Saturday March 25th 2017

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Addiction recovery for First Responders: The treatment our life-savers need

When our heroes need help … what do they do?

Most often, nothing!

First Responders see the worst moments in life. Their jobs involve constant response to life-threatening situations. Watching people in hopeless situations and being responsible for their lives…can you imagine the stress?

But all this responsibility and stress comes at a cost! First Responders experience trauma, which over time, builds and goes unresolved. To cope…add a chemical and the pain goes away. Is it any wonder that so many of our public heroes experience addiction problems?

Addiction help for First Responders

In this interview, we speak with expert Dr.Todd Langus, Psy.D, MFTI. He’ll share his insight with us about the REAL addiction and trauma issues among First Responders. And he speaks from experience!

A former police officer and sergeant for 20 years, Todd has been treating public safety personnel, First Responders, military personnel, and their families for more than a decade. Himself a trauma survivor, he specializes in treating the following conditions for First Responders:

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  • Postraumatic Stress
  • anger management
  • anxiety
  • chemical dependency
  • depression
  • grief
  • occupational wellness
  • relationship issues

As a vulnerable and susceptible population, the addiction recovery needs of First Responder are unique. And we believe that they need help!
But the interview does not end here…Please send us your questions in the comments section at the end. In fact, feel free to ask us more about addiction treatment for First Responders. We always try to provide personal and prompt responses to questions.

ADDICTION BLOG: What IS a First Responder?
DR. TODD LANGUS, PSY.D, MFTI: First off, I would like to clarify who I am talking about as a “Responder” or “First Responder”. For purposes of this interview and my lecture I consider a “Responder” anyone who’s occupation is in a position of care for the life of others such as but not limited to:

  • Law enforcement officers
  • Fire fighters
  • Military personnel
  • EMT personnel
  • Doctors
  • Nurses
  • Medical staff treating others

I would also like to add that ANYONE who does the job of a Responder long enough will be affected by the job in some way. Responders do not go through an entire career unscathed. Somewhere along the way it will take a piece of them. The reason Responders are heroes is because they are willing to give a piece of themselves to help others.

ADDICTION BLOG: Do people who choose careers in the high-stress world of emergency response typically have a history of trauma BEFORE they begin their careers? Or does trauma occur as a RESULT of the work?

DR. TODD LANGUS, PSY.D, MFTI: In most of the Responders I have treated, they have not entered the career with a history of trauma or PTSD. If someone has been through trauma in their past, prior to their occupation, and has successfully dealt with the trauma then they tend to be better able to handle subsequent traumas in their life.

If a person however, suffers trauma prior to their career and did not deal with that trauma… then it can complicate subsequent traumas and the current trauma can exacerbate the prior trauma. If this is the case both traumas need to be worked on in treatment.

Responders either suffer a single episode trauma where one event affects them or they can suffer from cumulative trauma where from seeing multiple negative things throughout their career, these events starts to affect them.

Most Responders get into their professions because they truly care in helping others. To be the most effective Responder, you have to care. The down side is that the ones who care the most often take the most scars. But these are scars that cannot be seen. They are emotional scars on the heart. To be the most effective Responder, you must care.

ADDICTION BLOG: Do many First Responders who deal with addiction share similar patterns of drug abuse? If so what are they?

DR. TODD LANGUS, PSY.D, MFTI: Yes. First Responders who deal with addiction share similar patterns of abuse.
First and foremost, we must understand that in the Responder occupation alcohol is not only accepted as a means to cope with the job, it is encouraged. In law enforcement, we have a term called “Choir Practice”. This means that after work we were going to a place to drink and get rid of our stress. Most Responder occupations have their own terminology for this.

If alcohol is accepted and encouraged then another pattern that occurs is that dependency and addiction behaviors becomes overlooked by the person, their peers, and the organization they work for even though the symptoms are out in the open. In this case, the addiction manifests deeper before being addressed.

Another pattern of behavior is the use of opiates and other ADDICTIVE medications. This pattern is that First Responders believe it is ok to take addictive medications because they have a legitimate injury and/or it has been prescribed by a medical doctor.

Another consistent similar pattern for Responders is what is called anhedonic withdrawal or what I like to call “Responder Depression”. It is when the Responder withdraws from their normal activities they used to enjoy doing.

Another pattern is isolation. The Responder begins to isolate from family, friends and co-workers. Anger and irritability usually accompanies the isolation.

