They’re often the first on the scene, but the last ones to heal. Working as a first responder, whether it be as a police officer, firefighter, EMT, or paramedic, can be a rewarding and challenging career. But serving others can leave little room for self-care. Balancing a career as a first responder can be so difficult that some may turn to substances to cope with conditions like post-traumatic stress disorder (PTSD) and other work-related issues. 

Whether it’s behind the phone or on the front lines, first responders often see and experience traumatic events. It’s important to recognize and understand the mental health and substance abuse risk that these men and women face. By understanding the roots of addiction and mental health issues, along with treatment options and ways to help, those who serve others for a living can lead healthy, substance-free lives.

PTSD and Substance Abuse in First Responders

Triggered by a disturbing or life-threatening event, post-traumatic stress disorder (PTSD) is a mental health condition that can affect any police officer, firefighter, EMT, paramedic or first responder. While most symptoms of PTSD typically appear within a month of witnessing or experiencing a traumatic event, the condition may remain dormant for months or even years.

Symptoms of PTSD can be grouped into four main categories:

Intrusive Memories:

This may include experiencing unwanted and upsetting memories of the event, reliving the event, having dreams or nightmares about the event, and feeling extreme emotional distress or physical reactions to people, places and things that trigger memories of the event.


In an attempt to curb upsetting thoughts or traumatic memories, people affected by PTSD often avoid talking about the traumatic event or coming into contact with the people, places and activities that remind them of the event.

Negative Changes in Thinking and Mood:

Because PTSD is an extremely distressing condition, it often brings about a variety of negative emotions and changes in perspective. These can include negative thoughts about oneself, hopelessness about the future, trouble maintaining close relationships, feelings of detachment from family and friends, decreased interest in former hobbies, and emotional numbness.

Changes in Physical and Emotional Reactions:

PTSD in police officers and other first responders can often lead to a state of increased arousal and anxiety. This may trigger changes in behavior, including engaging in dangerous activities; being easily startled; having trouble concentrating or sleeping; experiencing irritability, angry outbursts or aggressive behavior; or feeling an overwhelming sense of guilt of shame.

According to a recent report conducted by Canada’s Centre for Suicide Prevention, first responders are twice as likely than members of the general population to develop PTSD. The organization estimated that over 17 percent of Canadian firefighters and paramedics struggle with PTSD. Information released by the International Association of Fire Fighters (IAFF) confirms that an “alarming” number of first responders develop the condition after “repeated exposure to horrific events” while providing job duties. 

Because so many first responders struggle with PTSD, it’s no wonder that substance abuse is also more common among them. According to TIME, between 50 and 66 percent of people who have PTSD also struggle with addiction. These rates are likely even higher among first responders. Most people see any police officer, EMT, firefighter, paramedic or other emergency personnel as a protector. This creates a strong feeling of pride associated with emergency work, and a culture of silence in many fire departments and hospitals. Talking openly about the issue of first responders and PTSD helps dispel the stigma surrounding it, and makes it easier for those who are struggling to get help before they turn to drugs and alcohol to cope.

Signs of Substance Abuse in First Responders

Whether you’re a friend or relative of a first responder, you want your loved one to live a healthy life, free of substance abuse. Perhaps you’re already aware of the risks involved with these professions, but what you may not know as much about are the various signs of substance abuse. Some are obvious to virtually anyone, but others can only be discerned by those who know what to look for. If you’re concerned that your loved one is abusing drugs, alcohol or both, here are some common signs of substance abuse in first responders:

Health Problems:

This is one of the most dangerous signs of substance abuse, as certain health problems can be fatal. Smoking certain substances can lead to lung disease or infection, while ecstasy and meth use can result in kidney failure. Stimulants can cause a heart attack or sudden death, and painkillers can lead to respiratory collapse, liver disease and heart problems. Alcohol abuse can also result in liver problems (cirrhosis) and heart disease, among other issues.

Changes in Appearance:

Different substances affect the body in different ways. For example, recent heroin use causes constricted pupils, recent hallucinogen use results in dilated pupils, and recent marijuana and inhalant use reddens the eyes. Certain drugs can also affect the skin and teeth. For example, meth can cause acne and dull skin as well as rotten teeth and gum disease (meth mouth). Various substances can also produce an increase or decrease in appetite, resulting in weight gain or loss.

Neglect of Personal Hygiene:

Many individuals who abuse drugs or alcohol spend more time on their substances or addiction and less time focusing on their hygiene. This could mean they shower or wash their hair less than usual. They may also stop brushing their hair and teeth. Some even wear the same clothes several days in a row.

Drug Paraphernalia:

This is one of the most obvious signs of substance abuse. If your loved one is abusing alcohol, you might find bottles or cans lying around their house or in their car. Illicit drug paraphernalia might include syringes, spoons and pipes. It’s important to keep in mind that prescription drugs, such as painkillers (Vicodin, Percocet, OxyContin, etc.), may also be abused. One sign of this could be an excess of prescription bottles or constant requests for refills.

Memory Loss:

Different substances affect the brain in different ways, and some can result in memory loss. Anti-anxiety drug abuse (benzodiazepines) can affect short-term and long-term memory. Abuse of narcotic painkillers can also interfere with short-term and long-term memory, especially if they’re used for long periods of time.

Financial Problems:

While some prescription medications are completely or partially covered by insurance, other drugs are not, which can make substance abuse an expensive problem. If your loved one is abusing alcohol or an illicit substance, you might notice financial struggles. Does it seem like they’re always pressed and desperate for cash? Have you witnessed them asking someone for money on more than one occasion? If the answer is yes, look for other lifestyle changes, as they may be signs of substance abuse.

