You’re an acting captain. Your regular engineer calls in sick and the off-going engineer, someone you were hired with, stays over on OT, placing him on a 72. Around mid-afternoon, during normal tailboard banter, the engineer becomes verbally combative with you and the crew. If it weren’t for the fact that he has been on duty for the last 36 hours, you would swear he’d been drinking. You find the time to talk to him one on one, and he blows up at you to the point that you fear for you own physical safety. What would you do?
Here’s another scenario: You’re the company officer just coming on duty. As you relieve the off-going crew, only you and your engineer are present. Your firefighter, who you’ve worked with for some time, did not show or call in. You know through your social interactions with him and his family that he has a tendency to hit the bottle. In fact, you have observed a subtle behavior swing in him lately, and he confided in you that he has separated from his wife. What would you do?
No Surprise
Unless you’re a Pollyanna, none of this should be a surprise to you. Alcohol is not an uncommon problem in the firehouse, as it is in many high-stress occupations. Yet neither of these situations has to occur. It may be unreasonable to expect that our members will never drink too much or go through periods where their drinking is not entirely within their control. But it is reasonable to expect that we can improve our oversight of our members and identify problems before they get out of control. It’s critical that company officers be on the lookout for such problems and seek advice from department leadership on what actions to take with regard to counseling, interventions and treatments.
There are many approaches to solving problems with alcohol, including:
- Do it yourself–30% of people with an alcohol problem manage to reduce their drinking or abstain on their own.
- Counseling–A counselor can help the alcoholic talk through their problems and then devise a plan to tackle the drinking.
- Treating underlying problems–The alcoholic may have a problem with self-esteem, stress, anxiety, depression or some other mental health problem.
- Residential programs–Some alcoholics will require extensive rehab treatment that may include individual or group therapy, support groups, training, family involvement and activity therapy.
The sooner alcohol abuse is recognized, and interventions applied, the easier it is to address the problem. However, what typically happens is that friends and family wait too long, the individual’s job performance suffers, and in the late stages of the disease, the organization has to step in and intervene.
If you’re friends with someone you think is abusing alcohol, be a friend and have the tough conversation. If you’re a supervisor, be a supervisor and discus your concerns. If you believe there’s nothing you can do, turn in your badge. Not only are you turning your back on a friend or fellow firefighter, but you’re turning a blind eye to your oath and your mission (which includes protecting and saving our own).
Don’t think of this as a personal issue. If left unabated, it will destroy relationships, families and careers. In the fire service, we tell each other, “I’ve got your back.” That doesn’t just refer to the fireground. If we’re all committed to saving firefighters, even at the risk of our own lives, then why wouldn’t we strive to save them from an illness? Remember the ad campaign, “Friends don’t let friends drive drunk”? I would suggest that friends don’t let friends become drunks.
Detecting the Problem
If you suspect a firefighter may have a drinking problem, put yourself in their shoes and answer the following questions as if you were them:
- Have you ever felt you needed to Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
These questions are from the CAGE questionnaire, used to screen patients quickly in a doctor’s office. Two or more “yes” responses indicate that the respondent should be investigated further. The CAGE questionnaire has demonstrated a high effectiveness in detecting alcohol-related problems.
We know an alcoholic doesn’t become one overnight. It is a slow and gradual process and as such, it’s usually witnessed by a good many people–friends, family and co-workers–who fail to intervene. The unfortunate reality is that those closest to the alcoholic are the least likely to say anything, until it’s too late.
If we can agree that alcoholism progresses gradually, then we can also agree that early intervention can take place before the illness gets out of control. This is illustrated by the work of Dr. Vernon Johnson, an Episcopal priest who, in 1980, outlined four stages in the progression of the addict’s response to alcohol.
- Learning the mood swing: Introduced to alcohol, and enjoys the happy feeling it produces. At this stage there is no emotional cost.
- Seeking the mood swing: Drink to regain that feeling of euphoria experienced in phase 1. The drinking will increase, as more intoxication is required to achieve the same effect. At this stage, there are no significant consequences.
