PTSD and alcohol in first responders: what helps

First responders are often the first on the scene of dangerous and draining situations. SAMHSA estimates that about 30 percent of first responders develop behavioral health conditions such as depression and PTSD, compared with about 20 percent of the general population.

PTSD can develop after you go through or see a life-threatening event. Stress reactions are normal at first, and most people start to feel better after a few weeks. If symptoms last longer than a month and get in the way of your life, it could be PTSD. Only a mental health provider can diagnose it.

PTSD and alcohol problems often happen together. According to the VA's National Center for PTSD, more than 4 in 10 adults with PTSD also have problems with drug or alcohol use. Research suggests that for most people who have both, PTSD comes first.

Drinking can feel like it helps. People may drink to relax, to sleep, to feel more at ease around others, or to push away thoughts and feelings they would rather avoid.

Alcohol may seem to help in the moment, but the VA says it can make PTSD symptoms worse. Some people drink to fall asleep, yet alcohol can make sleep less restful.

The VA calls this negative coping. Regular drinking to escape problems or to sleep can put your relationships, your job and your health at risk.

People who have both PTSD and a substance use disorder also face a higher risk of depression, anxiety and suicide. That is a reason to get help early. There are good treatments for both.

If you notice these signs, reach out and help them get support as soon as you can, especially if the change is new or getting worse. If someone talks about wanting to die or has a plan, act now. See “When to get help now” below.

Having an alcohol problem does not mean you have to wait for PTSD treatment. The VA/DoD guideline suggests that a substance use disorder should not keep someone from getting these therapies, and the VA says treating PTSD and substance use at the same time works for both.

There are two ways to do it. You can work on PTSD and drinking in two therapies at the same time, or in one integrated therapy with the same therapist. One integrated example, called COPE, combines prolonged exposure with substance use treatment.

Treatment for alcohol use disorder can also include counseling, mutual support groups and medication. The FDA has approved three medications to help people stop or reduce drinking: naltrexone, acamprosate and disulfiram. For PTSD, the VA lists sertraline, paroxetine and venlafaxine as recommended medications. A doctor can tell you whether any of these fit you.

If you have been drinking heavily for a long time, do not stop suddenly on your own. Alcohol withdrawal can be painful and even life-threatening, so get medical help to plan it safely.

Worries about your career are real. Laws such as HIPAA, the FMLA and the ADA may offer some protection, and your department's policies and union contract matter too. Our first responder page explains what stays private and what to check.

True Again Care is a program of FHE Health. FHE Health's first responder program began in 2016 and serves police officers, firefighters, EMS professionals, dispatchers and corrections officers. It treats trauma, PTSD and substance use together in one coordinated plan.

Many of the program's clinicians and counselors have first responder or military backgrounds. Learn more about the first responder program and trauma and PTSD treatment at FHE Health.