BY PAUL J. ANTONELLIS JR. AND CAROL STABEN-BURROUGHS
The fire service has a great degree of pride in the service it provides. This pride tends to bond firefighters regardless of the size or makeup of the firefighter’s department. The pride firefighters have for the history and the future of the service can at times cloud the issues they or coworkers may be facing. The perception of mental health issues in one of our own still carries a significant stigma in many departments. The sidebar “Battling Alcohol Abuse: One Firefighter’s Story” is just one example of a firefighter who has had a long and colorful history dealing with the struggles of alcoholism and post-traumatic stress disorder (PTSD). As you read his story, you may be able to change his name to your name or that of a coworker and you may be able to change the name of the department to your department. The story is presented to share openly one firefighter’s struggle with PTSD and alcoholism that eventually led to a forced retirement. The objective of this article is to explore some of what firefighters experience when facing substance abuse and mental health issues. The article links some of the points made in this story with common reactions to these types of issues.
The fire service has made great strides in identifying, treating, and accepting mental health issues over the past 10 years. However, this momentum must continue if the fire service culture is going to evolve. Alcoholism and mental health illness remain social issues in the United States, and many in the fire service have been or may be impacted by their physical or emotional toll. Individuals in the fire service need to develop a deeper understanding and acceptance of firefighters suffering from mental health issues such as alcoholism, PTSD, depression, and anxiety and come to understand that these issues can have devastating impacts on the individual firefighters, family members, coworkers, and fire department.1 We have witnessed firsthand line firefighters, company officers, and chiefs who have had shortened careers in the fire service based on mental health- or alcohol-related issues. The daily blogs and news stories reporting firefighters who have been involved in alcohol-related incidents that impacted their jobs are common today. The fire service collectively has an obligation to openly, honestly, and respectfully discuss how alcoholism and mental health illness can impact the individual firefighter. The fire service must also understand that the firefighter who has struggled with alcoholism or mental health issues can still return to work in most cases and be a productive employee. How the department, individual, and coworkers respond to a firefighter’s suffering from PTSD or alcoholism can determine whether those involved will experience a successful or a devastating outcome.
PERCEPTION AND REALITY
The research is clear that emergency service providers are exposed to traumatic events at a much higher rate than the general population and that this high rate of exposure to traumatic events makes the emergency service provider vulnerable to developing PTSD.2,3 No training, education, or program can totally remove the effects of the stress firefighters experience in performing their duties even though some steps can be taken to reduce stress levels in firefighters who have been exposed to traumatic events and to improve the perception of firefighters who struggle with the effects of occupational stress. Firefighters will continue to be exposed to traumatic events that leave them vulnerable to developing mental health issues; however, the perception of a firefighter struggling with the effects of occupational stress needs to change to provide additional support for the firefighter in a recovery program. In many cases, firefighters who notice firefighters struggling with alcoholism or a mental health issue may look the other way so as not to get the firefighter in trouble (code of silence), or the coworkers may distance themselves from the struggling firefighter because they see that individual as “damaged goods.”
According to the National Institute on Alcohol Abuse and Alcoholism, nearly 14 million Americans are alcoholics or abuse alcohol, and more than 700,000 Americans seek treatment for alcoholism on any given day.4 Most people know someone who is abusing alcohol or is an alcoholic. Look closely; the firefighter sitting next to you may be silently struggling with alcohol abuse. The perception is that everyone would like to think that your firefighters would not come to work under the influence of a substance. The reality is that some of the firefighters working next to you may be abusing alcohol on or off the job, which can have a negative impact on how satisfied the firefighter is with the job.5 The firefighter who once found the job rewarding and positive may now exhibit a negative attitude toward the work and those around him. Stress and substance abuse can play a central role in the firefighters sitting in silence with their struggles, who have developed a negative attitude toward the work they once enjoyed.
There is no easy way to ensure that everyone on the job is clean and sober all the time, but the process can begin with a commitment from the administration and the employees that they all want a safe work environment. As a coworker, your goal should be not only to discuss openly the fact that some in the fire service struggle with abusing alcohol but also to ensure that coworkers know that they have a responsibility to report an individual they think is at risk and that they have multiple options for reporting an incident/issue. The reporting process must include multiple reporting options, to allow the reporting party to file a report with a person other than a direct supervisor. The firefighter must be allowed to step outside the normal chain of command to report a mental health concern or an alcohol-related issue in the workplace. The options should include reporting an incident to someone outside the fire department-for example, the community’s human resource department.
