Dealingwith Alcoholism and Substance Abuse in First Responders to TragicIncidences
Thispaper explored the nature of situation and practices of dealing withpost- mental complications affecting first responders following thecontacts with professional services. A large number of firstresponders are reported to suffer from many different forms of socialproblems triggered by the mental and psychological challenges. Someof the notable social problems include alcoholism and substance abuseand suicide. This group happens to be overrepresented in alcohol,substance abuse, and suicide cases. Although a standard earlyintervention requires considering several factors such as personalfactors, predisposing factors, peridisposing factors, postdisposingfactors and protective factors, many mainstream interventionpractices only tend to focus on the peridisposing factors, at theexpense of other areas. This failure compromises the capacity of theearly interventions to be inclusive. Therefore, it is recommendedthat practice should address this weakness to fulfill the needs offirst responders.
Theworld is increasingly acknowledging the role played by firstresponders as particularly crucial in the society. This growingpopularity is orchestrated by the occurrence of many disasters thatcall for emergency and rescue mission to save lives and property. Inessence, the term ‘first responders’ describes personnel who arelikely to be the first team of people responding to assistdistressing scenes such as terrorist attacks, accidents and naturaldisasters (Shubert,Ritchie and Everly et al. 2014).First responders typically include paramedics, ambulance drivers,police offers, firefighters, and community responders. Despite theirpivotal role in the society, first responders continue to experiencevarious adverse issues while at work. The most notable issue is theencounters with distressing stimuli that cause them mental problemssuch as post-traumatic stress disorder, alcohol abuse, suicide, andgeneral pro-social behaviors. The nature of this issue creates theallowance to question the nature of the welfare of the firstresponders. This paper explores the nature of situation and practicesin dealing with mental problems and other related complications, suchas substance abuse, among troubled first responders.
Natureof Situation of Working as a First Responder
Likesurvivors, first responders are not only prone to experiencestroubling physical injuries, but also psychological challenges.Indeed, it is now widely contended that post-traumatic disorder,among other mental problems, often develops after exposure to suchsituations (Centers for Disease Control and Prevention, 2014).Large-scale disasters such as Tsunamis, earthquakes, collapsingbuilding, terror attacks, and catastrophic accidents, which affect alarge population of people, do affect not only the physical andmental wellbeing of the survivors but also the individuals whocontact the scenes, especially the first responders (DeWolfe, 2014).
Indeed,according to Hodge, Gable, and Calves (2013), the prevalence ofpost-traumatic stress disorder among the first responders usuallyvaries between 10 and 25 percent, making them the second most heavilyaffected after the actual disaster survivors, whose prevalence variesbetween 25 and 40 percent. A study by Emergency Management AssistanceCompact (2013) on the impact of the World Trade Center terroristattack revealed that the first responders are indeed often adverselyaffected, although the extent of the psychological problems differsacross the occupations. The study reports that, for instance, siterescue and recovery operation agents (police and firefighters) arethe most affected with a post-traumatic psychological disorderprevalence ranging between 20 to 25 percent, followed by the medicswith a prevalence of 15 to 20 percent. Other groups, such asambulance drivers, recorded a post-traumatic psychological disorderprevalence ranging between 10 to 15 percent. The study also reportsthat prevalence was high among first responders who had not receivedprior training on coping with psychological problems.
Besides,some responders continue to work, assisting victims, and restoringcommunities. In other words, first responders perform a set of tworoles — providing rescue and providing social support. Whencontrasted to the traditional first responders who are only deployedtemporarily to work at the site, this group of responders works foran extended period in the distressing conditions, which makes themmore vulnerable to psychological and mental problems. In this regard,the mental and psychological statuses of this group of individualstend to differ significantly from the first traditional responders.Shubert, Ritchie and Everly et al.(2014) suggests that the prevalence of the post-traumatic disorderamong this group of responders tend to be as high as 20 to 25percent.
