Firefighters work in a dangerous field that puts them in the midst of trauma as they risk injury — and even death. Pair that with on-the-job pressure, erratic schedules, wayward sleep cycles, and little opportunity for downtime — it all can take a toll on mental and physical health.
Nearly one-third of first responders develop depression, post-traumatic stress disorder (PTSD), or other behavioral health conditions. That’s compared to 20% of the general public.
Firefighters also report higher rates of suicide attempts and suicidal thinking compared to the public at large. In 2019, 49 firefighters died in the line of duty in the United States, compared to 119 firefighters who took their own lives.
Barriers remain to getting help. They range from stigma to costs. Volunteer firefighters, as well as female firefighters, face their own unique challenges as well.
Why Do Firefighters Have a Higher Risk of Developing Addiction
Firefighters have long held a heroic status in our culture. Doing the heroic thing can be stressful, however.
Firefighters risk their lives. The jobs are physically demanding and can be dangerous. They may suffer burns as well as exposure to chemicals and smoke inhalation. They may get injured in a fall or if a structure collapses. They may work long hours or get irregular sleep.
They don’t always have downtime after an incident, so they may not get the opportunity to decompress and process what they’ve seen and experienced.
Other sources of stress include:
- Poor communication
- Lack of leadership
- Heavy workload, or conflicting duties
- Long assignments
- Exposure to gruesome scenes
- Exposure to environmental hazards
- Contact with survivors or family
All of those things can fuel substance use.
Male firefighters — which make up the majority of the field — drink alcohol more frequently than the general public. One survey found 85% of full-timers drank in the past month. The numbers were a bit lower — 71% — for volunteers. Half of all firefighters admitted to binge drinking in the last 30 days. (Binge drinking generally is defined as five drinks in about two hours, for men — or for women, four drinks in the same amount of time.) The general population’s drinking rates were lower: 62% admitted to drinking, and 23% said they’d binged alcohol in the last month.
Mental Trauma or PTSD
Stress can manifest in any number of ways — physically, emotionally, or in behaviors. It can happen on the job, or rear its head weeks (or longer) after the fact.
Many signs of stress go hand in hand with PTSD. It doesn’t matter if a person is in the thick of an intense event, or if they’re witness to one; PTSD doesn’t judge. Flashbacks, anxiety, nightmares, and more can follow. They can flare when something triggers the victim or when someone is extremely stressed.
Physically, stress can show as chest pain, trouble breathing, or shock (shallow breathing, confusion, weak or fast pulse).
Stress can affect cognitive functioning, too. A moment of spacing out is one thing, but if symptoms linger they can interfere with work, and put the individual and others at risk. Confusion, disorientation, poor focus, memory troubles, and being on high alert or totally checked out are signs of a problem.
Stress impacts emotions, too. Strong emotions aren’t problematic in themselves, but if they drag on for weeks or get in the way of everyday life, it can be a sign of a problem.In those cases, medical attention may be necessary.
Signs of Mental Trauma or PTSD
Typically, if the traumatic event continues to affect the individual for weeks after the fact, or it negatively affects daily life, seeking professional medical or therapeutic help may be wise. Unchecked, long-term or chronic stress can overwhelm the body, weakening the immune system, negatively affect the health, and more.
Signs of Mental Trauma or PTSD:
- Nausea or vomiting
- Intense thirst
- Jaw clenching
- Profuse sweating
- Trouble seeing
- Substance Use Disorder
- Increased heart rate
- Emotional outbursts
- Sense of failure
- Weight gain
Co-Occurring Disorders Among Firefighters
Co-occurring or dual diagnosis disorders are present when a person has both a mental health disorder and a substance use disorder. Sometimes a person may resort to substance use to try and medicate an existing issue like depression or anxiety. However, substance use worsens mental health issues.
Firefighters are already more likely to drink. They’re also more prone to engage in risky behaviors. Stress can fuel behavioral health issues, further putting firefighters in danger of dual diagnosis.
Sleep disorders — far from rare among firefighters — are also linked to substance use. (It’s no guarantee, but they’re not strangers to one another.)
Burnout is a real concern for firefighters. There are three major signs:
- Withdrawal (especially at work)
- A cynical or unsympathetic attitude toward the job
Burnout results largely from chronic stress. Firefighters experiencing burnout may not follow safety measures — like using personal protective equipment — as well as they should.