Withdrawal from Social Activities:

Losing interest in hobbies and social activities is a common sign of substance abuse. Many individuals who abuse drugs or alcohol prefer to do so in private, which means they isolate themselves from family, friends and activities they once enjoyed. In many cases, substance abuse results in depression, which is another reason to withdraw from social activities.

Behavioral Changes:

Abusing drugs or alcohol affects the brain, which can then affect behavior. You might notice your loved one acting secretively, hiding their interactions with new individuals, experiencing frequent mood swings and lashing out at random moments. If they’re unable to acquire their substance of choice, they may also become extremely frustrated, angry and irrational.

Work Performance:

Being alert and performing well at work are key factors for a police officer, EMT, dispatcher or firefighter. Close calls in any of these professions, whether they be a seemingly careless mistake or a fragrant error, can be life-threatening for everyone involved. If you notice stark changes in behavior or attention to detail at work, it may be time to have a discussion about mental health and substances.

These are just a few of the signs of substance abuse, but not everyone who abuses drugs or alcohol exhibits the same behaviors. Whether you’ve noticed any of these signs or not, if you suspect that your first responder loved one is involved in substance abuse, help is available. There are many 24-hour hotlines staffed with professionals who can speak with you and provide you the counseling and answers you need. The life of a firefighter, police officer or other first responder isn’t always easy, but at the very least, you can help make it drug-free.

How to Help a First Responder Battling Substance Abuse or PTSD

Maybe you have a co-worker dealing with depression after a difficult call. Perhaps you have a friend battling PTSD following a series of traumatic events. Or maybe your spouse is struggling with substances to calm their nerves at night after work. No matter who you know, or how they’re affected, there are resources available to help everyone involved. 

The career of an EMT, firefighter, police officer or other first responder is filled with rewarding highs and potentially difficult lows, so empathetically understanding the challenges they face is often the first step in helping someone cope. Oftentimes friends and family realize that there is a problem before the person struggling with substance use disorder or mental health issues does. If you notice any of the signs of substance abuse, PTSD or other mental health conditions, it’s important to take action with meaningful steps that can help everyone involved heal. 

Talk It Out:

If you are concerned about a friend or loved one in the first responder field, discussing your concerns with them can be the first step toward helping them. Even if they are not ready or don’t realize they need help, having someone else talk to them about mental health and substance abuse can plant a seed for change.


Opening up about substance abuse or mental health is one of the most difficult and bravest things a person can do. If someone you know has chosen to speak to you about their struggles, it’s important to listen, reflect and offer open lines of communication. This doesn’t mean that you have to provide a perfect solution, but offering help in any way possible, even if it’s just hearing them out, can be beneficial for firefighter, EMT and police officer PTSD and substance abuse.


The road to recovery can be long, challenging and full of potential setbacks. This can be discouraging for everyone involved, including family and friends. But encouraging your loved one can be reassuring and keep them from giving up. For first responders like police officers and firefighters in action, support is especially important, as they need positive morale to successfully perform their jobs.


Although recovery from substance abuse or mental health issues is a personal journey, it helps to have advocates in friends and family members. Being an active part of recovery can be extremely helpful, whether you participate in family therapy sessions, avoid substances alongside a partner, or encourage others at work to open up about the emotional effects of the job.

Seek Professional Help:

Encouraging a first responder to seek help can be transformative, but sometimes it takes a little more than a simple nudge at home. First responders and PTSD too often go together in a cycle that can lead to substance abuse, addiction and denial. If you know someone going through this cycle, sometimes a mention is not enough to get them on the path to recovery. You can anonymously call several hotlines to learn more about how to help, or request information about treatment programs. The Recovery Village can help you find the right care for yourself or someone you know, including specialized programs for IAFF members. Your confidential call could help save a life.

Issues like substance abuse and addiction can be especially difficult for first responders, including professionals like police officers, EMTs, dispatchers and firefighters. PTSD, depression and other mental health issues are just as serious and can often co-occur alongside a substance use disorder. But with the right support, these men and women can work through complex, emotional trauma — physical and mental — that is so often associated with the challenging and rewarding careers they dedicate their lives to.

Substance Abuse Treatment for First Responders

When it comes to substance use disorders and co-occurring conditions, a professional program is usually the best way to return to the path of wellness. But with so many treatment methods available at facilities across the country, it can be difficult to decide which is right for you or a loved one. Full-service centers like The Recovery Village offer clients the option to undergo inpatient or outpatient care depending on their individual needs. With several locations in the United States, The Recovery Village can offer the support and evidence-based treatments that first responders need to get back to the work they love. Facilities with programs specially tailored to help emergency workers overcome trauma and substance abuse may also be beneficial.

Are You an IAFF Member?

Located in Upper Marlboro, Maryland, the IAFF Center of Excellence is designed to address the unique concerns of firefighters and paramedics struggling with substance use or behavioral health disorders. If you’re an IAFF member who is struggling or know one who is, reach out to the IAFF Center of Excellence today. Intake coordinators are standing by to take your call.

As a first responder, you spend your days helping others. But do you ask for help when you need it? Addiction and co-occurring disorders can be overcome, but the first step to a better life is admitting you can’t fix your problems alone. Through evidence-based treatments, comprehensive support programs and dedicated staff, The Recovery Village has given countless people the chance to find hope and healing. You could be one of them. Call  844.881.6351 The Recovery Village today to get started.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.