Consideringthese adverse impacts, the concern for psychologist and otherrelevant players has been how to assist the first responders to copewith associated psychological problems effectively and live normally.However, despite the broad acknowledgment of the adversepsychological mental conditions, the practice interventions have notbeen cited as being effective to help the responders overcome theproblems. A large proportion of this population has been reported tosuffer from many different forms of social problems resulting frompsychological distress. Some of the notable social problems includealcoholism and substance abuse and suicide.
Indeed,the statistics on drug addiction and suicide involving firstresponders are well documented. Wheeler, McKelvey and Thorpe et al.(2014), for instance, covering the subject of case of Canada, statesthat over 72 first responders commit suicide for each year after anencounter with distressing duty services. The World Trade CenterMedical Monitoring and Treatment Program (2013), covering the case ofthe US, reports that well over 120 first responders commit suicideper year because of failure to cope with the resultant depression.The author particularly notes that 19 of the first responders to theSeptember 11 Attack reportedly committed suicide. Besides, EmergencyManagement Assistance Compact (2013) has reported that retired firstresponders are overrepresented in the statistics of people who commitsuicide — first responders have a suicide risk that is high as 25times those of the generalized population. Hodge, Gable and Calves(2013) suggest that the statistics of responders committing suicidemight be underreported because suicide is stigmatized. This group ofpeople is also overrepresented in the population of individualsinvolved in alcohol and substance abuse — the first responders aremore likely to engage in heavy alcohol and drug abuse 15 times thegeneral population. This situation invites the question concerningthe problems with interventions of responders.
Itis worth noting that research has lauded early interventions to beeffective in addressing the psychological and mental problemsresulting from contact with adverse first responses. However, many ofmainstream interventions are not always effective and literature hashighlighted various issues surrounding the interventions.
Oneof the important issues is the lack of a framework to guide theinterferences. The standard response framework requires consideringfive factors: personal factors, predisposing factors, peridisposingfactors, postdisposing factors and protective factors (DeWolfe,2014).However, not all interventions consider these factors. In this case,personal factors pertain to the personal, relational, cultural andfamilial, as well as religious aspects that characterized anindividual. The predisposing factors include issues such as exposureto past violence and aggression that a person encountered during theprofessional life, as well as private life. Peridisposing factors arerelated to the responders’ professional functions, experiences(such as rescuing and firefighting), private functions, and skills(such as a parent, son, and daughter and lastborn, etc.). Thepost-disposing factors pertain to the adverse experiences that resultfrom first responses and lack of assistance and support of theprofessional and personal levels. The protective factors describe thecapacity or procedures available for the responders to cope orovercome the mental and psychological challenges. Resilience andstress buffers characterize the protective factors. Despite the factthat all these elements are critical for successful intervention,DeWolfe (2014)has observed that many intervention practices only tend to focus onthe peridisposing factors, ignoring all other areas. This view hasbeen supported in some discussions.
DeWolfe(2014)furtherdiscusses the problem of lack of prior training on coping withadverse psychological challenges resulting from the first response.For instance, firefighters are only trained on how to deal put outthe fire paramedics are only trained on how to treat the survivors,while ambulance drivers are only taught road issues. Therefore, manyof the first response teams are left to face the experience as theyarise without psychological preparation. Centersfor Disease Control and Prevention (2014)discusses that the psychological interventions do not providefollow-up to check on the state of the first-responders long afterproviding service to disasters. The author particularly notes thatthe interventions are short-term, often taking just one month afterthe service response, which is inadequate because many mental andpsychological problems may even develop over more than a year later.EmergencyManagement Assistance Compact (2013)has singled out that many of the interventions fail because they arenot multi-faceted. In particular, the responses tend to stop atcounseling, overlooking other forms of support such as financialhelp.
Itseems the problem with the intervention is lack of inclusivity to theresponders` needs. A study by Hodge,Gable and Calves (2013) thatinvestigate the reason why many responders perceived theinterventions as being ineffective was that they did not give themwhat they needed. In fact, this was one of the reasons for the lowturnouts of first responders to the counseling programs. The studyreports the broad negative perception of the intervention programsand that many active first responders would prefer to deal with themental problems by themselves. The observation that many serviceresponders are likely to participate in alcohol drinking and manyforms of substance abuse does not come by surprise —many considerit as a way of coping with emotion on distressing experiences.
