Stressful occupations and drug abuse


BEHAVIORAL HEALTH

CarolinaFireJournal - Ernest J. Bordini, Ph.D.
Ernest J. Bordini, Ph.D.
10/10/2014 -

For the first time in 2009, drugs caused more deaths (37,485) than motor vehicle accidents. That was double the rate of drug-related deaths in 1999. A steep rise in deaths from overdoses of prescription narcotics contributes to this ongoing trend. Peak ages of use involve late adolescence and early adulthood. 

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Historically, the most frequently abused drug is marijuana, with prescription psychiatric medication and pain relievers coming in third and fourth in terms of numbers of people abusing within the past month.  Given the trend of increased narcotics deaths since 2009, this percentage has likely risen in recent times.

People that are employed consume approximately 75 percent of illegal drugs.  Ten percent of that drug use is believed to occur in the workplace.  Half of that is alcohol-related.  Both on-duty and off-duty alcohol and drug abuse impact workplace safety.  Pilot judgment errors have been shown to persist 14 hours after alcohol abuse. Individuals who abuse alcohol or drugs are four times more likely to be injured at work. 

Alcohol is typically the substance most abused by public safety workers. Approximately 9.1 percent of workers in a group that includes firefighters reported heavy alcohol use in the previous month. The rate of alcohol use in the protective service category was slightly above the national average. Firefighters and law enforcement workers had the lowest rate of illicit drug use of any group of workers, with 1.5 percent reporting drug use in the past month. (Source: The Party is Over; Emergency Vehicle Response: http://emergencyvehicleresponse.com/news/fullstory/newsid/123015 )

The U.S. Firefighters Association (USFA) estimates that as many as 10 percent of firefighters may be abusing drugs.  It estimates the threat of alcohol abuse among firefighters is more than double that of the general population. Cincinnati’s National Institute for Occupational Safety and Health conducted a survey in 1993. It surveyed 145 firefighters and reported an estimate that up to 29 percent of firefighters have had problems with alcohol use and/or abuse. Thirty-seven percent of approximately 50 respondents to a Virginia Beach Fire Department survey reported their fire department lost one or more firefighters in the past two years due to alcohol abuse.  When asked about successful interventions for dealing with alcohol and drug problems in the department the most common successful intervention — 33 percent — was reported to be EAP programs.

There is a general relationship between stress, stressful occupations and substance abuse.  Boxer and Wild (1993) found that more than 40 percent of firefighters were experiencing psychological distress. Almost 30 percent of them were experiencing problematic alcohol use.  Studies report 30 to 50 percent of American men and a little more than 25 percent of women with PTSD have also had problems with drug abuse or dependence at some point during their lifetime.  This was approximately double the rate of those individuals without PTSD (Brady et al 2004, Kessler et al 1995).  There is an increased risk of PTSD in first responders.  Research demonstrated FDNY was at higher risk for alcohol problems after 9/11. (http://firehouse.com/article/10466012/fdny-was-faced-with-alcohol-drug-abuse-problems-following-9-11)

Research indicates that a combination of alcohol use and PTSD produces a tenfold increase in the risk of suicide (Violanti, 2004).

A useful quick measure for self-assessment on battle fatigue in soldiers or developing burnout and stress overload in firefighters, law enforcement and first responders is the ProQOL. This measure has sub-scales for compassion satisfaction, burnout and compassion fatigue. It is commonly used to measure and monitor the negative and positive effects of helping others suffering traumatic experiences (Stamm, B. H., 2009, Professional quality of life: Compassion satisfaction and fatigue version 5 (ProQOL).

While alcohol and substance abuse are likely to be problems which may interfere with occupational performance and home life, the addiction of cigarette smoking also takes its toll on firefighters’ lives.  USFA estimates that the fire service loses approximately 1,800 members per year from smoking.  Firefighters who smoke have a higher level of risk from heart and lung diseases than firefighters who do not smoke. Multiple attempts are often required to quit smoking.

Firefighter Suicides
The number of firefighter fatalities has steadily decreased over the last 25 years, from a high of 171 in 1978 to a low of 75 in 1992. Despite this trend in absolute terms, approximately 100 firefighters are killed in the line of duty each year. In 2000, 102 firefighters died. (Source: USFA, 2000).  The United States Fire Administration (USFA) reported 85 on-duty firefighter fatalities in the United States as a result of incidents that occurred in 2010, a six percent decrease from the 90 fatalities reported for 2009.

Statistics about firefighter suicides are somewhat difficult to accurately obtain and there is variability in rates reported by varying sources.  However, when compared to line of duty fatalities, it is clear that this remains an elevated risk for firefighters, as it is for other first responders such as law enforcement.  Training in accessing and using preventative services, such as EAP and counseling services, should be considered as important as any other life-saving training or equipment.

Whether a firefighter, law enforcement officer, soldier of veteran, coping with the suicide of our warriors is difficult.

(This article was originally presented in an invited panel presentation to Gainesville Fire and Rescue, 2013.)

Ernest J. Bordini, Ph.D. is a licensed psychologist with more than 30 years of training and experience. He provides fitness for duty evaluations for law enforcement, government and other organizations.He serves the Gainesville, Florida Fire Department and Gainesville Police Department through Employee Assistance Program contracts.In his limited spare time he enjoys tactical and defensive firearm training and is an NRA certified Firearm Instructor.

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Issue 32.4 | Fall 2018

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