PTSD and alcohol: Common, treatable concerns for firefighters

Research shows firefighters develop PTSD at the same rate as military veterans, and are more likely to abuse alcohol more than the general public


By Lia J. Smith, M.A.; Faith Nomamiukor, B.S.; Brooke A. Bartlett, M.A.; Jana K. Tran, Ph.D.; and Anka A. Vujanovic, Ph.D.

Posttraumatic stress disorder (PTSD) and alcohol use problems are two common mental health concerns among firefighters. However, these conditions are rarely spoken about in the firehouse, and most firefighters may not know how or why they may be at risk. It may also be difficult to tell which symptoms to look out for, when something is a problem and what to do to get help.

What is PTSD?

Firefighters are more likely than the general population to experience occupational stress, to think about or act on suicidal thoughts and to have an alcohol use disorder. (Photo/USAF)
Firefighters are more likely than the general population to experience occupational stress, to think about or act on suicidal thoughts and to have an alcohol use disorder. (Photo/USAF)

PTSD is a mental health condition that may develop after a person experiences a traumatic event. PTSD symptoms may include flashbacks, nightmares and upsetting emotional or physical reactions when reminded of the trauma.

Individuals with PTSD may tend to avoid thinking about the trauma or going near people, places or things that remind them of the trauma. Individuals suffering from PTSD also commonly experience negative changes in their mood or beliefs about themselves, others or the world.

Finally, PTSD symptoms may also include sleep disturbance, irritability, reckless behavior, difficulty concentrating, hyper-awareness of surroundings or elevated startle response. If symptoms persist for more than a month and interfere with work, home or relationship functioning, it may be time to seek help.

How common is PTSD among firefighters?

Many people may not realize that firefighters are at risk for developing PTSD. However, recent research demonstrates that PTSD might be as common among firefighters as it is among military veterans. For example, current studies report that PTSD rates in the fire service range between five and 37 percent. In comparison, only 6 percent of people in the general population have PTSD while 11 to 30 percent of military veterans have PTSD.

Therefore, firefighters have similar rates of PTSD as military personnel. This is surprising, given that firefighting is not often associated with PTSD in the general media, and there are fewer resources available to support firefighters with PTSD than there are for those who have served in the military.

If firefighters are at risk for PTSD, why don’t more people know about this?

As research among firefighters is extremely limited, many people may simply be unaware of their risk for developing PTSD. The research that is available has only recently begun to look into the psychological health of members of the fire service.

What causes PTSD among firefighters?

PTSD may develop following a traumatic event, or can develop due to repeated exposure of such events. Around 91 percent of firefighters report being exposed to trauma, which can often occur on the job by working during natural disasters, assisting severely injured persons, running into fires to save lives or many other traumatic or life-threatening activities that are common to firefighters.

What are other mental health concerns for firefighters?

Firefighters are more likely than the general population to experience occupational stress, to think about or act on suicidal thoughts and to have an alcohol use disorder. In fact, research indicates that alcohol use disorder is especially prevalent among firefighting populations, and those with PTSD are even more likely to have alcohol use disorder.

What is an alcohol use disorder? How is it different from normative drinking?

Alcohol use disorder refers to excessive or uncontrollable alcohol use that interferes with one’s ability to function and maintain healthy relationships. Symptoms of alcohol use disorder may include drinking larger amounts of alcohol than intended, finding it difficult to control alcohol use and spending large amounts of time drinking or recovering from hangovers.

It may also include urges to have a drink, difficulty carrying out obligations due to alcohol use and continued drinking despite the negative effects it may have on physical or psychological health or interpersonal problems.

Finally, individuals with alcohol use disorder may give up other activities in favor of drinking, use alcohol in dangerous situations (e.g., drinking and driving), develop increased alcohol tolerance or experience physical symptoms (e.g., headaches or shakes) after not drinking for a while. If symptoms persist for several months and interfere with work, home or relationship functioning, it may be time to seek help.

How common is alcohol use disorder among firefighters?

Many times, alcohol use may begin by going out with other firefighters to deal with a tough day on the job. However, relying on alcohol to cope with stressful and difficult experiences may lead firefighters to develop symptoms of alcohol use disorder.

Current research shows that approximately 33 to 47 percent of firefighters may meet criteria for alcohol use disorder at any point in their lives, whereas less than 30 percent of the general population may develop alcohol use disorder at some point during their lifespan.

If firefighters are at risk for alcohol use disorder, why don’t more people know about this?

Due to a lack of research on firefighters and a general lack of awareness, many people may not realize that firefighters are at risk for developing alcohol use disorder. Fortunately, research among firefighters has begun to explore what motivates firefighters to use alcohol and how to best support them.

What can be done to treat PTSD and alcohol use disorder in firefighters?

The first step is to talk to a mental health provider or medical doctor if you think you might be at risk for one or both conditions. Talk therapy alongside certain types of medication are common treatments for both PTSD and alcohol use disorder. Talk therapies are available that can address both PTSD and alcohol use disorder at the same time.

It is important to seek support and treatment for these conditions, because, if left untreated, firefighters who experience symptoms of PTSD and alcohol use disorder have an increased risk of experiencing:

  • depression
  • anxiety
  • other substance use (e.g., marijuana, non-prescription Adderall)
  • loneliness
  • anger management issues
  • legal problems
  • marital conflict
  • other physical or mental health problems

The good news about firefighter PTSD and alcohol abuse

PTSD and alcohol use disorder are both highly treatable. If you worry that you or a coworker might be dealing with either PTSD or alcohol use disorder, it is important to seek help. It takes courage to face these issues and there is no shame in seeking help or support for mental health concerns. Seeking help demonstrates strength, as the longer mental health symptoms go untreated, the more dangerous they may become for ourselves, our families and our fellow fire service members.

If you or anyone you know is struggling with the emotional impact of stressful and/or traumatic events on the job or using alcohol excessively, please do not hesitate to reach out for professional help and support. Please call the Fire/EMS 24-hour helpline number if you or a coworker are struggling with job-related stress at 1-888-731-FIRE (3473).

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