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All-responder treatment programs: Just another gimmick?

January 27, 2015
by Mark Lamplugh, Jr.
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Mark Lamplugh, Jr.

Recently in the addiction recovery field, we have seen a few all-responder 24/7 treatment programs pop up across the country. These facilities offer first responders complete isolation from “normal” people. The only people the patient is around in the treatment program are other first responders.

On the face of it, it sounds reasonable. The work firefighters, police, and EMS workers are asked to do generates more than an average amount of trauma. And if you ask responders what clinical setting would make them feel comfortable, a common answer might give you the impression that they are a breed apart—a fraternity that is used to depending on cohesion as a matter of life or death.

But it is important for clinicians to ask, “Do these programs that single out first responders work better for their overall recovery?”

Deciding to seek help for alcoholism, drug addiction, or mental health problems represents a major commitment. It may be particularly difficult for many first responders because they work in a culture where admitting that they have a substance use problem equals admitting to weakness. It may mean destroying the sense, arguably useful on the job, that they are heroically invincible. “I’m a firefighter.” “We are tough as nails.” “We don’t get problems, we fight them.”

From a treatment perspective, this very thought process, which makes it hard to ask for or receive help, explains why all-responder programs may not be a good idea. Getting first responders to realize they are just like everyone else will be the first job of any program.

Informed opinion

I spoke with Joel Brier, second executive vice president of the International Association of Fire Fighters (IAFF) Local 2928, who also heads up behavioral health for the Professional Firefighters and Paramedics of Palm Beach County, Fla. His 18 years working with firefighters on behavioral health treatment, through a wellness program and employee assistance program (EAP) providers, give him an informed perspective on the issue of responder-only treatment.

“After countless pre-screening interviews, interventions, and working with various treatment centers throughout the country, I have found that our firefighters are really no different than anyone else needing assistance in breaking free from the grip of substance or alcohol abuse,” says Brier. “And in fact they prefer not to be placed where they may encounter other firefighters.”

He says that the placement process for those entering treatment includes protocols to reduce the chance that firefighters will be in treatment together.

Telling firefighters or police officers they can’t get better unless they are in a “responder-only program” is not helping the responder community. And it’s not helping sick responders to get any better. Look at it this way: If someone experienced a particular trauma, a licensed therapist would treat the trauma. That role wouldn't be left to a peer from the profession the individual worked in when the trauma occurred.

“While there may be trauma-related issues to being a first responder, these issues are typically handled by clinicians specifically trained in trauma therapy,” Brier says.

Breaking free from habits

Another problem with an all-responder program is the simple fact that not much is going to be accomplished by responders inhabiting the buddy support system they should be leaving behind—a setting where the talk centers on big fires and amorous conquests. How does this same environment make anyone better? The fact of the matter is it doesn’t. Inpatient recovery works best when individuals make a break from familiar surroundings, underscoring their commitment to abandon old habits.

In fact, the sense of being so unique that you need a special cohort before you can begin your recovery is actually a well-known symptom of the disease of addiction. There’s a saying among those in recovery that “addicts suffer from terminal uniqueness.”

“A firefighter’s ability to get the tools through treatment is no different from anyone else’s,” Brier says. “It requires anonymity, desire, and the ability to accept the things they cannot change, the courage to change the things they can, and the wisdom to know the difference.”

Brier of course is quoting the Serenity Prayer, used often in 12-Step programs. He strongly believes that 12-Step programs should be part of the firefighter’s recovery plan. They are a developed recovery habit and they provide strong roots of support in the community, giving recovery some continuity.

“These programs are generally started while the client is still in treatment,” says Brier, “and continue as they evolve back into everyday life.”

Nurturing long-term recovery

From the view of long-term recovery, responders can’t leave rehab with the same “I’m different from everybody else” attitude that dragged them down to begin with. It’s the same attitude that will tell them they are too unique to attend 12-Step meetings or to attend group therapy or any other support system that doesn’t happen to have first responders in it. And in the same way, this thinking will ensure relapse. First responders have a unique job with unique, dramatic and important experiences, but individual responders are not unique. They need help just like everyone else.

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I am not a long term treatment provider. But I have been working with People suffering from addiction for over 30 years.We have just opened Confidential Recovery. Focusing on Professionals and First Responders.
As a new IOP/PHP In San Diego I feel anything we can do to eliminate barriers to get Folks into treatment we are going to do.
Example Law Enforcement based on our focus groups and my experience, want to be with other professionals in their field. We think starting there is a great way to go. Like anyone suffering from this disease, once underway with long term recovery and support they will need to go through learning how to live life on Lives terms. That is were I feel folks can re integrate.Doctors have the same request as far as confidentiality, Celebrities do as well. So with up to 25% of addiction with First Responders and the Trauma they and their families experience. I say come on in We will do what we can to help you feel comfortable.I hope this helps.
As a footnote not all first responders have the same issue. EMT's,911 operators for example.
Best,
Scott H. Silverman
Confidential Recovery
www.confiendtialrecovery.com
619-452-1200
Call me and let's talk. We want to help anyway we can.

