Experts: 'No weakness' culture difficult for firefighters to face addiction

The first of its kind treatment program caters to the unique stresses and needs of emergency responders

Chicago Tribune

CHICAGO — Scott Schaben started working as a suburban firefighter in the 1980s, bonding with his co-workers over off-duty beers. But his social drinking turned compulsive after he went through a divorce a few years ago, consuming his life until he knew he needed help.

He ended up seeking treatment at Rosecrance, a Rockford-based recovery center that has what it bills as the nation's first treatment program aimed exclusively at firefighters and paramedics. Schaben, 52, said that being among others who knew the stresses and demands of his job was a considerable help.

"It was just like a huge load taken off my shoulders," he said. "I just felt that even though I didn't know someone, I could still talk to them. It made a big difference."


Researchers have consistently found that members of the fire service drink more than the average adult, a legacy of consumption that dates to when some firehouses doubled as the local tavern.

But when off-duty imbibing leads to addiction, getting help can be problematic, some say. The job's pressure and "no weakness" culture make it difficult to face up to the problem, and its insular culture creates a belief that outsiders won't be able to help.

That led Rosecrance last month to create a separate unit at its inpatient center for firefighters and paramedics. Led by an active-duty Chicago Fire Department battalion chief, it aims to provide the expertise and understanding that will help its clients get better.

"No one told us the effects the job would have on us and our families, and no one gave us the tools on how to deal with it, day in and day out, for a career," said Dan DeGryse, the battalion chief. "It's going to take time to change. What we're trying to do now is address it after 150 years of the same stuff."

Researchers say aspects of the fire service are risk factors for addiction. Firefighters and paramedics witness traumatic scenes over and over, sometimes multiple times per day. They have unusual schedules, typically working 24-hour shifts followed by two or more days off -- time some fill with drinking.

And they have a culture some say has long tolerated, if not encouraged, drinking to excess once the job is done.

"Alcohol is used as a social lubricant," said Sara Jahnke of the Kansas-based Center for Fire, Rescue and EMS Health Research. "A lot of the debriefing happens at the bar, talking about things that happened on the shift."

Jahnke, the daughter of a retired fire chief, recently contributed to two papers focusing on alcohol use within the fire service. One found that during the prior month, about half of career and volunteer firefighters binge drank and about 10 percent reported driving while intoxicated -- numbers that are significantly higher than in the general public.

The second paper looked at firefighters' perceptions of alcohol use, concluding that many inaccurately believe their profession is no worse than the norm when it comes to problem drinking.

"The alcohol ... is not one of those (things) where it's abused," one firefighter told the researchers. "But socially, you get that tolerance like you're in college."

Christopher Scrol, a Rockford firefighter and paramedic who leads the local union, disputed the idea that alcoholism in the fire service is worse than in other jobs, saying the image of the hard-drinking first responder is out of date. Firefighters today, he said, are increasingly well-educated and health-conscious.

"We work a 24-hour shift," he said. "The last thing I want to do at 8 a.m. is go hit a bar. It's not on my radar."

Chief Sean Maloy of the Bedford Park Fire Department, who also leads the Illinois Fire Chiefs Association, said that while he understands how the stress of the job can lead to substance abuse, he sees no evidence that it is a widespread problem.

"The potential is there for a lot of them ... (but) I think it would be the exception, not the rule," he said.

But Jeff Dill, a captain in the Palatine Rural Fire Protection District and founder of a training service called the Firefighter Behavioral Health Alliance, said firefighters are well-skilled at concealing their issues.

"I talk about cultural brainwashing: When you put this uniform on, this is how you're supposed to act -- show unity, strength, no weakness, handle all your problems on your own," he said. "Now we're starting to find (some) can't meet those expectations."

Dill is on the advisory committee for Rosecrance's Florian program, named after the patron saint of firefighters. The roughly monthlong residential program was developed under the idea that the job conditions and customs that lead some firefighters and paramedics into addiction require a unique response.

"There are treatment programs that claim to treat first responders, but we're not all the same," DeGryse said. "We don't all drink at the same bars. We don't experience exactly the same thing."

Pat Spangler, who has worked with firefighters for years at Rosecrance, said conditions vary even within the fire service. Members of big urban departments might have more acute sleep problems and exposure to more trauma, while rural volunteer firefighters might know the people they come to help.

But one commonality, he said, is the urge to keep personal problems buried.

"They don't really address the trauma of (the job), because they don't want to open Pandora's box," he said. "As one fireman told a therapist I was talking to: 'You don't want me questioning whether I should run into that house. You want me to be confident.'"

Rosecrance counselor Diana Rudeen said part of the treatment is to help firefighters deal with job stress without drugs or alcohol. That can include everything from deep breathing exercises to "thought stopping" -- a technique to banish negative ideas before they become overwhelming.

"It's like planting your feet on the ground -- 'I'm OK, I'm here, I'm going to go into the fire and I'm going to save lives, '" Rudeen said.

A further challenge comes when it's time for firefighters and paramedics to return to work. The job's strain and sleep issues will still be there, as will colleagues who believe in bonding over a drink. Rudeen said the program tries to address that with follow-up counseling that can include online chats or face-to-face peer counseling.

So far, she said, it seems to be working.

"When they go back to the firehouse, they talk to the guys they're on the (rig) with and say, 'I'm in treatment. I'm not going to be able to go out afterward, '" she said. "I've had (former clients) who have been really successful with that."

Tim Gibbons, 55, who just retired as a Chicago Fire Department battalion chief after almost 35 years in the fire service, got sober 30 years ago and has since supported other firefighters struggling with substance abuse -- including some who have gone through Rosecrance.

He said that while the old firehouse drinking culture has gone away, problems with alcoholism remain. He plans to do peer counseling for the Florian program even in retirement, saying that "letting tough guys and gals be vulnerable with each other" helps their recovery.

"The problems are still there," Gibbons said. "Our ability to pull what used to be shameful into the light of day is what's different. People are much more accepting of what can no longer be denied."

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