# Mental Illness and Substance Abuse in EMS Workers



## MassEMT2012 (Dec 12, 2016)

Hey everyone, I am new to EMTLife and this is my first post/thread.  Sorry to bring on such a serious and heavy topic, but its something really important to me, and should be to all of us.

          Due to the sensitivity of this topic (as well as our mutual friend HIPAA), everyone should remain completely anonymous. NO NAMES of ANYTHING, including PEOPLE, PLACES, or DEPARTMENTS/AGENCIES that may give clues as to where people are located or have been employed.  (I am from Massachusetts, which is currently in the grip of the worst opiate epidemic in the countries history, that is all the personal information I shall share.)

          Long story short,  I have about 2 years of EMT experience off and on.  Nothing too serious, I have had one or two traumas involving CPR, lots of blood, and unfortunate death of patients, but besides that, I have worked for private EMS services that do the typical BLS transfers from dialysis, SNFs, hospitals, etc. and the occasional low priority calls for someones grandma whose O2 Sat is low.
          I have suffered from mental illness my whole life.  Depression, OCD, and some other acronyms out of the DSM that various psychiatrists have labeled me with.  I have been hospitalized inpatient a number of times since I was 16 y/o, and have been in therapy and on some form or another of psych med since.  Luckily it has been the better part of 5 years since I was last hospitalized, and I even managed to work as a psychiatric technician in a locked inpatient psych unit for about a year and half since that point.  I got better enough through therapy and medication that I went from being the patient, to being the provider and helping those whose shoes I had been in not too long ago.

          Now for the post itself, given that bit of history about myself.  Like many people with mental illness, I found my way into the amazing-at-first, and then soul-crushing world of heroin abuse.  It started about 3 years ago, when I was halfway through college (in fact around the time I was working as a psych tech).  Like many others, its started from some percocet a buddy gave me after his leg surgery, and once those were up, I was right onto heroin.  Using it nasally, luckily I have never been a big fan of needles (perhaps its a good thing EMT-Bs dont know how to start IVs).  It got bad enough to where I was using everyday, constantly as long as I had money for it and my sinuses would still let air through.  The thing I am most ashamed of in my entire life was the fact that I used on the job, both during my time working on the psych unit, as well as the few private EMS companies I have worked for over the past few years as well.  It would take all of two seconds to slip into the bathroom after a BLS transfer, snort a line, and get back to work.
          I lost a total of 2 or 3 EMS jobs because of my poor attendance. No doubt from sleeping through all my alarm clocks, and being constantly exhausted from my drug use.  Now on my last EMS job to date, I finally got caught.  My demons caught up with me.  Several co-workers sent an email to the boss after realizing how much time I took in the bathroom, my constant need to have nasal spray and blow my nose, having sniffling constantly, general bad hygiene, not tucking my shirt in, being late, etc.  All tell tale signs of a drug user who has burnt out from his drug use.     My boss found out, called me into his office.  At which point I experienced one of the kindest and considerate acts I have ever had.  My boss made me admit to my problem with opiates, then told me to take a medical leave, get cleaned up, and come back when I was ready.  I had to sign a legal contract and allow my substance abuse healthcare providers to communicate with him, as well as routine drug screens.  Instead of reporting me to the state and having my license taken away (as well as possible jail time), my boss had mercy on me and gave me compassion which I admit I hardly deserved for what I had done, and the danger I had put my partners and my patients through.
          Now ultimately I only lasted a few more weeks with the service, before I left voluntarily, telling my boss that I was not healthy enough yet and needed more time to fully recover, attend a real rehab facility, and devote my full time to my recovery.  My boss understood, and wished me the best.
          I will never forget the kindness and understanding that he showed me, even when I did not deserve it.

          Since then I have been doing much better, I am on medications to help with the cravings, so I suppose I am not 100% "clean", and I still have a beer from time to time.  But I am not nodding off all the time, and I am not putting anyone in danger.  I have several months of clean time under my belt, and am preparing to head back to the job that I love so much, and the job that I am still able to work given the mercy of my previous boss, and the second chance at life that he gave me.

        It is no secret that mental health issues and drug abuse are common in healthcare workers.  About half the people in my rehab stay were healthcare workers, and not just CNAs....we had everyone from firefighters, police officers, EMTs, CNAs, RNs, all the way up to actual MDs.

