First Responders Need Specialized Addiction Treatment

By Brian Whitney 09/11/15

For firemen, police officers, EMTs and combat veterans, death, violence and seeing horrific images are often all part of a day's work. Many cope by using drugs and alcohol to mask their fear and pain.

First Responders

You’re at your job. You aren’t having a good day at work. You are hearing gunshots. Bodies are lying on the ground. There is blood everywhere. Lots of it. You have just a few seconds to react, to do what has to be done, you need to save others, and possibly even save yourself, and those seconds go by quickly. You do your job. You do it well. Later that night you go home from work. Then it’s over.

But is it?

For firemen, police officers, EMTs and combat veterans, death, violence and seeing horrific images are often all part of a day's work. People that work at these jobs all deal with a kind of stress that the rest of us could never imagine. Especially when they are first responders—those that are first on the scene of an accident, a horrific crime or a natural disaster.

It isn’t like most first responders have a comfortable place to talk about these things either. To show that you are affected by witnessing horrible acts, death, and chaos could make one appear weak and could affect your future and career goals.

“Jeff” a police officer that I know in my city, was recently the first to arrive at a particularly nasty death scene, this one was a suicide. How did he handle it? “I joked around and pretended it didn’t bother me. You don’t want to be saying to the other guys that you are having a hard time dealing with stuff like this. It kind of goes against the code. Everyone would call you a baby.”

So how do a lot of first responders deal with such things? Many cope by using drugs and alcohol to mask their fear and pain.

Experiencing these terrible things day after day can often lead people, even without prior addiction problems, to seek solace by using substances, and those that already have issues with drugs and alcohol often go farther down a path of destruction. And when they do go down that path, a lot of first responders just keep their problems inside and hidden, as many feel there is no place to get help that can help them.

However, there are such places. There are rehabs out there that offer specialized programs for law enforcement, firefighters, EMTs/paramedics, corrections officers and combat veterans that combine peer support with clinical, evidence-based treatment. 

What first responders see can range from mundane to horrific at a moment’s notice. Every violent, disturbing, scary story that you read in the paper or see on the news, first responders were there, whether it be child abuse, death, violence or rape. 

“Tim” a 35-year-old fireman, has been addicted to some form of mind-altering substance since high school. In his teens and early 20s he was into what he thought of as "party drugs"—alcohol, marijuana and cocaine. He didn’t feel like an addict, and thought he was keeping it under control at his job because he could stop using for long periods of time, usually for one or two months at a time, before he would pick up again. When things got bad he could always pull it back for a bit.

He was injured on the job and became addicted to pain meds. He tried to stop numerous times but the longest he could go was about a week before he would be back to taking them again.

When asked about this time Tim said: “Once I realized that by taking the opiates I could minimize the physical pain I was in and that they could help drown out the mental issues too, I began to abuse them a lot more. I started believing that by taking them every day, I wouldn't have to relive the tragic events that happened at work. I really thought by continuing to abuse them that the pain of what I saw and experienced would just go away. After a substantial period of time and more added traumatic stress, they not only didn't take either the physical or mental pain away anymore, my addiction actually made them worse.”

Finally, things became unmanageable and Tim went to an inpatient program specifically designed for first responders at Livengrin. “I really needed to talk about my underlying problems as well as my addiction. With the graphic and traumatic events I saw and experienced at work, I don't think I would have felt as comfortable to talk about these specific situations at a typical treatment center. Having other addicts and counselors familiar with my job and the stressors that come with it, this provided a very comfortable setting to be able to talk about much more than just my addiction.”

While there are some progressive departments out there that have mandatory "debriefings" after major incidents, many do not provide any support at all for those who are struggling. As a result, many first responders do not address the horrific amount of cumulative stress that they are under, or figure out how to deal with their constant exposure to traumatic events. Because of the unwritten code for such professions, first responders often don’t trust outsiders, especially mental health professionals. The fear is that if they admit to needing help, they will be found unfit for duty and have their gun or badge taken away and they will be put out of work indefinitely. This lack of trust coupled with their training that teaches them that they must always be in control is a pretty solid foundation for not seeking help. 

Clare Seletsky is the clinical coordinator of the First Responders Addiction Treatment Program at Livengrin Foundation. She handles all referrals from police and fire departments, as well as the correctional system, the National Guard and any other first responder agency with an employee or former employee in need of help. She also runs therapy and educational groups, develops an ongoing first responder psycho-educational curriculum, provides trainings, answers their 24-hour helpline, completes evaluations and facilitates "return to work" services for her patients. 