As Talbott says in his story, his firefighters feared saying anything to him or reporting his unacceptable on-duty behavior to the administration. Line firefighters struggle with the possibility that if they make a complaint about a supervisor or a coworker and the complaint is determined to be unfounded, they will pay a “price” for reporting the problem to the administration. Retaliation often comes in the form of intimidation, retaliatory actions, and other methods of bullying by the officer or other members in the department, such as peer pressure. This fear and intimidation perpetuate the code of silence that is often deeply rooted in the department culture.
Today, all fire departments should have a zero-tolerance policy pertaining to the use, possession, distribution, and sale of alcohol and other drugs at work. A zero-tolerance policy does not automatically mean that the employee who violated the policy is terminated; the policy is the starting point for identifying unacceptable behavior and outlining the actions that might be taken if a violation occurs. Labor and management must be willing to strike a balance for the member in need of services and the safe operation of the department.6 One goal of a zero-tolerance policy is early detection so that the member can be removed from service to allow for a safe work environment and create a pathway for recovery. Because relapse is part of the recovery process, it can be predicted that the firefighter may have a later event that revolves around the same issue.7,8 The zero-tolerance policy should fall under the workplace safety umbrella, in which labor and management work in partnership to create, maintain, and enforce a safe environment for the entire department.
The zero-tolerance policy must have a process that allows members of the department to report an issue to a supervisor or human resource manager without fear of reprisal from others in the department (administration, supervisors, coworkers). Labor and management should work together to ensure that the zero-tolerance policy is disseminated to all employees annually and that specialized training is conducted on the different aspects of the policy with an emphasis on reporting unacceptable behavior.9 The reporting process will often require a change in the fire service culture to alter this code of silence that prevents us from reporting our own. Reporting our coworkers will enable the firefighters to seek professional help early and will set the stage for the greatest results in the firefighter’s recovery process. This may save the person from a protracted process and possibly the loss of a career, coworkers, friends, and family. The new culture should be based on the concept that by reporting alcohol or mental health issues, we are preventing further harm to the firefighter, therefore protecting our own. If the motto of protecting our own rings true, why are we not helping our fellow firefighters to seek professional help early? Why are we waiting until the situation becomes a forced retirement issue, demotion, loss of life, or loss of marriage?
As in Talbott’s story, toward the end of his career he spent a great deal of energy protecting himself, hiding out in his office with the door closed, and creating a toxic work environment for those around him. It is important to point out that he is the first to admit that he created this negative work environment himself (granted, the captain did not see it as a problem at the time he was isolating himself) and wants others in the fire service to learn from his mistakes. Creating a negative environment prevented his firefighters from teaching and learning new firefighter skills and allowed the firefighters to see and be part of this toxic work culture. Thankfully, the department administration sent the message that Talbott’s unacceptable behavior would not be tolerated. Credit must also be given to the department for providing an opportunity for the abusing firefighter to seek professional help and allowing a pathway back to work once the employee was in a recovery program. As he indicated in the story, Talbott had made several attempts to deal with his alcohol abuse; however, he chose to take the path that resulted in the end of his career. Regrettably, many others in the fire service are repeating this story with the same tragic results-a career ended too soon.
CULTURE OF CHANGE
Open communication would help change the perception that the person struggling with alcohol abuse is just a “drunk” and a “lost cause.” Some have devoted their entire life to the fire service, and the service should view mental health issues and substance abuse as illnesses from which the person may need time to recover. One researcher argued, “Drinking was usually considered the sole business of the individual. Any questions or intrusions were viewed as an invasion of the person’s privacy, much like asking another person about his sex life or religion. This taboo meant that employers felt as though they could not talk to an employee about what he was doing, even if it were affecting his job performance.”10 Today, if the behavior or actions have a negative impact on the job performance, the employer has every right to speak to the employee about the issue. As a supervisor, it is key for you to make note of the facts and not suggest or imply that the person has a drinking problem or is suffering from a mental health issue. The supervisor’s job is not to determine what is bothering or impacting the firefighter; that is the responsibility of medical professionals. This is an error far too many supervisors make: They tell the person he has a drinking problem or PTSD. The supervisor’s job is to document the facts that demonstrate an unacceptable behavior and refer the individual to the department employee assistance program (EAP) or the department medical office for assessment and diagnosis and treatment.
The emphasis on culture and its elements should encourage and support the long road in the recovery process for the firefighter struggling with a mental health issue or a substance abuse problem. Other researchers argue, “Drinking as part of the workplace culture or environment poses a special set of challenges for a significant subset of employees: recovered alcoholics. Recovered alcoholics are generally invisible in society; they are faced with social stigma and workplace barriers that are largely unintentionally constructed.”11 The fire service needs to take a proactive approach in creating a culture that minimizes the challenges that returning firefighters may face during the recovery process. If a firefighter had any other type of injury or illness, we all would be working hard to help the firefighter return and have a successful career; however the stigma, lack of understanding, and invisible nature of mental health issues, substance use/abuse, and alcoholism remain significant issues for many firefighters today.
