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Psychological Effects of Co-Occurring Disorders on First Responders

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Figuring out which comes first, a mental health problem or substance addiction, is one of many questions tough to answer. Given that drug abuse and alcoholism are in themselves defined as mental health disorders, distinguishing key differences in the psychological effects of each can add to this subject’s complexity.


First responders are at heightened risk for developing these disorders.

In 2016, statistics showed that more than eight million adults had a mental illness and substance use disorder. First responders including active duty military and veterans are more likely to have PTSD and other mental illnesses. As a result, many turn to drugs or alcohol to deal with these conditions.

What You Will Learn:


Time, Trauma, and the Stigma of Strength

Ending The Stigma Around Addiction - First Responders

Whether substance abuse is a coping mechanism to deal with pain, emotional or physical, chemical dependency can quickly turn into addiction, further enhancing depression or anxiety.

But there’s another aspect of mental health that is more challenging for paramedics, police officers, firefighters, as well as military servicemen and women: The dictated perception that they can handle ‘it’, whatever it is. That’s a lot of pressure.

Ongoing exposure to traumatic events will take a toll on a person, no matter the extent of their training for these types of circumstances. During trauma, the human’s natural answer to it known as our fight or flight response is engaged. What one person can get through will differ from another, based on a variety of factors.

Trauma left unchecked will bring about a host of harmful psychological effects that not only impact the person experiencing them but their coworkers, family members, and friends. For first responders, trauma and its affects are often neglected due to the negative stigma associated with showing signs of emotional weakness.

The Truth about Their Trauma

Continuum Recovery Center continues to witness the ill-effects of trauma on Phoenix area first responders seeking outpatient treatment for behavioral health issues.

A recent University of Phoenix survey noted the experiences of 2,000 participants, first responders, and reported that:

  • 85% experienced symptoms related to mental health issues
  • 27% were diagnosed with depression
  • 10% were diagnosed with post-traumatic stress disorder (PTSD)

Mental health conditions can be devastating, compounded by drug and alcohol abuse. Once mental health is compromised, personal problems are more convoluted and grow more serious. To unravel the root cause(s), it requires long term help from licensed professionals who specialize in this area of medicine. Here’s why.

The Link between the Two Problems

Let’s say you have a substance abuse problem and a mental health illness like depression or PTSD at the same time. This is known as a co-occurring disorder or dual diagnosis.

Dealing with substance abuse can be even more difficult when you’re also struggling with mental health issues, and often the reason why sufferers do not get the help they need.

The mental health problem and substance addiction can have their own separate symptoms, though there are also some similarities. Each condition, in its own rite, affects one’s ability to function at work or maintain a stable home life. Together, co-occurring disorders also affect each other.

This means that if a mental health problem isn’t treated, the substance abuse problem is likely to get worse as drugs or alcohol are often used to quiet the symptoms of mental illness, a form of self-medication. When substance abuse increases, mental health issues are magnified. It’s all a vicious circle.

Is There a Quick Fix

Substance abuse and mental health disorders are closely linked. Some substance abuse can cause prolonged psychotic reactions.

Alcohol abuse is usually used to forget about one’s problems. If you’ve been having a tough time struggling with your emotions, or know someone who is, drugs and alcohol can seem like the best way to fix things.

But relief from co-occurring disorders isn’t that simple. Because of the side effects apparent in each condition, substance addiction and mental illness, each worsens the symptoms of the other.

Negative Psychological Effects of Drug Abuse

Mental problems can be a result of genetics, the environment, and other outside factors. They may be a combination of several issues. Substance abuse could dramatically increase symptoms of mental illness or even trigger new ones.

Drug and alcohol abuse can also interact with medications. These include antidepressants, anti-anxiety pills, or mood stabilizers. They can make them less effective. They may also interfere with the adherence required when taking prescribed medication.

Signs of a Co-Occurring Disorder

The signs and symptoms of a mental health disorder compared to drug abuse can vary because there are many different types of dependencies.