        I want to know what other people experiences are, either personally or through people they have known.
If you think that I am a no-good, scum bag, dope fiend that should just hang himself, I can hear that too.  I have heard just about every bad thing from other healthcare workers, as well as the general population, and it seems to be about 50/50.

I hope someone can relate to this story and feel like they are not alone, that they are not the first, and not the last EMT or healthcare or emergency services person to go through this.


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## VentMonkey (Dec 12, 2016)

Bold first post, thanks for sharing though.
Best of luck to you.


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## NomadicMedic (Dec 12, 2016)

I don't think you're a no good scum bag, but I don't think EMS is for you. 

The amount of stress that EMS providers are exposed to, coupled with alarming high rates of PTSD, substance abuse and suicide make this a poor choice of career for a person with a history such as yours. 

Congratulations on working toward managing your stress and addiction issues.


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## Carlos Danger (Dec 12, 2016)

I feel the same as DE.

I certainly don't think your addiction makes you a bad or worthless person, but like anyone else with any kind of serious chronic illness, you have to think about how your life choices will affect your illness, and vice versa. Just like being a pilot probably isn't a good career choice for someone with a seizure disorder, working in a high-stress job with easy access to narcotics probably isn't a good choice for someone with a history of opioid addiction.

Best of luck, and thanks for sharing your experience.


EDIT: I recently read a pretty good CE thing on addiction in anesthesia. On the whole, probably no profession has a less favorable combination of high stress and very easy access to multiple drugs of abuse than those who provide anesthesia. Because of that, almost 20% of anesthesia providers will abuse anesthetic drugs at some point in their career, and many will develop chronic addiction problems. However, the article did mention that a growing number of anesthesia providers are returning to practice after treatment for their addiction. Interestingly, this is done with the full knowledge and understanding that relapse rates are very high, and that relapse is even considered by many to be an _expected _part of the recovery process. For whatever that's worth.


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## Drwlemt (Dec 12, 2016)

In the military I saw close friends throw away their careers to substance abuse (Alcohol, Prescription drugs, illegal drugs). Some of those guys aren't with us today. I do know a few though that either got kicked out of the military and cleaned up their act or got control of the abuse issues and are still serving today. I think it is awesome you put your experiences out there for others to learn from. While I would definitely caution against jumping straight back into the same kind of environment that helped fuel your addiction until you are completely clean. You shouldn't let your past hold you back. If its something you are truly passionate about pursue your goals, get your life straight, and be the most kick *** provider you can be. Heck if you were able to last as long as you did while using imagine how great you can be with a sober mind!


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## StCEMT (Dec 12, 2016)

I think DE summed it up pretty well. I by no means think a past of drug use makes you useless. Hell, if anything it gives you an ability to communicate with people currently using in a way we can't. I would have concerns like the others about EMS being the right field for you for the same reasons, but that doesn't mean you have no place in a role that allows you to help others. Congrats on the progress you've made, that's awesome.


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## VentMonkey (Dec 12, 2016)

Perhaps the op would make a great counselor?


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## MassEMT2012 (Dec 13, 2016)

I wanted to thank you all for giving such polite and compassionate responses, 
I am definitely thinking alot about my future and shall be cautious and careful for everyone's sake no matter what road I decide to pursue.

Thanks all so much!


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## MassEMT2012 (Dec 13, 2016)

VentMonkey said:


> Perhaps the op would make a great counselor?



I actually studied psychology and philosophy for my undergraduate BA. It was during this time in college that I worked in an inpatient psych unit during school/summer breaks, as well as weekends (As my friends were going out to party, I was getting my scrubs on and going to a "party" in the psych unit of my own, Haha!!!).

I ultimately do want to become a clinical psychologist, which would require either a Ph.D or Psy.D (The Psy.D is the clinical psychology equivalent of an M.D., it is a terminal professional degree designed to train people to treat patients instead of doing research and writing a dissertation which are not part of the Psy.D or M.D., at least to not nearly such an extent as a Ph.D academic/research degree designed to create college professors).

Thanks!

I forgot to mention that I really do love EMS, and was hoping to EMS to ultimately be a sort of "side job" or Volunteer type of thing.  It involves medicine and hands on treatment, that psychology obviously does not involve.


