Alcohol Use and Trauma in First Responders 

By Stephen Odom, PhD, Founder and Chief Clinical Officer, FR Health Family of Companies

As we recognize Alcohol Awareness Month this April, it’s an important time to shine a light on the complex relationship between alcohol use and trauma in first responders. These are the men and women on the front lines—law enforcement officers, firefighters, correctional officers, EMS personnel, 911 dispatchers—who routinely witness tragedy and stress in their work. Alcohol itself is not inherently bad; enjoying a drink off-duty can be a normal part of life. The concern arises when alcohol is used as a tool to self-medicate unresolved trauma and stress. Unfortunately, this scenario is common among first responders, given the intense pressures and frequent trauma exposure in their professions. Empathy and understanding are crucial when discussing this topic. Rather than casting blame, we must recognize how easily a coping mechanism like alcohol can turn into a deeper struggle.

Trauma Exposure: Frequent, Cumulative, and Unique Vulnerability:

Traumatic incidents are not one-off events for first responders—they are part of the job description. Over a career, a firefighter might pull victims from countless fires or accident scenes; a police officer may witness violence and death regularly; a paramedic may see daily medical crises. This repeat exposure to trauma is frequent and cumulative, and it takes a psychological toll. Research shows that first responders have significantly higher rates of chronic stress and post-traumatic stress symptoms than the general population (Bonumwezi et al., 2022). Many first responders suffer in silence with subclinical levels of trauma-related stress that don’t always meet a PTSD diagnosis, but manifest as insomnia, anxiety, heavy alcohol use, or other distress signals.

In fact, studies have found that post-traumatic stress disorder (PTSD) symptoms in first responders are strongly associated with increased alcohol and drug use (Bonumwezi et al., 2022). In other words, the more psychological trauma a first responder carries, the more likely they may be to turn to alcohol as a coping mechanism. Alcohol can dull hyperarousal and intrusive memories in the short term, making it an appealing (but ultimately unhealthy) self-prescription for the pain they cannot easily discuss.

The vulnerability is also reflected in drinking prevalence data. While estimates vary, studies indicate that a sizable minority of first responders engage in hazardous or heavy drinking. A recent meta-analysis found about 26% of first responders screen positive for hazardous alcohol use (Irizar et al., 2021). Other research on firefighters showed nearly 40% of female firefighters reported binge drinking in the past month, with 16.5% screening positive for problem drinking (Haddock et al., 2017). These figures are well above comparative rates in the general population. Clearly, the combination of high trauma exposure and easy access to alcohol (a legal and socially accepted substance) creates a perfect storm of risk.

Cultural Norms: Bonding Over Brews and the “Toughness” Ethos

First responder communities often develop a strong sense of camaraderie and a “tough it out” mentality. This culture can be a double-edged sword. On one hand, the brotherhood and sisterhood among firefighters, police, EMS, and others provide essential peer support. On the other hand, bonding over a few drinks after a tough shift is a long-standing tradition that can unintentionally reinforce unhealthy coping. Peer encouragement is a strong factor in drinking behavior. It’s not unusual for crews to hit the bar together to decompress, swapping stories over beers. In moderation, this can cement friendships. But when drinking is the primary outlet for stress, it can normalize using alcohol to manage emotions.

One study of urban firefighters found that after a critical incident, their alcohol consumption significantly spiked in the days following the event, which researchers partly attributed to the firehouse “brotherhood” culture encouraging group drinking (Homish et al., 2012). In some departments, there’s an unspoken understanding that sharing a bottle is how you deal with a bad call.

Moreover, the toughness ethos in first responder culture—priding oneself on being strong and unfazed—may discourage open discussions about mental health. Admitting to nightmares, anxiety, or that you’re drinking to sleep at night can feel like confessing weakness. This stigma can lead many to silently self-medicate with alcohol rather than seek counseling. As a result, drinking to “take the edge off” trauma can start to seem not only acceptable, but expected, especially among long-tenured first responders. Over time, these cultural norms set a trap: the very camaraderie that offers support can also enable denial about alcohol misuse.

