Major stress and constant pressure are all part of the job for emergency-services personnel and other responders. A less obvious but greater danger is caused by drug and alcohol addictions. Professional help is available, but not always wanted. What is most needed, and in the long term most effective, is an all-hands alert to recognize the addiction earlier, provide the help needed, and avoid being judgmental.
The past several months have been especially noteworthy because of the intense media attention on celebrities suffering from and, in some cases, dying from drug and alcohol addictions. It is difficult to turn on the television without seeing at least one news report, or “entertainment” program, covering, dramatizing, and/or intervening with some form of substance abuse. This public attention serves to educate the community about the existing dangers and treatments available.
In the emergency services professions, in contrast, addiction problems have historically been handled quietly, often interspersed with periods of denial and secrecy until the professional performance of a member becomes both public and problematic. In some cases – and with the best of intentions – the local “culture” of a police or fire department may enable a substance-abuse problem to remain unchecked for a considerable period of time.
Nonetheless, veteran emergency services personnel are often personally familiar with a department’s denial or at least non-recognition of the seriousness of the affected person’s behavior – both on and off the job.
The High Cost of Addictions – In Time, Energy & Money
Addictions come at a very high cost – the most devastating of which is the suffering that many and probably most users (and those close to them) face as the disease progresses. Dependence is defined as developing a tolerance for a particular substance – typically, by going through a physical adaptation, consciously or non-consciously, that requires using more and more of the drug to achieve the same and increasingly addictive effect. Another non-monetary cost of addiction is the painful withdrawal symptoms that occur when the user tries to break the habit. With very few exceptions, those suffering from drug addictions will almost always go through the same cycle: spending considerable time, energy, and money on finding, using, and finally – if they are fortunate – recovering from the drug.
As the addiction progresses, the need and quest for the drug can become an overwhelming and all-consuming interest. Personal relationships quickly, and visibly, begin to show the strain of an active addiction. Performance on the job – whatever that job is, and despite whatever responsibilities go with it – also becomes compromised and, if ignored, worsens. Serious health consequences start to emerge as well – frequently in the short term or early stages, and almost always in the long term.
Addiction also can negatively affect the course of other stress disorders and depressions – which already rank high in the less publicized dangers of the emergency-services profession. Not surprisingly, post-traumatic stress disorder is often associated with alcohol abuse, and that problem, if not addressed in the early stages of addiction, usually leads to a more difficult and longer recovery period.
Although the costs of untreated addiction are personally destructive, public safety agencies themselves also are negatively affected. It has been estimated by the Livengrin foundation that the cost of recruiting and training one law enforcement officer is greater than $200,000. Obviously, though, the intangible losses – less experience and unit cohesion as well as lower morale – resulting from losing just one important team member to an addiction problem cannot be quantified in dollars and cents.
Early Intervention, the Denial Syndrome, Care, and Compassion
Given the importance of addressing this problem, each member of a department can and should, insofar as possible, take an active role in helping to prevent addictions from going unchecked. Early intervention is one of the key factors in helping any addict recover from a substance abuse problem. Addiction is a progressive and insidious disease – which for practical purposes means that, as with other diseases, providing professional help in the early phases of an addiction is much more effective – less expensive as well – than waiting until a life and/or career are damaged.
Experience shows that the most effective programs for early intervention involve educating all personnel in a department about the warning signs. Among the most common behavioral changes that should be noticed are unusual mood swings and difficulties in getting along with colleagues. The more quantifiable changes are tardiness, absenteeism, and poor job performance. The most difficult problem to deal with, though – in most if not all cases – is the denial that a problem even exists. Here it should be emphasized that it is not always the addict who is in denial – coworkers, colleagues, friends, and supervisors can be just as guilty in this respect.
Supervisory personnel can receive specialized training in how to approach a person about substance issues in a caring and compassionate manner. The skills needed to make a referral can also be learned in such training. Because one major barrier to seeking help is the fear of a person’s career being damaged, perhaps beyond repair, departmental policies can be formulated, and officially implemented, to support the treatment needed without the person being treated having to fear stigmatization on the job – or, in worst-case situations, termination.
The Path to Recovery: Effective Programs Already Available
Early treatment for substance abuse can be particularly effective in saving both lives and careers. To help ensure early treatment, first-line supervisors can and should solicit, and use, local, union, and agency resources for the treatment of substance abuse. Employee assistance programs can be an invaluable asset in seeking and encouraging treatment. Programs specifically designed for public safety personnel struggling with substance abuse issues already exist, fortunately, and are often facilitated by fellow public safety workers as well as mental health professionals.
Of course, substance abuse treatment must be matched as closely as possible to the specific individual seeking help. Fortunately, that approach can be effective in a variety of settings, depending on the individual circumstances of the person needing treatment and the severity of his or her problem. In some cases, a medically supervised detoxification will be the first step – but very seldom the last one. In other situations, the individual employee, group, or a family counseling specialist can be a valuable resource. Also, several well-known “12-step” programs are available that not only provide a path to recovery but also include a much-needed support group to others (friends, relatives, and fellow employees) who might be tangentially affected.
Public safety professionals serve the public daily, usually without recognition, and sometimes at great personal cost. Knowing how to support a colleague in distress can be the all-important difference between early recognition and treatment vs. enduring problems that threaten the professional and personal life of a friend, colleague, or anyone else suffering from addiction.
Victor Welzant, PsyD, is the Director of Education and Training and a past member of the Board of Directors of the International Critical Incident Stress Foundation in Ellicott City, Maryland. He also maintains a private consulting and clinical practice in Towson, Md., and serves as: the Clinical Director for the Anne Arundel Fire Department’s Critical Incident Stress Management team; a consultant to the Harford County Maryland Sheriff’s Department’s Crisis Negotiation and Peer Support teams; a member of the adjunct faculty of Towson University in Psychology, Nursing, and Homeland Security; and a member of the editorial board of the International Journal of Emergency Mental Health.