First Responders and Substance Use Disorders: Causes, Care, and a Path to Recovery
First responders and substance use disorders is a subject that often hides in plain sight. Behind the sirens and split-second decisions are human beings carrying heavy experiences, trauma scenes, moral injury, sleep disruption, and relentless operational stress. When alcohol or drugs become a coping tool, the risks compound: safety, family life, career progression, and mental health can all be affected.
This guide explains why substance abuse in first responders happens, how it connects to trauma and mental health, the treatment options that work (including intensive outpatient programs for first responders), and how to seek confidential help through StepStone Connect’s telehealth IOP.
Why First Responders Are at Elevated Risk
Daily exposure to tragedy and danger creates unique conditions for first responders and addiction. Firefighters, police officers, EMTs, dispatchers, and paramedics routinely encounter life-threatening events, fatalities, and child-related trauma, each capable of leaving a psychological imprint.
Over time, repeated exposures contribute to cumulative stress and post-traumatic stress disorder (PTSD), depression, and anxiety. These conditions heighten the temptation to self-medicate, especially with alcohol, sedatives, or stimulants.
National behavioral health authorities have long flagged responders as a high-risk group for mental health and substance use concerns. SAMHSA’s disaster and responder-focused publications outline how traumatic exposure, shift work, and limited downtime can drive maladaptive coping, including alcohol misuse and drug use. Peer-led support, leadership engagement, and readily accessible professional care are key protective factors (more on those below).
Recent research during the pandemic period adds that occupational stress and drug use are linked through burnout: when organizational pressure is high and support strategies are weak, problematic use increases. These findings underscore what many in public safety already know: organizational culture and resourcing matter just as much as individual resilience.
Trauma and Addiction: The Bidirectional Loop
Trauma and addiction can reinforce each other in a loop. Hyperarousal, nightmares, and intrusive memories make sleep and calm feel out of reach; substances may offer short-term relief but worsen sleep architecture, mood, and judgment. Over time, the brain’s reward and threat systems get entangled, making it harder to recover without structured, evidence-based care.
Key patterns to watch:
PTSD and substance use occurring together (co-occurring disorders)
Increased alcohol use among first responders after critical incidents
Escalating tolerance (“needing more to get the same effect”)
Using alcohol or drugs to come down after shift, to sleep, or to avoid reminders
Growing secrecy, addiction stigma in public safety, and fear that seeking help will derail a career
Integrated, stigma-aware care closes this loop, especially programs designed for responder culture that protect confidentiality, address return-to-work goals, and teach practical, on-shift coping.
Role-Specific Risks and Signals
Firefighters
Shift rotations (24s, 48s), smoke and trauma exposure, pediatric calls, and line-of-duty deaths stack up. Fatigue plus “station culture” can normalize drinking, raising risks and delaying help-seeking. Firefighter addiction recovery works best when services are tailored to the fire service and connected to peer and union resources. The IAFF emphasizes building robust behavioral health supports, from education to treatment linkages.
Police Officers
Police officer substance use risk rises with violence exposure, moral injury, public scrutiny, and policy stressors. Hypervigilance and poor sleep often drive maladaptive coping. Confidential access and mental health awareness in law enforcement training help officers seek support earlier.
EMS and Paramedics
EMTs and paramedics face relentless emergency worker burnout, OD scenes, pediatric codes, and time-pressured decisions. Some studies report high proportions of at-risk alcohol or drug use in EMS cohorts, highlighting the need for targeted interventions and paramedic addiction treatment options that fit rotating schedules.
The Power and Limits of Peer Support
Peer support programs reduce isolation, provide early check-ins, and connect colleagues to professional care. While growing evidence suggests benefit, researchers also note that peer programs should be paired with clinical services and clear boundaries (peers aren’t therapists). Blending peer teams with clinician-led treatment pathways gives responders multiple doors into care.
When Is It Time to Get Help?
Consider a professional assessment if you notice any of the following for more than two weeks or sooner if safety is a concern:
Drinking or using more than intended; relying on substances to sleep or “switch off”
Missing shifts, conflicts at work or at home, disciplinary issues
Nightmares, flashbacks, irritability, or avoidance of routine duties/places
Thoughts of hopelessness, escalating risk-taking, or unsafe use behaviors
Early intervention protects careers and saves lives. Many departments also offer employee assistance programs (EAP), crisis intervention training, and behavioral health support for first responders, but specialized treatment is often still needed.
