The abuse of prescription pharmaceuticals is an epidemic within the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the “…extent of the problem is staggering, with national surveys showing that in 2003 approximately 15 million Americans, ages 12 and older used a psycho-therapeutic for a condition other than…” prescribed (Compton & Volkow, 2006). Although, in many situations, prescriptions are used for recreational use, we are seeing a strong emergence of cases where people abuse prescription drugs in order to cope with physical and emotional issues.
First responders, such as firefighters, are professionally at a higher risk for prescription drug abuse due to the stressors and trauma they face on a daily basis. To put this issue in perspective, in 2001, a study was conducted on firefighters who were first responders during the terrorist attack of the World Trade Center (WTC). An acute assessment piloted 2 weeks after the attack found as many as 22% of the responders had acute posttraumatic stress Disorders (PTSD); 13% of which still had symptoms a year after the attack. Fire Fighters are exposed to physical and emotional trauma putting them at risk for conditions such as PTSD, anxiety, depression, insomnia and adjustment disorders. The physical rigors also play a toll; in efforts to save lives, fire fighters spend hours in extreme physical exertion, many acquiring life long injuries. In 2010, it was estimated that over 71,000 firefighter injuries occurred in the line of duty with over 45% occurring during fireground operations. The leading type of physical injury was musculoskeletal (e.g. strains and sprains) followed closely by lacerations and wounds.
In order to deal with these physical and mental injuries, prescriptions pills are provided by physicians and life is expected to go back to normal again; unfortunately this is not so for many first responders as studies show a “ …[s]ignificant linear relationship [between] years of experience and levels of traumatic stress and depression” (Regehr et. al, 2003). In attempt to fulfill professional and personal responsibilities, fire fighters develop dependencies or behaviors of prescription abuse. Studies repeatedly reveal a “…need to provide acute and long-term medical monitoring, treatment, and counseling to…” (Perrin et. al, 2007) fire fighters exposed to disasters; a resource not readily available to many who need it.
Treatment for prescription drug dependencies requires an intensive multidimensional (emotional, mental, physical) approach that involves the use of therapeutic communities; also known as residential treatment centers. Therapeutic communities have been shown to be significantly better than outpatient services; a recent study showed that subjects who received services in a therapeutic community for longer than seven weeks were more likely to be employed or in school and less likely to be in jail or back to pharmaceutical abuse. An example of such a community is the Station House in Boynton Beach, Florida; a facility created specifically for first responders by first responders. This facility follows a peer modeled recovery system where current clients struggling with addiction get intensive rehabilitation structured by professionals who are also fellow first responders.
The structure of peer modeled rehabilitation has proven very effective because although social“… support [plays] an important role in helping drug users achieve abstinence; these benefits may depend on the type of support experienced” (Wasserman et. al, 2001). With the peer modeled therapy at Station House; clients get to interact with fellow responders who know the intimate details of the psychological and physical demands of the profession and how this exposes them to false coping mechanisms such the abuse of prescription drugs. As “… experienced firefighters [have] lower levels of social support and lower self-efficacy” (Regehr et. al, 2003), Station House provides clients meetings with recovered program alumni who can share the strategies they developed in order to maintain sobriety upon return to professional life. Station House provides quality rehabilitation in an emotionally safe and peer rich environment.
With the acknowledgment that the road to recovery tends to be a long one, Station House provides a residential program that incorporates physical wellbeing with resources for mental hygiene, all the while focusing on the issue of prescription dependence. Clients have access to community meetings where they interact with other clients and alumni of the program. As family is a vital part of the recovery process, Station House has services structured to incorporate the client’s family into the process. Treatment doesn’t end upon discharge; building upon the foundation developed in the residential program, Station House prepares the client for full integration back into the community by putting a support system in place. “Overall, patients’ social support networks following treatment [are] more important factors than the pre- or during-treatment variables examined” (Broome et. al, 2002). At discharge, clients have access to local peer support groups and therapists all the while with the option of maintaining contact with their in-house Station House therapists.
The mental and physical rigors of profession put Firefighters at a higher risk for prescription dependence and abuse. It is vital that we, as a society, have resources in place to provide help for as many needing. Treatment should involve an intense but rich multidimensional and individualized plan to provide the utmost chances for full recovery of professional and personal life.