Firefighting can be one of the most stressful jobs. Due to the nature of the work, many firefighters cope with post-traumatic stress disorder, trauma, and anxiety because of firefighting hazards. To cope with mental health issues, some firefighters turn to drugs. Being directly exposed to fire and risk death regularly is mentally demanding. Many of them take refuge in drugs and alcohol to ease their symptoms. But, there are numerous side effects we will discuss later in using drugs. To add to that problem, firefighters also face barriers to seeking help, including stigma and the cost of treatment. However, preventive programs have been implemented worldwide to boost not only protective but preventive factors. As for preventive plans, the widespread use of drug testing seems to be a simple and expedient solution to such complex social problems.
With the increase in industry suicides in the past few decades, monitoring the mental health of firefighters has become a priority for many departments. All of the isolation and the heavy lockdowns caused a lot of depression. This pandemic is one more challenge for firefighters to face.
To discuss the challenges encountered by firefighters during regular duty as well as following disasters, we will shed more light on the risks and behavioural health consequences (such as PTSD, stress, and depression) of serving as a first responder.
Because they are the first to respond to all kinds of emergencies, being a firefighter is mentally and physically demanding. They face a lot of challenges daily such as death, trauma, danger, increased risk and exposure.
Due to acute stress and trauma, it’s common for emergency responders to develop co-occurring mental health and substance use disorders.
Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are the two most prevalent disorders among first responders. These disorders can begin from the stress of the job or preexisting stress that comes from the job the first responder is doing now.
A study of firefighters, published in the Journal of Clinical Sleep Medicine, suggests that recurrent sleep disturbances (e.g. insomnia, nightmares) increase the risk of depression and related disorders, and impair the ability to make efficient use of emotional control strategies.
Suicide is one of the leading causes of death worldwide for adults. South Korea, in particular, is a country with a markedly high rate of suicide for the past several years. One occupation group that particularly deserves such attention is firefighters because they frequently experience traumatic events that can increase suicidal behaviors. A report from the National Fire Agency reported that the number of firefighters who died from suicide was greater than the number who died in the line of duty in South Korea. In the United States, there were also more suicides than on-the-work deaths in firefighters during the last decade.
From cities to ships, firefighters are everywhere in the world. Their work is highly demanding as they are directly exposed to fire and risk death regularly. To cope with those challenges, some find refuge in drugs.
One of the core risk factors for first responders is the pace of their work. As first responders, firefighters are always on the front line facing highly stressful and risky calls. This tempo can lead to an inability to integrate work experiences.
For instance, according to a study from SAMHSA, 69% of American EMS (Emergency Medical Services) professionals have never had enough time to recover from traumatic events.
The nature of their work, including repeated exposure to painful and provocative experiences and erratic sleep schedules due to long 24-hour shifts, causes stress and trauma daily. Traumatic calls can also lead many firefighters to suffer from mental health problems such as post-traumatic stress, acute stress and depression.
Firefighters are exposed to major professional hazards such as heat stress, dehydration, smoke toxins, medical hazards, dangerous environments and intense physical challenges. As a result, firefighters have a high prevalence of work-related medical and mental disorders compared to the general public.
Historically, the most frequently abused drug by firefighters is marijuana (cannabis). THC, the main psychoactive ingredient, causes various effects on metabolism and behaviour. It may also affect users' mental health conditions.
Cannabis has indeed side effects that create occupational hazards. It actually disrupts brain function by causing cannabinoid intoxication, impairing alertness, memory, psychomotor skills and time perception. And the effects may last for a while.
According to Drugs and Me, a Mental Health Education Foundation site, the effects may wear off in 1 to 3 hours when vaped or smoked.
Moreover, marijuana often can leave users anxious, afraid, or panicked. Using pot may raise users' chances for clinical depression or worsen the symptoms of any already-existing mental disorders.
Alcohol is typically the substance most abused by public safety workers. A study funded by FEMA's Research and Development reported 85% of career and 71% of volunteer firefighters reported drinking alcohol in the past 30 days. More and more firefighters report recent heavy or binge alcohol drinking. The proportion of male firefighters abusing substances is bigger than the female firefighters' though this gap is shrinking.