I am a retired Sheriff's Deputy who went to rehab while I was still an active duty Detective. I now volunteer at two different treatment centers. In my opinion, you are off your mark on many things in this article. For one, in order for first responders to get help, they have to feel safe. At my rehab, which was well known and somewhat upscale, there was a girl who came in to avoid being caught on a warrant. She hated law enforcement. There were no locks on our doors in our rooms. Soon, she started stealing and got kicked out. How could I feel safe knowing she was across the hall. I had to talk about my job in treatment, it's part of what got me there.

I have had a sponsor who was also a first responder and a sponsor who knows nothing about law enforcement. The sponsor with a law enforcement background, understands me, my mannerisms, the things I've seen etc... way more then the other sponsor. I don't think first responders feel "terminally unique" when we develop substance abuse issues. We just feel really, really bad and we miss the camaraderie that comes with the job, other people can't relate to that. It would have been helpful if you had interviewed cops who have been to rehab for your article. I go to AA meetings all over town but my favorite is the one that is dedicated to First Responders. If you think a cop wants to see a parolee when he looks across the room at a treatment center you are wrong. If you think a firefighter wants to see some family member who's home burned down or someone who's kid he scrapped off the cement at an accident scene when they are in recovery, you are wrong. A district attorney or judge should not have to see someone they put in jail or family member at a treatment center and should be free to talk about there job openly which certainly can't always be done in mainstream rehab. Feeling safe first, is the only way to start getting help, feeling understood is even more important. You are wrong in every way when you say, that responders should leave behind the buddy system. That's an aspect of the job that is essential. I was in treatment with another tough, old, hard as nails cop. We didn't tell one war story. We were so fascinated with learning about recovery and how we could apply it to the job. The statement about amorous affairs and conquering is an indication that you are shallow minded about the profession and perhaps have some disdain. A bit insulting and unexpected from this genre. Perhaps time for an inventory.

Barb C

Spoke to a few Of my LE colleagues. They reminded me that only LE arrest people, most other first responders don't. Makes a big difference when it comes to confidentiality or at a minimum if you think you might be sharing a room with someone you arrested.The odds are you won't come in. Why don't we just make it easy for First Responders to get access to treatment in a confidential way.

Scott

As a career fireman with over a quarter century sober I can also give an informed opinion ... the quote - "Telling firefighters or police officers they can’t get better unless they are in a “responder-only program” is not helping the responder community. " ... is ridiculous, irresponsible, and off topic.

And yet another "Another problem with an all-responder program is the simple fact that not much is going to be accomplished by responders inhabiting the buddy support system they should be leaving behind—a setting where the talk centers on big fires and amorous conquests." ... wow, where's your facts? You're stating problems, but where is your facts to back it up? I know it will work because at Mt Sinai hospital in Miami that have been hosting physician only treatment for several decades now. But the real problem with this statement (tough choice because there are so many to chose from) is that the application of "support" is utilized in treatment, in meetings, and sponsorship! But lets look further ... talking about big fires ... why should a fireman expose people to things that are unnecessarily traumatic to those not privileged to serve in our capacity, such as the smell of burning flesh, or the odor of rotting corps, two smells I can still smell years after the fact. That support, the support of my brothers and sisters who would understand this is vital to heal. Regarding the amorous comment, thats just a cheap shot at supporting a position,

Do you really believe that responder programs won't work? - “A firefighter’s ability to get the tools through treatment is no different from anyone else’s,” Allow me to give you some facts, firefighter suicides outpaced firefighter line of duty deaths last year. The degree of exposure to PTSD makes us different than most. It is why the divorce rate is so high in our field, it is why abuse rates are so high in our field, and it is why suicide seems like a plausible way out.

With all due respect to all those involved with this article I bring these points up as a reference for perspective. There is much more that the men and women in our industry (public service) have to deal with than what people outside of our industry can possibly know. Maybe your next article should be "Why First Responder Programs Work".
RR

Thanks for the thoughtful responses. Research on this question is in the early stages, so I can only speak from my own experience. When I was in treatment, I shared a room with two individuals, one who was suffering with schizophrenia, another who was just out of prison. I found those two individuals to be great people suffering with the disease of addiction. I personally started a successful "First Responder Program" as well. Most programs marketed today as responder programs are predominately just that: marketing. Responders are typically assigned to responder groups that meet 1 or 2 hours a day; then the rest of the time they're in with normal people just like everyone else. I've worked in the treatment industry in both types of programs, "responder programs" and regular programs. And what I find is that when we can accept our disease of addiction and embrace recovery, we can all get better, no matter what our profession. I think the first step in getting well, for any first responder, is to accept we have the same disease just like everyone else. And we can get well just like everyone else. Our disease isn’t different.

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