What Treatment Looks Like: Levels of Care
Rehab facilities for first responders and behavioral health centers typically offer a continuum:
Outpatient therapy (weekly): helpful for mild cases or after higher levels of care.
Intensive Outpatient Program (IOP): multiple days per week of group + individual therapy; you live at home and continue working.
Partial Hospitalization Program (PHP): day-long treatment (often 5 days/week) without overnight stay.
Residential/Inpatient: 24/7 care for stabilization and safety.
A responder may step up (from outpatient → IOP → PHP/residential) or step down as symptoms improve. Integrated, dual diagnosis in first responders care is essential when PTSD, depression, or anxiety co-occur with substance use. NIDA and SAMHSA highlight individualized planning, adequate duration, and evidence-based therapies as core to outcomes.
Evidence-Based Therapies That Work
CBT (Cognitive Behavioral Therapy): Targets thoughts/behaviors that reinforce substance use, insomnia, anxiety, or depression.
DBT (Dialectical Behavior Therapy): Skills for distress tolerance, emotion regulation, and interpersonal effectiveness; supports relapse prevention.
Trauma-focused treatments (e.g., Cognitive Processing Therapy, Prolonged Exposure): Strong evidence for PTSD and often combined with SUD care.
Motivational Interviewing & Relapse Prevention: Enhances readiness and creates practical plans for high-risk moments.
These modalities align with APA, SAMHSA, and NIDA guidance and are widely used in quality first responder treatment programs.
Why IOP Fits First Responder Life
IOP balances intensity with flexibility, ideal for responders who need more than weekly sessions but can live safely at home.
Typical IOP schedule for responders (StepStone Connect model):
Group therapy sessions: 3 days/week, 3 hours per session
One individual session/week
Cohorts tailored for first responders; trauma-informed care with culturally competent clinicians
Telehealth IOP on a secure, HIPAA-compliant platform; day and evening options to fit shift work
Insurance guidance and verification; step-down planning and aftercare
StepStone Connect’s first responder treatment programs emphasize integrated mental health and substance use care, with specialized tracks for dual diagnosis and clinical expertise in PTSD, Acute Stress Disorder, depression, anxiety, mood disorders, grief, substance use disorder recovery, alcohol addiction, and behavioral addictions.
StepStone Connect’s Approach (Built for the Badge)
StepStone Connect operates online across multiple states, focusing on small, specialized cohorts and intensive outpatient programs for first responders. Highlights include:
Telehealth platforms that reduce stigma and barriers (no commute, private log-ins)
Culturally competent clinicians; team includes retired military and first responders
Joint Commission accreditation noted on program pages
Clear How It Works details, fast access to an intake team, and insurance support
Strong emphasis on confidentiality and practical, shift-friendly scheduling
Department and Leadership Levers
Agencies can reduce risk and improve outcomes by weaving wellness into the operational fabric:
Normalize help-seeking. Integrate mental health in safety briefings and debriefs; leaders model attendance at wellness training.
Invest in peer + clinical pathways. Strong peer teams with formal referral bridges to clinicians.
Training & policy. Resilience training, crisis intervention training, and addiction prevention programs reduce stigma and create common language for early intervention.
Leverage EAPs, then go further. Make sure EAP is a doorway, not a dead end; track quality and responder-specific referrals.
Parity and benefits. Understand mental health parity rules and ensure plan designs don’t create hidden barriers to SUD/MH care. Recent federal rulemaking aims to improve network adequacy and “true parity” in coverage.
Skills Responders Can Use Today (Stress Management for First Responders)
Breathing resets (Box Breathing 4-4-4-4). Short, post-call downshifts reduce sympathetic over-activation.
Grounding (5-4-3-2-1). Pull attention out of replay loops; pair with hydration and a light snack after prolonged calls.
Sleep anchors. Protect a 90-minute core sleep window after nights; avoid alcohol as a sleep aid, as it fragments sleep and worsens next-day performance.
Micro-debriefs. Brief, non-graphic “what happened / what I feel / next step” check-ins with a trusted peer.
Trigger mapping. Know your top 3 triggers, top 3 early warning signs, and top 3 coping steps; share with a peer or clinician.
These tactics complement, but do not replace, professional treatment, especially for post-traumatic stress disorder or depression, and substance abuse.
How Families Can Help
Name the signs without judgment: escalating use, isolation, sleep problems, irritability.