She says that “many police officers live by the saying ‘one trooper, one riot'—meaning that you should be able to handle anything and everything on your own, with no exception. It’s such a strange dichotomy because that way of thinking can save their life in a potentially lethal encounter, while at the same time it can lead them down the spiral of addiction because they refuse to find help. Reconciling this mentality with the First Step of admitting powerlessness seems impossible and many first responders believe that sheer willpower will rid them of this disease.”

When asked what other factors contribute to addiction in first responders she says: "There is a culture of ritual drinking as well as one of enabling in many departments across the country. With body cameras and shifting trends, it is less likely now than in past decades to get let go during a DUI stop because you have a badge or a military ID. It does still happen. I had a soldier once who would report for PT still drunk or too hungover to run, so the medics would rehydrate him with IV fluids to prevent his Sgt. from finding out that he had a serious problem. I’ve also had firefighters who have stolen from their station’s petty cash to pay for drugs only to have their coworkers replace the money because they know what’s going on but don’t want the firefighter to get in trouble.

“As if that isn’t enough cards stacked against them, there is more. In addition to the stress and trauma on the job, lack of trust in mental health professionals, their training to never surrender, hyper-masculinity and the drinking/enabling culture, there is also the heightened potential for physical injury on the job. The average duty belt worn by a police officer is around 40 pounds. The average backpack worn by a Marine on foot patrol in Afghanistan is around 100 pounds, and they may be walking 20 plus miles per day. Firefighters are crawling through tight spaces, hauling equipment, corrections officers are at extreme risk of assault on the job and EMTs/paramedics are lifting bodies and dealing with combative patients. There are too many physical hazards to name. This, of course, leads to acute and chronic pain, which then leads many first responders to prescription opiates. Once addicted, all bets are off just like any civilian.

"One major difference is that they may also have access to their drug of choice through their job; police officers arresting drug dealers, firefighters responding to calls from the elderly, medics administering morphine. Similar to all other addicts and alcoholics, their morals and ethics are no longer running the show; it’s now all about how to get their drink or drug. The biggest difference is, unlike the addict who works at a grocery store, the danger to the public is extreme. Even their risk to self is greater. First responders, as a group, have a higher rate of suicide than the general population, even without looking specifically at those struggling with an addiction. Ninety-three percent of police officers that commit suicide are under the influence of drugs or alcohol at their time of death. And, there is roughly twice the number of police suicides per year than line of duty deaths.”

Livengrin is not alone in providing specialized programs for law enforcement, firefighters, EMTs/paramedics, corrections officers and combat veterans. Other nationally recognized programs include Station House, and F1rst Responder Treatment. 

Peer support is an enormous part of the rehab experience for first responders. Seletsky says, “The fact that our patients have specialized care provided by active and retired first responders means that we give them an even playing field when it comes to their guilt, shame and the stigma of addiction. Keeping them in a mixed group every day would do them a disservice because we know from experience that they are not going to be comfortable enough to get honest because, as one patient put it, 'I don’t want to disgrace other police officers with my addiction in a group of civilians. I don’t want to disgrace my department in a group of other police officers. I don’t want to disgrace my unit in a group of police officers from my department.' There is a lot of shame to work through while in treatment, our program makes it that much easier for them to open up. Our first responders also room together because the fear of being housed with someone they have arrested or supervised in prison is very real and can be enough to prevent them from staying. For all of the service they have provided to our communities and families, we truly owe them the highest caliber treatment available.”

So far, the First Responder Addiction Treatment program has worked for Tim. “I absolutely believe that the First Responders Addiction Treatment program is one of the main reasons I am still clean and sober today. This program afforded me the opportunity to not only deal with my addiction, but to also deal with some severe underlying issues that helped fuel my addiction. It is my experience in this program that with being able to share in a room full of peers that I became more relaxed and comfortable, which helped me completely buy into the 12-step program.”

When I asked Seletsky if there was anything else she wanted to say to first responders she replied, “You do not need to lose your job because of this disease. You don’t need to lose your family or your life because you are struggling with an addiction. You are not alone”

Brian Whitney is a pseudonym for an author and ghostwriter, his book Raping the Gods became available in the spring of 2015. He last wrote about Sarah Hepola.

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Brian Whitney has been a prisoner advocate, a landscaper, and a homeless outreach worker. He has written or coauthored numerous books in addition to writing for AlterNetTheFixPacific Standard MagazinePaste Magazine, and many other publications. He has appeared or been featured in Inside Edition, Fox News,,, True Murder, Savage Love and True Crime Garage. He is appearing at CrimeCon in 2019. You can find Brian on Facebook or at