Substance use among firefighters may owe to being unfit mentally or physically before a disaster to perform relief work, as well as inadequate training, live events, including personal trauma and loss before the disaster.
Their occupations are often physically demanding and involve risks of injury that may require the prescription of opioid painkillers. Although they are the first to experience the effects of these drugs, no one is physically immune to the addictive nature of opioid drugs.
While alcohol and substance abuse can cause work performance problems, addiction can also lead to mental and behavioral symptoms:
Firefighters who suddenly stop taking drugs or alcohol may suffer from withdrawal symptoms. If left untreated, these symptoms can affect the firefighter's performance. Their performance is more or less damaged depending on the frequency/prevalence of use.
They do not use products by choice or medical choice or medical necessity. (e.g. lifelong abstinence after detoxification)
They consume drugs with controlled use and no identifiable harm.
Their use entails immediate or delayed risks to health and safety.
Their use causes detectable damage to their health, safety, private and professional life.
The frequency of use among firefighters also depends on the position they hold.
Career firefighters report higher levels of problematic alcohol use and PTSD as compared to the volunteer firefighters, while the volunteers reported higher levels of depression and suicide attempts and ideations.
Volunteer firefighters are often under-appreciated for the work that they do – if you’re not motivated by personal satisfaction, you should be warned that they don’t often get a pat on the head or formal recognition for their efforts.
Young firefighters are between 13 and 17 years old. Like other teenagers, young firefighters are being exposed to drugs at an increasingly early age. It is in their teenage years that young people are the most influenced and most rebellious.
You must pass a background check and in some instances, a drug screening as part of the requirements to be a firefighter.
If you have a criminal history or fail the drug test, you will most likely be disqualified from becoming a firefighter.
American courts have accepted five types of testing: pre-employment; periodic; post-accident or incident; random, and for cause (or reasonable suspicion).
Random drug testing is not the solution as not every firefighter is associated with increased risks of post-disaster mental health issues. As discussed earlier, drug use actually varies from a firefighter to another depending on their position or age. Identifying the most vulnerable firefighters to drugs help to implement an efficient and cost-effective preventive plan. To detect them, an increasing number of fire departments choose drug detection solutions. For instance, we at Synens contribute to preventive programs by providing drug testing solutions adapted to every department’s needs.
The widespread use of drug testing devices seems to be a fast and easy solution to this complex social problem. Workplace stress, ignorance, lack of employee support services and the continued treatment of addiction as a social deviation rather than a disease justify pursuing a course of action to drug testing.
As firefighters have safety-security, they are required to undergo drug testing. The drug testing requirements vary depending on the country or the State.
Increased prevention and education efforts in active firefighter support organisations have raised awareness of the prevalence of mental health problems among first responders and firefighters. It has also improved access to appropriate care and treatment.
Drug use and addiction are still taboos. Judgments from others explain the fear of confiding in someone about their addiction. Stigmas surrounding mental health and addiction in the workplace may indeed be keeping firefighters from getting the help they need. Yet, sharing their personal stories as drug addicts might help prevent drug use among the youngest. The concrete aspect of those testimonies would lead others to become aware of the difficulties and the numerous side effects drugs cause.
Young people are more sensitive to personal and customized messages. Thinking of a preventive program as an advertisement helps to better capture teenagers’ attention. The target audience will feel concerned and interested in the message sent.
Protective factors included occupational factors such as stable employment over time, which acted as protections against PTSD and burnout, while low job satisfaction was associated with higher risk. Specialised training, a high level of professional mastery and confidence in personal and collective abilities acted as protective factors and were associated with lower stress.
Providing tuition assistance to volunteer firefighters help to make them appreciated and important in the eyes of the community. This may make a difference in volunteers' health conditions knowing how under-recognized their efforts often are.
Substance Abuse and Mental Health Services Administration (SAMHSA): A mental wellness agency that aims to reduce stigma in the United States by debunking myths and raising awareness of the individual experiences of those living with different mental health symptoms.
European Association of Firefighter Psychology (AEPSP): an association that deals with the psychological aspects of the operational activity of firefighters.
CDC's National Institute for Occupational Safety and Health: the U.S. federal agency responsible for conducting research and developing solutions for the prevention of work-related injuries and illnesses.