Offer two concrete supports (drive to intake, handle childcare, cover a chore) instead of general advice.
Encourage specialized care, not “toughing it out.”
Use plain, supportive language: “I’m on your side. Let’s call together.”
What to Expect in Recovery
Recovery isn’t linear. With the right support, responders rebuild control over sleep, mood, and work performance and often rediscover meaning in the job. Programs like StepStone Connect measure progress, update goals, and create continuing care plans, including alumni groups, community supports, and step-down options.
Stigma loses power when leadership, peers, and families speak openly and when responders see confidential, effective care in action.
Confidential Help for First Responders Starts Here
Ready to take the next step toward recovery on your schedule, from home? StepStone Connect’s telehealth Intensive Outpatient Program is built for first responders, with 3 group sessions/week + 1 individual session, trauma-informed clinicians, and help verifying insurance.
Call (866) 518-2985 or request a confidential consultation at StepStone Connect.
Works Cited
International Association of Fire Fighters. “Behavioral Health.” IAFF, 2025, https://www.iaff.org/behavioral-health/. Accessed 23 Oct. 2025. (IAFF)
National Alliance on Mental Illness (NAMI). “Mental Health Parity.” NAMI, https://www.nami.org/Advocacy/Policy-Priorities/Improving-Health/Mental-Health-Parity/. Accessed 23 Oct. 2025. (NAMI)
National Institute on Drug Abuse (NIDA). “Discipline Spotlight: Emergency Physicians and First Responders.” NIDAMED, 30 Dec. 2022, https://nida.nih.gov/nidamed-medical-health-professionals/discipline-specific-resources/emergency-physicians-first-responders. Accessed 23 Oct. 2025. (National Institute on Drug Abuse)
Reuters. “Biden Administration Finalizes Rule to Strengthen Mental Health Parity Law.” Reuters, 9 Sept. 2024, https://www.reuters.com/world/us/biden-administration-finalizes-rule-strengthen-mental-health-parity-law-2024-09-09/. Accessed 23 Oct. 2025. (Reuters)
SAMHSA. First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. May 2018, https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf. Accessed 23 Oct. 2025. (SAMHSA)
—. A Guide to Managing Stress for Disaster Responders and First Responders. 2022, https://library.samhsa.gov/sites/default/files/pep22-01-01-003.pdf. Accessed 23 Oct. 2025. (SAMHSA Library)
—. Behavioral Health Best Practice Resources Addressing Trauma and Violence. 2024, https://library.samhsa.gov/sites/default/files/resources-addressing-trauma-violence-pep24-01-032.pdf. Accessed 23 Oct. 2025. (SAMHSA Library)
U.S. Department of Labor. “Final Rules under the Mental Health Parity and Addiction Equity Act (MHPAEA) — Fact Sheet.” dol.gov, https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/final-rules-under-the-mental-health-parity-and-addiction-equity-act-mhpaea. Accessed 23 Oct. 2025. (DOL)
van Stolk-Cooke, Katherine, et al. “Understanding Problematic Substance Use among First Responders during the Early Stages of the COVID-19 Pandemic.” Addictive Behaviors, vol. 152, 2023, https://www.sciencedirect.com/science/article/pii/S0955395923003080. Accessed 23 Oct. 2025. (ScienceDirect)
Florida Atlantic University. “Study Examines Substance Use in First Responders During the Pandemic.” FAU News Desk, 2023, https://www.fau.edu/newsdesk/articles/first-responders-pandemic-study.php. Accessed 23 Oct. 2025. (Florida Atlantic University)
AlcoholHelp.com. “Emergency and First Responders and Alcohol Abuse.” AlcoholHelp, 2025, https://www.alcoholhelp.com/resources/alcohol-addiction-first-responders/. Accessed 23 Oct. 2025. (Alcohol Help)
Husain, Anam, et al. “Peer Support Programs for First Responders: A Critical Review and Agenda for Future Research.” International Journal of Environmental Research and Public Health, vol. 22, no. 10, 2025, https://www.mdpi.com/1660-4601/22/10/1532. Accessed 23 Oct. 2025. (MDPI)
Federal Bureau of Investigation, Law Enforcement Bulletin. “First Responder Peer Support Programs.” FBI LEB, 2022,https://leb.fbi.gov/articles/featured-articles/first-responder-peer-support-programs. Accessed 23 Oct. 2025. (LEB)