The Responder is usually good at hiding patterns and symptoms on the job. Most patterns of behaviors come out off the job. That is why I always say, “If you want to know what is going on with the Responder ask his/her family. “

ADDICTION BLOG: How does addiction treatment need to be customized to the First Responder population?

DR. TODD LANGUS, PSY.D, MFTI: Many times treatment fails for the First Responder because they are in programs that focus primarily on the addiction and not the stressors of the job, Posttraumatic Stress (PTSD), Traumatic Brain Injury (TBI), or job related traits and behaviors learned to carry out job functions while on duty or in the battle field. These traits and behaviors later become a detriment when they attempt to implement these learned occupational traits and behaviors in their personal life when trying to solve personal issues.

Both the addiction and the co-occurring stressors must be addressed at the same time in order to lower the risk of relapse as well as lesson symptoms and reactions they have been repressing by using the substance. When the Responder is in recovery and does not have the substance to “numb out” the repressed traumatic recollections, they trigger causing reactions that can make treatment more difficult if they are not dealt with. I have seen Responders expelled from treatment programs because their symptoms of PTSD/ TBI etc. were triggered once the substance was removed and staff did not recognize that the reactions were related to their condition and/or they did not know how to treat the condition. My training lectures teach the clinician how to identify these issues as well as how to treat the Responder.

Secondly, Responders do not feel comfortable sharing their situation in a group setting of “Civilians”. They do not feel comfortable talking to people that cannot and do not understand their work or the things they go through. Also, some Responders have seen some very ugly things that if told to the “Civilian Population”, it may shock them so the Responder does not open up because they do not want to traumatize the group or therapist. They do this to protect the group… which becomes a detriment to the Responder’s recovery. Remember, First Responders always try to protect and help others so this mentality continues in treatment also.

First Responders open up better when in the company of other Responders who understand them or clinicians who can identify with them or who have been there themselves. In my lecture I teach clinicians tools to understand the Responder and help be able to identify with the Responder. This also helps to form the therapeutic bond and maintain it. Remember with the Responder trust is a huge issue.

ADDICTION BLOG: What does the term “treating the entire patient” refer to and why is it so important?

DR. TODD LANGUS, PSY.D, MFTI: To me it refers to treating the entire person by addressing all the presenting issues not just a few of them. If we tunnel vision on one or two areas, we may not be doing enough to cure the patient and/or even removing the one or two issues we are focusing on.

For example, if we just focus on the addiction component of the patient how can we be sure that the addiction issue is the cause or just a symptom of the cause. If it is just a symptom of the cause and we do not address the cause, then we can temporarily extinguish the symptom but without addressing the cause symptoms normally return.

Many times addiction can be a symptom of the cause or started out as a symptom. As most of us know, most people with addiction are dual diagnosis. Let’s not kid ourselves. If you do not address causation, then you are setting the patient up for failure. I do not know of one person who walks into a shoe store and only buys one shoe. What good is one shoe (especially if it is a high heel shoe for you ladies)?
If it is an addiction to medication due to an injury, then we need to address the chronic pain component. We may not be able to cure the injury but we can address the chronic pain component in treatment.

In treating the entire patient, it also means getting to know their personality and learning style. We cannot just treat everyone uniformly.
You cannot expect to treat a Responder the same as a civilian and expect to get the same result. Responders have their own style and personality. This personality is formed through their training as well as through on the job experiences. This personality has to be trained/formed in order to be able to function in emergency and high threat situations. Responders are not born with this personality. You must treat them according to the personality style for best results. Failure to do so can cause the Responder to shut down during therapy or never open up to therapy.

Treatment needs to treat the entire patient. For First Responders, you need to treat:

  • the addiction
  • any co-occurring disorders
  • any stressors
  • the occupational personality/behavioral traits
  • any health condition

…to be able to have the best outcome for the Responder. In order to treat the entire Responder, one must understand their job traits and behaviors they develop to accomplish job tasks as well as how they are trained and think. The therapist also needs to learn how trauma occurs to the Responder and how they are different than the civilian population. My lecture addresses these areas to help clinicians better treat the Responder.

ADDICTION BLOG: Is addiction recovery any different for the First Responder population than it is for others? What is unique and what is different?

