First Responder Substance Use & Where to Get Help
Substance use, especially drinking, is elevated among first responders — usually a way of coping with trauma and broken sleep. Why, the warning signs, and confidential help.
Substance use — especially drinking — runs high among first responders, and it is usually a way of coping with trauma, stress and broken sleep, not a moral failing. Research on firefighters finds heavy use is common: a 2024 study found 38.8% were drinking at hazardous levels, and reviews estimate that around half of firefighters report binge drinking. Alcohol and drugs often ride alongside post-traumatic stress and shift-work sleep loss, each making the others worse. The important part: it is treatable, help is confidential, and you do not have to hit bottom to reach out. You can call the free, confidential SAMHSA National Helpline at 1-800-662-HELP (4357), 24/7, for treatment referrals. If you are in crisis, call or text 988. This guide covers why use is elevated, the warning signs, and where responders can get confidential help.
Why substance use is higher among first responders
First responders are not more prone to addiction by character; they are more exposed to its drivers. The work delivers repeated trauma, chronic stress and disrupted sleep, and alcohol is the most available tool for turning the volume down — to come off the adrenaline after a shift, to fall asleep against a wrecked circadian clock, or to numb the images from a bad call. Firefighter research has long found that binge drinking and sleep deprivation are among the most prevalent health problems in the field, and that drinking is often woven into how crews bond and decompress.
That culture matters. When winding down with a drink is the norm and asking for help is seen as weakness, a coping habit can slide into dependence without anyone naming it. Add post-traumatic stress — which frequently co-occurs with alcohol misuse — and you get a loop: the drinking dulls the symptoms for an evening and deepens them over months. Understanding this as a predictable occupational pattern, not a personal flaw, is what makes it easier to interrupt.
How common is substance use among first responders?
Heavy drinking is the clearest signal, particularly among firefighters, where the research is strongest. A 2024 study of career firefighters found 38.8% were drinking at hazardous levels on a standard screening tool, and reviews report that roughly half of firefighters engage in binge drinking, with past-month binge drinking exceeding half among male firefighters in some samples. Other substances appear too: one study of 1,310 current and retired responders found 15.3% had ever used marijuana, and a firefighter study found a 14% lifetime rate of illicit prescription opioid use.
The figures vary by study and sample, and the research on police and EMS specifically is thinner than on firefighters, so these are indicators rather than exact national rates. SAMHSA’s first-responder bulletin notes the pattern clearly — for example, a study after Hurricane Katrina found responders’ average daily drinking rose from two to seven drinks. The takeaway is not a single number but a direction: the job elevates risk, which is a reason to screen for it and treat it early.
The warning signs worth taking seriously
Substance use becomes a problem long before anyone would call it addiction, and the signs are worth knowing in yourself or a crew member. Treat these as reasons to reach out, not to wait:
Using to cope — to sleep, to come down after shift, or to numb memories from calls.
Failed attempts to cut back, or feeling you cannot relax without it.
Problems it is causing — at home, with money, with health, or at work — that you keep explaining away.
Hiding it, or getting defensive when someone mentions it.
If several of these ring true, that is the point to make a confidential call — not a reason for shame. And if there are thoughts of suicide alongside the use, treat that as an emergency and call or text 988 now.
Where first responders can get confidential help
Help ranges from a phone referral to responder-specific treatment, and the confidential options mean a first step does not have to involve your command. The SAMHSA National Helpline (1-800-662-HELP) gives free, 24/7 referrals to local treatment and support. The IAFF Center of Excellence offers residential treatment built around the fire service for IAFF members facing substance use and co-occurring PTSD. Most agencies run an Employee Assistance Program (EAP) with confidential counseling at no cost, and peer support teams can connect you to care quietly.
The confidential, responder-answered lines help here too: CopLine (1-800-267-5463) and Safe Call Now (206-459-3020) are staffed by people who understand the job and the fear of career fallout, and both are open to families. Because substance use and post-traumatic stress so often travel together, treating them at the same time works best — see our guide to PTSD in first responders, and browse the RESPONDin wellness directory for more.
Frequently asked questions
Why do first responders have higher rates of substance use?
Because they are more exposed to its drivers: repeated trauma, chronic stress and disrupted sleep. Alcohol is the most available way to come off adrenaline after a shift, fall asleep against a broken clock, or numb a bad call, and a culture that normalizes drinking to decompress can let a coping habit become dependence. Post-traumatic stress frequently co-occurs and worsens the cycle. It is a predictable occupational pattern, not a personal flaw.
How common is heavy drinking among firefighters?
Common. A 2024 study of career firefighters found 38.8% were drinking at hazardous levels on a standard screening tool, and reviews report roughly half engage in binge drinking, with past-month binge drinking above half among male firefighters in some samples. Figures vary by study, and research on police and EMS specifically is thinner, so these are strong indicators rather than exact national rates.
Where can a first responder get confidential help for substance use?
Call the free, confidential SAMHSA National Helpline at 1-800-662-HELP (4357), 24/7, for treatment referrals, or text your ZIP code to 435748. Responder-answered lines — CopLine (1-800-267-5463) and Safe Call Now (206-459-3020) — and your agency’s EAP and peer support team are also confidential. For IAFF members, the IAFF Center of Excellence offers responder-specific residential treatment. For a crisis, call or text 988.
Will getting help for substance use cost me my job?
For most people, no — and untreated substance use is far more likely to end a career than seeking help is. The SAMHSA Helpline, EAPs and peer-support and responder lines are confidential, and reaching out is not automatically a fitness-for-duty report. Policies vary by agency, and some protections exist for people who seek treatment, so a confidential line or EAP can walk you through your options before anything reaches your command.
Is substance use connected to PTSD in first responders?
Often, yes. Alcohol and drug misuse frequently co-occur with post-traumatic stress: substances dull trauma symptoms for a while and deepen them over time, and poor sleep ties into both. Because they reinforce each other, treating them together — rather than one at a time — tends to work best. Responder-aware programs like the IAFF Center of Excellence are built to treat co-occurring PTSD and substance use.
RESPONDin is the online network for first responders — firefighters, EMS, law enforcement, dispatchers and corrections officers — where responders connect with peers, honor the fallen on the line-of-duty memorial wall, find first responder jobs, and reach the wellness and crisis resources the work demands. You do not have to hit bottom to make the call — start with the SAMHSA Helpline or a responder line today.
Sources: SAMHSA National Helpline (1-800-662-HELP); SAMHSA Disaster Technical Assistance Center, First Responders bulletin, 2018; peer-reviewed firefighter studies on hazardous drinking (2024, AUDIT ~38.8%), binge drinking, marijuana and illicit prescription opioid use (PubMed/PMC). Figures are indicators from mostly firefighter samples, not exact national rates. This guide is general information, not medical advice.
Published October 15, 2026 on the RESPONDin blog, the network for first responders.