Certain behavioral patterns do occur but often the signs can be quite unique to each individual. The signs of depression and marijuana abuse might appear quite different from the signs of schizophrenia and opioid abuse, or PTSD and alcoholism. However, there are warning signs that could indicate that a co-occurring disorder exists.

First Responders and PTSD

Using Drugs and Alcohol to Cope

The reasons behind substance abuse are many and can change over time.

People often default to drug and alcohol use to:

  • Cope with difficult feelings
  • Manage pain
  • Control intensity of moods
  • Better face challenging situations
  • Enhance socialization skills
  • Maintain focus and alertness
  • Numb or disassociate from trauma

Family Predisposition

Co-occurring disorders can run in families, especially if being a first responder is a generational tradition. If you have concerns about your own family or are noticing potential signs of a co-occurring disorder in someone close to you, ask yourself if there is a history of depression, PTSD, anxiety, or other co-occurring mental health issues.

But co-occurring disorders don’t develop in just the first responder population. Any person is at risk for this condition who has unresolved trauma or a history of abuse – physical, sexual, or emotional.

Accurate Diagnosis Is Crucial

A co-occurring disorder can be missed by a healthcare practitioner, especially one who isn’t trained in the area of addiction treatment. Even if treatment for an addiction or mental health disorder has already taken place, a co-occurring disorder requires therapy to effectively treat each condition. If only one aspect of the disorder is dealt with, the likelihood of relapse is greater. In order to treat the whole person properly, both disorders must be identified and treated simultaneously.

Mental Health Quote - CS Lewis

The Issue of Denial

Denial adds yet another dimension to first responders with mental illness and, unfortunately, is not uncommon in those who abuse substances as well.

It’s not easy to admit how dependent you are on drugs or how much they affect your life. Denial occurs with mental disorders as well. Some people find the symptoms so frightening that they choose to ignore them in the hope that they’ll go away. This is especially true of first responders because they need to continue with their jobs and can’t let their own issues cloud their response time. There can also be a degree of shame attached to both issues.

The truth is that substance abuse and mental health issues could happen to anyone, because stress is what fuels both. And not many of us can claim to live a life that’s stress free.

Treatment for Co-Occurring Disorders

Admitting you have a problem and then seeking help are seen as the first steps on the road to recovery.

Some of the most effective treatments for co-occurring disorders involve an integrated approach. This means that both the substance abuse and mental disorder are treated at the same time. The same team of treatment providers should be used for both issues.

Treatment for the mental health problem could include medication, counseling and peer support. It could also involve making lifestyle choices such as a better diet and more exercise to support every aspect of wellness. Treatment for substance abuse should run alongside this.

For many, a good way to start treatment is by including MAT, medication assisted treatment. Detoxification from addicted substances and the management of withdrawal symptoms can be made easier through specific medication, geared to assist in recovery from a particular drug or alcohol addiction.

Opioid addiction is one of the most difficult addictions to overcome. Detox is the biggest hurdle since it can be painful and hard on the body. MAT is often recommended but Continuum Recovery Center utilizes a leading technology, a medical device, to replace medication-assisted treatment during the detox process. Known as the Bridge Device, it was developed to drastically reduce opioid withdrawal symptoms, bridging the gap between needing opioids and wanting them.

As you can tell, treatment for co-occurring disorders is not a one-size-fits-all process. Careful monitoring of MAT during the initial stage of treatment is important to ensure that physical responsiveness to the medication is normal and not putting a patient at risk for other health issues.

In addition to MAT, treatment usually includes varied therapies, acquiring stress management techniques, learning positive life skills, and ongoing attendance of support groups. MAT can reduce and often eliminate the repercussions of dealing with recovery while reintegrating to everyday life. MAT provides a much needed counterbalance throughout recovery, when needed.

Staying Strong

Prescription medication is often necessary in the treatment of mental health conditions. Mixing it with other drugs or alcohol could pose serious risks. Similarly, working through the psychological effects of mental illness with a therapist will be far less effective if you’re under the influence during these sessions.

Relapses do happen and support groups can be very useful during those moments in life when stress triggers the urge to use. These are the tests of recovery and happen during the course of recovery.

