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.
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.