previous 30 days. Authors of the study mentioned that, in comparison, the national rate of binge-drinking among men is 20 percent, far below that of firefighters.

FHE’s Health’s Specialized Treatment Program for Firefighters

Firefighters need mental health and addiction services that address their unique physical and emotional needs. Whether it’s depression, PTSD, an alcohol problem or another issue, the “Shatterproof” program at FHE Health provides individualized treatment for your specific needs, within a supportive community of other firefighters and first responders. If you or a loved one is suffering, reach out to FHE today and ask about our Shatterproof program. One of our caring counselors will be able to answer any questions.

More Resources And Support For Heroes In Firefighting:

• 7 Reasons First Responders Need Specialized Mental Health Treatment and Support 
• The Firefighter’s Guide to Addiction and Mental Health Help
• Why Peer Support Is Key in First Responder Rehab
• First Responder Attrition and Retention: Mental Health’s Role
• First Responder Burnout – An Interview with Dr. Sachi Ananda
• First Responders to the New Haven Overdose Praised by Experts at FHE Health
• The Real Dangers of Fentanyl Exposure for First Responders 
• First Responder Mental Health at Heart of New Partnership 
• What Sets Shatterproof FHE Health Apart