By sharing these thoughts and feelings with others who have been down that same road, it helps remove the burden of stress and guilt for having those moments. This is part of why recovery is referred to as a process.

There are many support groups for first responders in the Phoenix area, including a first responders/military therapy group at Valley Hospital. There is more support online, including Survive First, a resource for first responders.

What the Craig Tiger Act Means

In August of 2018, Arizona passed the Craig Tiger Act which guarantees that first responders involved in a traumatic incident get 36 visits to a licensed counselor. It also allows for up to 30 days of leave if the counselor determines that the first responder cannot perform his or her duties while receiving treatment.

The Act is an important step to help remove the need for self-medicating against trauma. Without it, for some, the risk of suicide remains as the inability to overcome the trauma and the ongoing psychological effects can prove too much to bear.

Find the Right Program for You

If you already have a substance abuse addiction along with a mental health issue and you want help, these are the characteristics to watch for when choosing a treatment program.

  1. Make sure the facility has the correct license and accreditation.
  2. It should demonstrate experience in dealing with co-occurring disorders: substance abuse and mental health conditions.
  3. Check for an adequate aftercare program to reduce the risk of relapse.
  4. Have personal involvement in setting recovery goals and developing strategies for lifestyle changes to better support sobriety and mental wellbeing. This includes removing former negative behaviors and replacing them with positive people, places, and activities.
  5. Ask about new, progressive, and effective treatment available that may differentiate one program from another.

Specific Treatments

With anxiety, bipolar, and depressive disorders, for example, medication is often a part of an ongoing treatment program. As recovery from compromised mental health and drug addiction become more apparent, you may be advised of recommended modifications to your MAT. This should be an interactive encounter between doctor and patient. It’s important to have the opportunity to discuss the role drugs or alcohol played in your life as it will impact what’s needed to achieve recovery.

All dealings with a treatment facility should be confidential, in all forms of communication. In addition, the physical environment should make you feel safe and comfortable.

You will also need to receive some instruction on how mental issues interact with medications, drugs and alcohol. You may need help to find employment during the recovery process.

The professionals working with you should help you identify and develop your own recovery goals. This process will involve learning about steps toward recovery from both illnesses.

Counseling from specialists for individual and group therapy should be part of your program and can include family members or peers.

Recovery Tips

You’ll have to find healthy alternatives to cope with everyday stress. You may need to incorporate mindfulness meditation into your daily routine. Regular exercise will help too; aim for at least half an hour of aerobic exercise on most days. It helps in keeping a positive mental attitude.

Understanding what can trigger your substance abuse or mental health problem is important too. This is the hard part, especially for first responders, because the trigger is the job itself. Learning to work around it through techniques such as breathing exercises or meditation is important.

Success is all about having a plan to deal with all of this. Cultivate connections with members of your family or friends who you know will be supportive. And don’t forget your coworkers and support groups. Having a common experience and being able to talk about it helps diffuse the problem before it gets worse.

Starting a New Way of Life

Stick to the advice your doctor gives you. Don’t just stop taking any prescribed medication because you feel better. That’s what medication is supposed to do, make you feel better. But it doesn’t mean it isn’t needed anymore.

Your chances of staying away from drugs are likely to improve if you are participating in a social support group and getting therapy.

Exercise is a natural mood elevator and should become part of your new routine. Also adding yoga or Tai Chi can engage a positive mental attitude.

A Healthier Life After Addiction

Helping a Loved One

Those suffering from co-occurring disorders will often resist treatment. This can be a great cause of frustration to a loved one watching from close by. The road to recovery may also be long.

Remember that you cannot force anyone to stay off drugs or alcohol. You are there to offer love and encouragement in a non-judgmental way though you deserve support as well.

Be realistic about the amount of time and energy you can offer. Learn everything you can about your loved one’s problems. The more you understand, the better you’ll be able to support them during recovery. However, don’t neglect your own self-care in the process.

Discover the Continuum Recovery Center approach to dual diagnosis treatment and how to attain whole health through the eight dimensions of wellness.


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