Usually when leadership focuses more on safety, insists team members take regular breaks, encourages downtime after a fire or rescue effort, engages the department, and promotes health and wellness, those efforts can better nip burnout in the bud.
Injuries are especially concerning. Not only is there a chance they become sources of lifelong aches and pains — or worse — but getting hurt in the line of duty elevates the likelihood of developing PTSD.
Firefighters are already documented as drinking more alcohol, and in greater quantities, than the general public. Part of that can be due to culture — anecdotal accounts say the profession and drinking are deeply intertwined.
Firefighters are also at greater risk of on-the-job injuries. In 2019: were injured in the line of duty were due to overexertion or strain were from falls, jumps, slips, or trips
Opioids may be prescribed for some of those injuries. While they can help pain, they also may quickly become habit-forming, putting firefighters at greater risk for substance use disorders.
were injured in the line of duty
were due to overexertion or strain
were from falls, jumps, slips, or trips
Signs of Addiction and Mental Health Issues in Firefighters
A substance use disorder isn’t a moral failing. It’s a chronic medical condition where the brain adjusts to the substance in question, and the reward, self-control, and stress processing centers are altered.
Addiction can be genetically linked, but it has also been linked to environment, stress, and underlying behavioral health disorders like depression or anxiety. Signs of a problem include:
- The urge to use a substance regularly
- Needing more of a substance to experience the same effect
- Devoting time and money in pursuit of the drug
- Neglecting work, social, or home obligations so one can use a substance
- Using a substance despite knowing the dangers and negative consequences
- Resorting to illegal activity to secure the drug
- Experiencing withdrawal when one stops using the drug
- Engaging in risky activities while on the drug
Why Firefighters Don’t Seek Help
Firefighters and first responders not only face mental and physical stress on the job, but they tend to be the last to seek help for stress. They’re known for their resilience, for their strength and for their willingness to return to the fray.
There are a number of reasons why firefighters may not seek help for a substance use disorder.
The firefighter culture is one aspect. They may not want to be seen as weak. They may believe that they should just work through things on their own or tough them out. Some of them may also fear that reaching out for help may negatively affect their career prospects.
Others may think since they’ve been trained for the worst, they shouldn’t develop a problem.
Survivor guilt may be another factor. They’ve survived, where others around them haven’t. That should be enough, some might reason. Never mind that an intense ordeal can leave a lasting emotional mark, even if there are no physical scars as evidence.
Self-Care Tips for Firefighters
The signs of stress may not always be obvious. They can be subtle such as a weakened immune system, weight gain, or increased blood pressure. Self-care, regular checkups, and healthy habits can help prevent a lot of that.
Some departments are bringing on full-time psychologists to help their teams. Self-care can help a lot, too. This includes balancing work with personal life. A strong support network, both among friends and co-workers, can help significantly as well. Developing a positive outlook on one’s career may help as well. All of these strategies take time and work.
The federally run Substance Use Disorder and Mental Health Services Administration (SAMHSA) suggests developing resilience, focusing on four components:
- Regular sleep
- Balanced nutrition
- Regular physical activity
- Active relaxation
Life-and-death situations are part of a firefighter’s job. They face some of the most grueling situations and scenes imaginable. It can take a toll. Self-care is vital. Allowing oneself to grieve the losses and celebrate the wins can help too.
- samhsa.gov – First Responders: Behavioral Health Concerns, Emergency Response, and Trauma
- nfpa.org – Firefighter Fatalities in the US – 2019
- cdc.gov – Stress… on the job
- firerescue1.com – Firefighters and alcohol: What the data says
- cdc.gov – Traumatic Incident Stress
- mayoclinic.org – Post-traumatic stress disorder (PTSD)
- nih.gov – Stress among on-duty firefighters: an ambulatory assessment study
- firefighterclosecalls.com – Does Firefighter = Alcoholism?
- nfpa.org – United States Firefighter Injuries in 2019
- firerescue1.com – Opioid addiction: The epidemic’s impact on firefighters
- usfa.fema.gov – Firefighter burnout and workplace safety
- mayoclinic.org – Drug addiction (substance use disorder)
- columbiasouthern.edu – Why Mental Health Resources Are Critical for Firefighters
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.