The Slippery Slope: From Coping Mechanism to Dependence

What begins as an occasional drink “to relax” or “take the edge off” can slowly turn into a harmful pattern. Alcohol’s effects on trauma-related stress are only temporary, and as tolerance builds, a person may need more alcohol to achieve the same relief. This is the slippery slope where use edges into misuse or dependence. A paramedic who once had one drink after work might find, a year later, that they need three or four drinks just to fall asleep and block out the day’s images.

Some warning signs that alcohol use may be becoming a problem include:

• Using alcohol to self-medicate
• Increasing tolerance
• Neglecting responsibilities or interests
• Changes in mood or behavior
• Inability to cut back

For first responders, another red flag is performance issues on the job that stem from drinking. Unfortunately, the culture of “handle your own problems” means these signs might be glossed over or attributed to being overworked, rather than viewed as symptoms of a brewing alcohol use disorder.

Barriers to Seeking Help

Recognizing problematic drinking is one thing; acting on it is another. First responders face unique barriers to seeking help for substance misuse or mental health issues. A major obstacle is the stigma and fear of being seen as unfit for duty. Many worry that admitting to a drinking problem will label them “weak” or jeopardize their job and reputation. A systematic review found that common barriers include fear of negative career impact, concerns about confidentiality, and lack of accessible services (Haugen et al., 2017).

Another barrier is practical: shift work and odd hours make it difficult to attend regular counseling or support meetings. And some first responders have had poor experiences with general counselors who “didn’t understand what I’ve seen on the job.” This can lead to a belief that only peers can truly understand, yet talking to peers about an alcohol problem can be equally daunting.

Resources and Strategies for Support

The good news is that awareness of these challenges is growing, and tailored programs are emerging to support first responders in healthier ways. Peer support teams, employee assistance programs, and departmental chaplaincy services provide confidential support.

Importantly, there are now specialized treatment programs designed exclusively for first responders dealing with PTSD and substance use. These programs, such as First Responder Wellness, understand the culture and the job demands. They often incorporate evidence-based therapies (like cognitive-behavioral therapy and trauma-focused treatments) in a setting with cultural competence.

Innovative strategies have also emerged, such as resilience training and workshops that teach healthy coping skills before problems arise. Departments are increasingly hosting seminars on trauma and alcohol awareness, sometimes led by seasoned responders who share their own recovery stories. This kind of open dialogue helps chip away at the stigma.

We’re Here to Help

Alcohol use of itself isn’t “evil,” but when it becomes a go-to salve for trauma, it can evolve into a dangerous foe. First responders face an unparalleled barrage of critical incidents and stressors that make them especially vulnerable to falling into that trap. The path from a beer after work to calm nerves, to a dependency that affects one’s health, family and career, is often a gradual one. By fostering understanding and empathy, we can better support those who save lives and protect communities.

This Alcohol Awareness Month let’s acknowledge the hidden struggles our first responders may carry. It’s time to break the silence and the stigma – to encourage open conversations about stress and substance use, to promote available resources, and to continue developing programs that meet first responders where they are.

References

Bonumwezi, J. L., Tramutola, D., Lawrence, J., Kobezak, H. M., & Lowe, S. R. (2022). Posttraumatic stress disorder symptoms, work-related trauma exposure, and substance use in first responders. Drug and Alcohol Dependence, 237, 109439. https://doi.org/10.1016/j.drugalcdep.2022.109439

Haddock, C. K., Poston, W. S. C., Jahnke, S. A., & Jitnarin, N. (2017). Alcohol use and problem drinking among women firefighters. Women’s Health Issues, 27(6), 632–638. https://doi.org/10.1016/j.whi.2017.07.002

Homish, G. G., Frazer, B. S., & Carey, M. G. (2012). The influence of indirect collective trauma on first responders’ alcohol use. International Journal of Emergency Mental Health, 14(1), 21–28.

Irizar, P., Puddephatt, J., Gage, S. H., Fallon, V., & Goodwin, L. (2021). The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression. Drug and Alcohol Dependence, 226, 108858. https://doi.org/10.1016/j.drugalcdep.2021.108858

Haugen, P. T., McCrillis, A. M., Smid, G. E., & Nijdam, M. J. (2017). Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. Journal of Psychiatric Research, 94, 218–229. https://doi.org/10.1016/j.jpsychires.2017.08.001