Firefighters, Policeman, Doctors, Nurses…all these inpiduals incorporate what is known as the helping professions. These are people who are on the front line when problems arise. In fact, trauma is part of the job description of these professions. It is something that is seen every day. So, how do these inpiduals deal with this?
Obviously, it takes a certain character and disposition to work in these professions, but even the most qualified inpidual will eventually be affected by what they see and hear. Some people go to counseling, support groups, or exercise to relieve stress. However, for a strikingly large number of inpiduals, seeing trauma on a daily basis leads to substance abuse. This is not only harmful to the inpidual in question, but is also detrimental to the cause they hope to serve.
One of the earlier areas where the connection between trauma and substance abuse was made was regarding Vietnam Veterans. Many Vets were diagnosed with post-traumatic stress disorder (PTSD) and were found to be utilizing substances, in all probability to deal with the symptoms of PTSD. Self-medicating is something not specific to veterans health professionals. Utilization of drug and alcohols is something found in physically, sexually, and emotionally abused inpiduals and is therefore not a new phenomenon. However, the effects of trauma and stress on healthcare professionals, is a topic that has not been researched sufficiently.
With any trauma, trying to predict how someone will respond to future trauma is often dependent upon the way they reacted to trauma in the past. There are a variety of different symptoms that an inpidual can experience in relation to trauma. The majority of symptoms can be pided up into four different categories:
- Cognitive: intrusive thoughts and reliving the incident, reduced ability to concentrate, or mental confusion.
- Behavioral: substance use, withdrawal from others, or acting-out behaviors.
- Physical: fatigue, recurring headaches, or inability to sleep or eat.
- Emotional: unfounded or unusual anger, depressive feelings, or anxiety reactions.
Certainly most inpiduals will not experience all of these symptoms, but rather a combination of the different categories.
What are the different incidents of substance abuse among different occupations?
- Doctors: In a study conducted by Cicala (2003) 8% to 12% of physicians were estimated to develop a substance use problem. Emergency medicine, not surprisingly, and anesthesiology, are usually the highest-risk specialties among doctors. Utilization of opiates and benzodiazepines are danger signs of potential substance abuse among doctors.
- Nurses: Trinkoff and Storr (1998) conducted an investigation where substance use was studied among nurses. Thirty-two percent of 4,438 respondents indicated some substance abuse. This cohort was asked about use of the following:
Again, emergency room nurses were 3.5 times as likely to use substances as general practice or pediatric nurses. Oncology or administrative nurses were 2 times as likely to binge-drink. Psychiatric nurses were 2.5 times as likely as general practice nurses to smoke.
- Firefighters: Boxer and Wild (1993) found that more than 40% of firefighters were experiencing psychological distress. Almost 30% of them were experiencing problematic alcohol use. The results of this study indicate that there is a direct correlation between alcohol abuse and high-stress occupations.
- Police Officers: According to research, almost 90% of police officers consume alcohol to some degree. At least a quarter of officers are dependent upon alcohol because of on the job stress. Alcohol is used to cope with the stress related to being on the job.
When the terrorist attacks occurred on the World Trade Center and Pentagon on September 11th, 2001, rescue workers on the scene were significantly affected. This also speaks to the importance of secondary traumatic stress. This is stress that occurs from the knowledge that a traumatic event happened to someone else.
In addition, Robbers and Jenkins (2005) found that workers on the scene of the attacks are still experiencing high levels of PTSD. Interestingly, length of exposure at the attack site is related to increased levels of PTSD.
Trauma, substance-abuse related disorders, and stress responses share a common theme that should not be ignored (The need for immediate attention). Intervening in the early stages of these disorders is the way to stop the possibility of exacerbation of the symptoms of these conditions. Inpiduals who are utilizing substances because they are weighed down with the trauma they have experienced are usually too overwhelmed to take care of themselves. It is known that substance abuse can be chronic and have a delayed onset, so catching the problem early can hopefully, stop the progression.
Perhaps the best treatment for a problem of this magnitude is inpidualized treatment regarding the traumatic events. Assuming that these events are what have caused the substance abuse, identifying the stressor should stop the necessitation of substances to control the problem. However, having said that, the utilization of substance abuse treatment should not be discredited. Often times, the inpidual will need a combination of treatments in order to effectively treat their problem. Ideally, programs will be set up specifically for the healthcare professions. This way, the specific traumas these inpiduals experience can be addressed. Treatment programs for these inpiduals are necessary, not only for the sake of the health professional but also for the sake of the people whom these inpiduals have helped and have the potential to assist in the future.
Cicala, R.S. (2003). Substance abuse among physicians: What you need to know. Hospital Physician, 39(7), 39–46.
Cross, C.L., & Ashley, L. (2004). Police trauma and addiction: Coping with the dangers of the job. FBI Law Enforcement Bulletin, 73(10), 24–32.
Flannery, R.B., Jr. (2004). Managing stress in today's age: A concise guide for emergency services personnel. International Journal of Emergency Mental Health, 6, 205–209.
Friedman, M.J. (2001). Post-traumatic stress disorder: The latest assessment and treatment strategies. Kansas City, MO: Compact Clinicals.
Hughes, P.H., Brandenburg, N., Baldwin, D.C., Jr., Storr, C.L., Williams, K.M., Anthony, J.C., et al. (1992). Prevalence of substance use among US physicians. Journal of the American Medical Association, 267, 2333–2339.
Richmond, R.L., Wodak, A., Kehoe, L., & Heather, N. (1998). How healthy are the police? A survey of life-style factors. Addiction, 93, 1729–1737.
Robbers, M.L.P., & Jenkins, J.M. (2005). Symptomatology of post-traumatic stress disorder among first responders to the Pentagon on 9/11: A preliminary analysis of Arlington Country Police First Responders. Police Practice and Research, 6, 235–249.
Trinkoff, A.M., & Storr, C.L. (1998). Substance use among nurses: Differences between specialties. American Journal of Public Health, 88, 581–585.
Wagner, S.L. (2005). Emergency response service personnel and the critical incident stress debriefing debate. International Journal of Emergency Mental Health, 7, 33–41.
Weiss, D.S., Marmar, C.R., Schlenger, W.E., Fairbank, J.A., Jordan, B.K., Hough, R.L., et al. (1992). The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans. Journal of Traumatic Stress, 5, 365–376.