Every day of the year, America’s police officers, paramedics, EMTs and firemen provide frontline assistance for people facing emergency situations. These first responders are widely acknowledged for the role they play in saving lives and protecting the public welfare.

However, less attention is given to the emotional/psychological impact of witnessing severe human distress on a daily basis. Current evidence shows that significant numbers of first responders develop symptoms of posttraumatic stress disorder, or PTSD. In turn, the presence of PTSD increases the risks for developing the symptoms of a substance use disorder.

PTSD in First Responders

PTSD occurs when exposure to a traumatic event leads to lasting changes in physical and mental well-being[i]. Common PTSD symptoms include:

  • Involuntary reliving of the event(s) that led to emotional/psychological trauma
  • A strong urge to avoid reminders of the source of trauma
  • An inability to disengage the body’s built-in “fight-or-flight” mechanism

First responders and other people who react to emergency situations can develop a sort of second-hand PTSD. The term for this condition is secondary traumatic stress disorder[ii]. It constitutes an intensified form of compassion fatigue. The U.S. Department of Health and Human Services reports that specific manifestations of secondary traumatic stress include[iii]:

  • Sleep problems
  • Feelings of isolation
  • Dissociation from reality
  • Feelings of guilt, sadness or other powerful and damaging emotions
  • Aching joints or muscles
  • Concentration problems
  • Perfectionist thinking
  • A sense of apathy

Not everyone who experiences severe trauma will develop PTSD. Similarly, not everyone who witnesses other people’s trauma will develop secondary traumatic stress disorder.

PTSD and Substance Use Disorders

People affected by substance use disorders (SUDs) have serious, diagnosable problems with drugs, mind-altering medications and/or alcohol[iv]. In some cases, these disorders are marked by symptoms of clinical substance addiction. In others, they’re marked by symptoms of non-addicted substance abuse. In addition, many affected people experience overlapping problems with addiction and non-addicted abuse.

Post-traumatic stress disorder is known for its tendency to increase the risks for substance use disorder. In fact, research shows that these two conditions frequently appear together[v]. Most experts believe that the main explanation for this phenomenon is a misguided desire in people suffering from PTSD to self-medicate their symptoms. The combination of PTSD and SUD often leads to greater harm than either of these conditions would produce on its own.

First Responders’ Difficulties in Asking for Help

First responders who suffer from secondary traumatic stress and substance problems often find it difficult to admit what’s happening and ask for help[vi]. Several factors help explain this reality, including:

  • The desire to maintain an appearance of professional invulnerability
  • The desire to maintain the confidence needed to act in emergency situations
  • The fear of not measuring up to the expectations of being a first responder
  • Fear of the cultural stigma that can come from admitting to the presence of mental health problems
  • Fear of experiencing workplace repercussions for mental health issues and/or substance use

First Responders

Taking Advantage of HIPAA Laws

EMTs, firemen and other first responders who fear workplace consequences for their substance use must understand some important facts. Chief among these facts is the protection they’re given under the nation’s HIPAA laws. HIPAA is the acronym for the Health Insurance Portability and Accountability Act, a piece of federal legislation that took effect in 1996. Under the terms of this law, all health care providers and health insurance companies must maintain patient confidentiality when handling certain kinds of information[vii]. Examples of HIPAA-protected information include:

  • The details of the type(s) of care provided during treatment
  • Personal history of physical health problems
  • Personal history of mental health problems

Anyone relaying this information must omit all identifying personal data, including a person’s name, social security number, date of birth or address.

In the workplace, HIPAA protections apply to all first responders. This means that any responder who needs help for PTSD, secondary traumatic stress or substance use disorder can seek treatment without fear of having that treatment revealed to a boss or supervisor. In addition, once police officers or other responders seek treatment, they cannot be fired for their substance use problems.

In stark contrast, emergency personnel who don’t seek treatment for substance addiction or non-addicted substance abuse expose themselves to serious workplace consequences. In some cases, these consequences may stem from drug or alcohol use while on duty. In other cases, they may stem from performance-related issues such as recurring tardiness or excessive use of sick time. A marked decline in work performance could ultimately lead to disciplinary actions or even loss of job in severe circumstances.

Seeking Specialized Help

Help is available for first responders who develop substance use problems for any reason. Depending on the type of substance in use, professional treatment may include medication assisted therapy, behavioral psychotherapy or a combined course of medication and behavioral psychotherapy.

Effective treatment can take place in an inpatient setting, an intensive outpatient setting or a standard outpatient setting. Specialized help is also available for first responders affected by overlapping symptoms of a substance use disorder and PTSD. Some programs address the effects of PTSD before moving on to substance treatment. However, other programs address substance use first or treat the effects of PTSD and SUD at the same time.

[i] U.S. Department of Veterans Affairs – National Center for PTSD: What Is PTSD?
https://www.ptsd.va.gov/public/PTSD-overview/basics/what-is-ptsd.asp

[ii] Substance Abuse and Mental Health Services Administration: Tips for Disaster Responders – Understanding Compassion Fatigue                                     https://store.samhsa.gov/shin/content/SMA14-4869/SMA14-4869.pdf

[iii] U.S. Department of Health and Human Services – Administration for Children and Families: Secondary Traumatic Stress
https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress

[iv] Substance Abuse and Mental Health Services Administration: Substance Use Disorders
https://www.samhsa.gov/disorders/substance-use

[v] Clinical Psychology (New York): Post-traumatic Stress Disorder and Co-Occurring Substance Use Disorders – Advances in Assessment and Treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3811127/

[vi] Psychology Today: Trauma and First Responders – When the Helpers Need Help
https://www.psychologytoday.com/blog/where-science-meets-the-steps/201701/trauma-and-first-responders-when-the-helpers-need-help

[vii] U.S. Department of Health and Human Services: Health Information Privacy – Summary of the HIPAA Privacy Rule
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html