First Responders and Substance Use Disorders

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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First responders, classified as police, firefighters, paramedics, and EMT’s, offer immediate assistance in emergencies and disaster situations. Their efforts to provide medical care, support, and service in the midst of stressful and unsafe events is a vital service to society, however, the near-constant experiences with life-threatening situations, emotional stress, and hard physical labor and tough schedules places them at increased risk for mental health struggles and substance abuse. In a 2017 study of career first responders, over 50 percent of men and nearly 90 percent of women reported heavy drinking regularly over the past month [1]. The study also found that over 20% of EMT’s meet the criteria for the diagnosis of Post-Traumatic Stress Disorder (PTSD).

PTSD and First Responders

PTSD and substance abuse have a well-established connection—in the general population, around 1/3 of those seeking treatment for substance use also meet diagnostic criteria for PTSD. Exposure or involvement in natural disasters, war, serious accidents, and death are all classified as a potentially traumatic event, but what are the signs that an event has caused trauma? According to the National Institute for Mental Health (NIMH) [2], symptoms of PTSD are:

• Flashbacks—reliving the experience, including physical symptoms
• Bad dreams and trouble sleeping
• Avoiding people, places, things or thoughts and feelings that remind you of the event
• Feeling “on edge” or startling more easily
• Distorted sense of guilt or blame
• Angry outbursts or frightening thoughts
• Loss of interest in enjoyable activities
• Trouble remembering key things about the event
• The previous occur for more than 1 month and impact the ability to function in day to day life

The previous symptoms can occur after exposure to just one traumatic experience—first responders are exposed to these events on a daily basis in their work. Stress builds up over time, and with frequent exposure and often little time to decompress between incidents (such as responding to multiple calls in a shift), the risk factors are multiplied for first responders. Prolonged, repeated exposure increases the risk of developing PTSD, and traumatic history also increases the chances of using drugs and alcohol as a coping mechanism to quiet the overwhelming emotions and memories that arise as a result.

Another factor cited in complicating seeking treatment for first responders who suffer from substance use disorder is the cultural stigma that seeking help or having trouble with mental health issues is “weak” or that the person is not able to do their job effectively. Fear of job loss or ridicule is commonly cited as a reason to deny or avoid getting help. First responders routinely help others in extreme and difficult situations, and the unspoken expectation is to be “tough” as well. These negative beliefs can be internalized, leading to someone feeling reluctant to ask for help or disclose that they need treatment, as well as leaving the person feeling isolated and alone, further complicating their condition. Community among responders is also typically close-knit, and studies have indicated an increased risk of developing or intensifying substance use disorders due to trauma exposure after retiring from the force due to increased feelings of isolation.

The most effective treatment approach in working with first responders who have substance abuse issues and trauma is to focus on both conditions at the same time. Treating addiction as well as the emotional pain aid in building a strong foundation of recovery. The first steps involve a medically monitored detox stay, providing careful 24-hour care to safely navigate the withdrawal period. After detox, the client is offered individualized, holistic treatment from a team of trained clinicians and providers to build on the client’s strengths and identify a support network, work through any “stuck” emotions or traumatic experiences in a supportive environment, and build healthy coping skills for continued recovery throughout the treatment experience and beyond.

First Responders Addiction Treatment

Defining Wellness Centers utilizes an experiential approach to treating addiction and a trauma-informed care framework– meaning that we believe healing happens through experience with support and connection, and a feeling of safety and security is necessary to begin to uncover the wounds that we hide to protect ourselves. Using a variety of expressive techniques, our team helps facilitate the healing process in a hands-on way and aids the client in reconnecting to themselves– body, mind, and spirit. Often drugs and alcohol are used to numb the pain that we experience and feel unable to process, and trauma overwhelms our ability to cope. For the responders who put so much of themselves on the line each day, we are committed to offering a space for them and their families to seek refuge, become educated about addiction and recovery, connect with others and create a healthy support community, and care for themselves first. Working together as a team, clients and their treatment providers find what works best for each person to heal and succeed.


  1. SAMHSA,
  2. NIMH,

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