- At the third stage there are physical and social consequences (i.e., hangovers, family problems, work problems). A person will continue to drink excessively, disregarding the problems.
- The fourth stage can be detrimental; Johnson cites it as a risk for premature death. The person now drinks to feel normal and to block out the feelings of overwhelming guilt, remorse, anxiety and shame they experience when sober.
The first two stages are considered “normal” drinking and the last two are viewed as “typical” alcoholic drinking. We (YOU) have an opportunity to successfully intervene at the first or second phases. By the third stage, the problem usually requires organizational intervention, which frequently means the individual loses their job. No matter how much support we give to the individual through counseling and/or treatment, once the person has progressed to stage three or farther, the relapse rate is high (40—60%). At this stage, they rarely want our help, and can even be angry and defiant with friends, family and co-workers. Often, the only hope is that the alcoholic will hit bottom while still alive (which typically means losing family, friends, job, money and health), providing a chance to start over.
Types of Alcoholics
An article by Miranda Hitti for WebMD Health News reviews five types of alcoholics. Three of the types are demographics that are consistent with fire service personnel.
- Young adult alcoholics: Around 24 years old, they usually became alcoholics by age 20. “They drink less frequently than other alcoholics, but they tend to binge drink when they drink,” Hitti writes.
- Functional alcoholics: “Generally middle-aged, working adults who tend to have stable relationships, more education and higher incomes than other alcoholics. They tend to drink every other day,” Hitti notes.
- Alcoholics with a family history: Called the “intermediate familial subtype,” nearly half of this group has close relatives who are alcoholics. They generally “began drinking by 17 and became alcoholics in their early 30s,” Hitti writes.
Hitti quotes alcoholism researcher Howard Moss, MD, as saying: “When most people think of alcoholics, they think of middle-aged men. Our data shows that alcoholism is more a disorder of youth than previously suspected.”
Let’s look at the above categories again from a fire service perspective: Nearly all of your entry-level firefighters come from the young-adult category. More than likely, the vast majority of your current members are middle-aged. Now consider the following information:
- 15% of Americans are problem drinkers, according to the National Institutes of Health (NIH).
- Between 5—10% of male and 3—5% of female drinkers could be diagnosed as alcohol dependent, according to the NIH.
- 30% of Americans report having an alcohol disorder at some time in their lives, according to the Archives of General Psychiatry and JAMA.
Based on those statistics, it’s highly probably that some of the members in your department have an alcohol problem. Admittedly, the fire service should have a lower incidence based upon our professional standards and background checks in entry-level hiring. But we know alcoholism cuts across all social, gender, ethical and economic barriers. We do not hire alcoholics. However, it is very likely that due to lifestyle, genetics and other circumstances, some of our members will become one.
Final Thoughts
I’m not a teetotaler or an anti-alcohol zealot. I enjoy the occasional drink. Furthermore, I don’t want to simplify a very complex social issue. Drinking has both positive and negative associations in our society: People are perceived positively if they can drink a lot and “hold their liquor,” but alcoholism is often stigmatized as a weakness on the part of the individual.
I also don’t want to diminish the efforts of many courageous individuals who assist firefighters in this area. We should never “leave behind” an alcoholic member, even as they resist our best efforts to help. Our aggressive support of members with this disease should be a given. However, my goal here is to protect our younger firefighters, to ensure that they never have to hit bottom–losing family and friends, a career and their health–before they can get a handle on this disease. Alcoholism is an illness, and like all illnesses, early detection and courageous intervention are the cure.
Unlike other illnesses, however, the physical symptoms are not always visible. But most of us can clearly see the warning signs of those who are in trouble or are heading for trouble with alcohol abuse.
Gordon Graham said, “If it’s predicable, it’s preventable.” Alcoholism is both predicable and preventable. But each of us must have the courage to do the right thing while collectively creating a culture of concern. Only then can we eliminate this particular elephant in the room.