Inconclusion, the aim of this paper has been to explore the nature ofthe situation and practices of dealing with mental complicationsaffecting first responders in their line of duty. This paper has beenmotivated by the observation that, like the survivors, the firstresponders to the disasters is not only prone to experiencestroubling physical injuries, but also a psychological disturbance.Indeed, it is now widely contended that post-traumatic disorder andother mental problems often develop after exposure to suchcircumstances. Large-scale disasters such as Tsunamis, earthquakes,collapsing building, terror attacks, and catastrophic accidents,which affect a large population of people, have an impact on thephysical and mental wellbeing of the individuals who contact thescenes, especially those involved in recovery and rescue missions. Alarge proportion of this population has been reported to suffer frommany different forms of social problems resulting from psychologicalstress such as alcoholism and substance abuse and suicide. The firstresponders are overrepresented in alcohol, substance abuse, andsuicide cases. It is worth noting that research has lauded earlyinterventions to be effective in addressing the problemspsychological and mental problems resulting from contact with adversefirst responses, but many of mainstream interventions are not alwayseffective. Although a standard early intervention requiresconsidering several factors such as personal factors, predisposingfactors, peridisposing factors, postdisposing factors and protectivefactors, many mainstream intervention practices only tend to focus onthe peridisposing factors, ignoring all other areas. This failurecompromises the capacity of the early interventions to be inclusive.
Variousrecommendations are suggested to improve the welfare of firstresponders. First is that there is the need for adopting an elaborateearly intervention framework. This is particularly important becausea detailed framework to guide the early interventions in addressingthe requirements of early responders is lacking. The structure shouldbe based on the evidence-based researchpractice. Secondly, there is the need to adopt informed policies andstrategies on how the needs of first responders should be addressed.Practices are recommended to come up with policies and strategiestailored towards the first responder working and social environment’sneeds. The essence of developing its policies and procedures isbecause responder environments of work and experiences are unique,further implying that policies and strategies will need to be unique.Thirdly, the processes of addressing the first responders will needconcerted efforts to cooperation, coordination, and collaborationamong different players. For instance, the government will need tocome in handy by providing funding and human resource, while humanrights groups and non-governmental organizations will also need to beinvolved by acting as watchdogs to ensure that the rights of firstresponders are addressed. Lastly, it will also be important that allthese processes involve regular monitoring to inform on the necessarychange measures that would be needed. It is hoped that these stepswill go a long way in increasing the capacity for the interventionsto fulfill the welfare first responders. Indeed, this will require acommitment of leadership and management.
Centersfor Disease Control and Prevention (2014), “Attitudes towardMental Illness – 35 States, District of Columbia, and Puerto Rico,2007,” Morbidityand Mortality Weekly Report59 (2010): 619-625.
DeWolfe,D. (2014). FieldManual for Mental Health and Human Service Workers,DHHS Publication No. ADM 90-537.
EmergencyManagement Assistance Compact (2013). EMAC Articles of Agreement.Retrieved from http://www.emacweb.org/?1838
Hodge, L. A. Gable, D. & Calves, S. (2013) “The Legal Framework forMeeting Surge Capacity through the Use of Volunteer HealthProfessionals (2015).During Public Health Emergencies and OtherDisasters,” Journalof Contemporary Health Law and Policy 22:5-71.
Shubert,E. C. Ritchie, and G. S. Everly, Jr. et al., (2014) “A MissingElement in Disaster Mental Health: Behavioral Health Surveillance forFirst Responders,” InternationalJournal of Emergency Mental Health9: 201-213.
Wheeler,K. McKelvey, C & Thorpe et al., D. (2014) “Asthma Diagnosedafter 11 September 2001 among Rescue and Recovery Workers: Findingsfrom the World Trade Center Health Registry,” EnvironmentalHealth Perspectives115:1584-1590
WorldTrade Center Medical Monitoring and Treatment Program. (2013).Medical Treatment for 9/11 Responders, August 9,http://www.wtcexams.org/index.html.