DR. TODD LANGUS, PSY.D, MFTI: Addiction recovery is different for Responders in that their training and experience causes them to process things in different ways. Also, the traits and behaviors they develop to be able to accomplish stressful job tasks are different from the civilian population and although works well for getting the job done they are detrimental in their personal life and impede recovery.

As mentioned above, the way they are trained to think is different from the civilian population. How they are traumatized and the way they process the trauma can be different from the civilian population. It is important for counselors and therapists to understand these dynamics and how to conduct therapy with the Responder. If these issues are not addressed, then recovery is less effective. My lecture covers these areas as well as others to help the clinician work with Responders effectively.

ADDICTION BLOG: What are the long term consequences of exposure to stressors? How can they be managed inn addiction recovery?

DR. TODD LANGUS, PSY.D, MFTI: There are too many long term consequences to list. Stress affects a person’s mind, body and spirit.
In the mind, psychological disorders can develop as well as personality changes and lowered brain function.

The body can develop illness such as heart disease, cancer, hypertension, or diabetes to name a few.

The spirit is affected in many ways but can ultimately be affected by suicide.

To give an example using veterans, more veterans from the Iraq and Afghanistan war have committed suicide than were killed in combat. The stressors can be managed in therapy by understanding the Responder and learning how to conduct therapy with them.

ADDICTION BLOG: How do you approach patients with several failed treatments? What can be done to avoid referring them to another unsuccessful treatment program or medication therapy?

DR. TODD LANGUS, PSY.D, MFTI: First off, you need to find out why the treatments failed. Many times it is because Responders are treated the same as the general population which is not as affective. Their issues are not addressed in a manner that they respond to due staff not understanding the dynamics of Responders and how to treat them.

I believe that therapy needs to be tailored to the individual. Using one approach for everyone in treatment does not work. I like using an eclectic approach in treatment.

Many times treatment fails because the addiction is the only problem being addressed. In order for treatment to have the best chances of being affective all the issues need to be addressed by people trained to work with specific populations.

ADDICTION BLOG: How can integrative psychology help people who work in emergency response situation cope with daily trauma?

DR. TODD LANGUS, PSY.D, MFTI: Help for Responders should be proactive rather than reactive. Preventative maintenance is key.

Unfortunately, Responders receive little to no training and education in dealing with the stress of the job and how to manage it during initial occupational training. Responders need to get training in how to deal with stress and trauma during their initial training program or schooling.
Next, there needs to be ongoing training and education through their career. Problems and traumas need to be addressed quickly with the Responder immediately following a critical incident. Ongoing employee access to a mental health professional trained in dealing with Responders is also important.

My office has contracts with various police and fire departments. We develop a comprehensive what we call “Tactical Wellness Program” for each agency. This program consists of ongoing training and education in such areas as:

  • career survival
  • surviving lethal encounters
  • critical decision making under stress

…as well as other advanced occupational training. They have access to 24 hour emergency call-out response by our office to debrief employees immediately following a critical incident. Employees have access to therapy services for job related and personal related issues. We also have yearly wellness check-ups where employees come in once a year for a therapy session where they can talk about anything that is bothering them.

Further, we train and maintain the organizations peer support/trauma support team. These teams are made up of employees of the organization. They are trained in supporting and/or debriefing their own following a critical incident. They are also trained to recognize an employee in crisis and how to assist them.

ADDICTION BLOG: Do you have anything else to add for our readers?

DR. TODD LANGUS, PSY.D, MFTI: I would just like to invite everyone to my lecture at the upcoming conference. There are many Responders in need of help with a shortage of clinicians trained in taking care of them. They risk their lives every day for people they have never met. What are we willing to do for them? Remember, we sleep at night because we know there are men and women out there protecting us from the predators wanting to do harm. We need to keep them healthy in order for them to keep us safe.

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About the Interviewee: Dr. Todd Langus has dedicated the last 10 years to treating public safety personnel and their families. He has responded to national emergencies such as 9/11, treating hundreds of emergency Responders. He has treated victims of Hurricane Katrina and military personnel from Iraq and Afghanistan. Dr. Langus has responded to countless officer-involved shootings, line-of-duty deaths and critical incidences.
Private corporations have called on him to handle large-scale traumas. He formally served as a law enforcement officer for 20 years. Not only has he seen trauma from the front lines as a law enforcement officer, he is a trauma survivor. Dr. Langus provides training and lectures to agencies throughout the U.S.

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