RECOVERY PROCESS AND CHALLENGES
The recovery process is difficult in a situation like Talbott’s because two or more issues must be dealt with concurrently: the alcoholism, the PTSD, and the depression. Dealing with only one issue will not work for very long. Another aspect of these types of situations is that they take years to develop, and they cannot be solved in a matter of a couple of office visits to a mental health professional.12,13 Many firefighters function well on the job even as their mental illness or chemical disease is progressing. It is not until the situation reaches blatant critical proportions that coworkers, family, or friends take action. So much of that trajectory into alcohol abuse is that it is not seen as a problem in the early years. It is one of the ways of “being one of the guys.” We tend to assume individuals will know their limits and monitor their own levels of alcohol intake. It is frequently only after control is gone that it begins to affect job performance, relationships, and personality; by then the damage is done.
The effects of PTSD can also take years to develop. Often, after a critical incident, we see an immediate drop in functioning in one or more of these areas: behavioral, cognitive, emotional, or physical. Frequent reaction to a critical incident is to deny that anything has changed [for example, “something is wrong (with me)”] and to work harder to avoid thinking about, talking about, or otherwise dealing with that event. This starts a buildup of trauma. Firefighters, by the nature of their jobs, are exposed to life-threatening events, violent death, and the pain and loss of others. The things firefighters see, hear, smell, and touch are more critical and aversive than in most other careers. Sometimes, no matter how well-trained and prepared a firefighter is, things are going to get through the protective barrier.
Often, by the time one can be diagnosed with either PTSD or alcoholism, depression is fully developed; the brain has chemically changed. The symptoms of depression are obvious: sadness or irritability, isolation, loss of interest in daily activities, appetite or weight changes, sleep changes, loss of energy, self-loathing, reckless behavior, and feelings of helplessness and hopelessness (which are the precursors to suicidal thinking and behavior). (13) Appropriate treatment for the impaired firefighter may require concurrent treatment for all three issues: medication for the depression, cessation of alcohol use, and talk therapy for the underlying chemical dependency issues and talking about the events that led to the PTSD.
Fear of being labeled “crazy” or “weak” often creates a barrier to treatment. The fear of being placed on medication or labeled as having a mental health issue could result in a negative manner on career advancement or obtaining life insurance. Individuals refuse recommended medications, think they can stop drinking on their own (or maintain a moderate use), and deny that they were affected by critical incidents in their career. Oftentimes, firefighters do not get the help they need until they have endangered their job or their life and are forced to seek treatment, just like in Talbott’s story. Paradoxically, it is the qualities that create a good firefighter-independence, confidence, courage, and strength-that often become the greatest obstacles to effective, early healing. Hence, the very traits that make the best firefighters are the very ones that can also hamper the firefighter from seeking and receiving the professional help needed to deal with a mental health issue or alcoholism.
Though some individuals will develop alcoholism, PTSD, and depression issues no matter what their department does, there are some steps departments can take to reduce the incidence in their firefighters. The first is to educate firefighters about trauma-what it looks like and what it can do to the individual and that it is normal to experience it; it is not a weakness. Departments can offer critical incident stress debriefings for those “over-the-top” events, especially being mindful of those firefighters who are early in their careers or young in age, for they haven’t developed some of the coping mechanisms and may be more susceptible to the effects of the traumatic event than more seasoned firefighters. All department members should have annual training/education on the EAP and how it can benefit employees and their families. Follow-up after those incidents is also important, to allow the firefighter to continue to talk and “get it out.” Departments can create a culture of openness and acceptance. The veteran firefighters who are vocal about their own effects of trauma and their own ways of dealing with it, such as where they go for help and who they talk to when they see personal changes, are gifts to the younger, less-seasoned firefighters. The veteran firefighter can also be open about some of the steps taken in the past that did not prove helpful and resulted in compounding the traumatic incident, such as binge drinking. In a culture where there is open, honest, and respectful communication, members are less likely to hide symptoms and deny problems.
GUIDELINES AND RECOMMENDATIONS
The topics of substance abuse, alcoholism, and mental health are very sensitive. Many people hold strong beliefs and values on them. The strongly held beliefs and values can make the open, honest, and respectful communication process between labor and management challenging at best. The argument needs to be made that, collectively, the fire service needs to review these issues and create alternative approaches that will allow for supporting the firefighter in recovery. This will help stop the view that the recovery firefighter is “damaged goods” and no longer deserves a place in the fire service.14 The following are some recommendations that departments may find helpful when considering a process for dealing with these topics. The recommendations may be helpful to some departments and may stimulate productive discussions around the topics.
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