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## MassEMT2012 (Dec 13, 2016)

Remi said:


> I feel the same as DE.
> 
> I certainly don't think your addiction makes you a bad or worthless person, but like anyone else with any kind of serious chronic illness, you have to think about how your life choices will affect your illness, and vice versa. Just like being a pilot probably isn't a good career choice for someone with a seizure disorder, working in a high-stress job with easy access to narcotics probably isn't a good choice for someone with a history of opioid addiction.
> 
> ...



Wow! 20%?!?!?!?!?!? thats huge.....I have heard of other programs like that.  I knew a nurse in my rehab program who would "defer" meds (i.e. Dilaudid, oxy, etc.) to herself.  While she lost her license, she is allowed to return to the profession after at least I think it was 2 or 3 years of intensive treatment with good results and no relapsing.
I am sure similar things exist for all healthcare professions.
I even heard of a treatment program like that for pharmacists of all people who are exposed and handle **** LOADS OF NARCS......I have no idea how you could go back to that unless you have some sort of divine intervention that made you never want to use a narc again.


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## NysEms2117 (Dec 13, 2016)

before I start I'd like to set a baseline: *I do not think that criminal's or people that abuse drugs are bad people, I do think and know for a statistical fact, that drugs lead to further crimes. *
I really hope this is taken the right way. I am a parole officer with the state. I have to deal with what society calls "scumbags" and "dirtbags" ect. To this day substance abuse folks wether it be alcohol, drugs, or what have you, have been some of the nicest folks i've ever met. I personally have seen people go from being on parole for substance abuse, to WANTING to change, and now he is a CEO of a company. (http://www.etcny.org/#programs-home) My boss supervised the CEO on parole. Now i meet with him EVERY OTHER WEEK, and ask pick his brain, i send all of my SA parolees there. I actually just had a parolee a few months ago that said he always wanted to be a paramedic from the day he was little(keep in mind parole means a state bid = felony). I had gotten him a job working for an ambulance company(private) cleaning the ambulances, inside and out, and custodial work. Currently he is still under my supervision and is in EMT school right now. I personally will not let him go past becoming an EMT-B due to the fact he would have access to the drugs that started his criminal behavior. Again I see this from a different angle, most people don't get to see the "change", and sometimes i don't either. Furthermore, I personally feel that from a supervision side (not a personal experience) that drug rehabilitation and treatment, works at an astounding rate. Every SA parolee that I end up having to put back in prison has stopped going to drug treatment at least 1-2 weeks prior. I would like to know from you @MassEMT2012 would being with your family help? Do you think if you where home, instead of at college, having family support would have helped you? I'm trying to get the maximum amount of help i can to my parolees, and SA parolees would be allowed to travel to see families ect, they are a very low risk for leaving (unlike other offenders). 
Thanks,
Andrew


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## Seirende (Dec 13, 2016)

NysEms2117 said:


> I personally will not let him go past becoming an EMT-B due to the fact he would have access to the drugs that started his criminal behavior.



AEMTs don't usually deal with drugs of abuse, at least not in my area.


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## NysEms2117 (Dec 13, 2016)

Seirende said:


> AEMTs don't usually deal with drugs of abuse, at least not in my area.


they have access to limited pain control in my area of NYS. MS tbe + needle access alone, wont really help anything.


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## Carlos Danger (Dec 13, 2016)

NysEms2117 said:


> before I start I'd like to set a baseline: *I do not think that criminal's or people that abuse drugs are bad people, I do think and know for a statistical fact, that drugs lead to further crimes. *
> I really hope this is taken the right way. I am a parole officer with the state. I have to deal with what society calls "scumbags" and "dirtbags" ect. To this day substance abuse folks wether it be alcohol, drugs, or what have you, have been some of the nicest folks i've ever met. I personally have seen people go from being on parole for substance abuse, to WANTING to change, and now he is a CEO of a company. (http://www.etcny.org/#programs-home) My boss supervised the CEO on parole. Now i meet with him EVERY OTHER WEEK, and ask pick his brain, i send all of my SA parolees there. I actually just had a parolee a few months ago that said he always wanted to be a paramedic from the day he was little(keep in mind parole means a state bid = felony). I had gotten him a job working for an ambulance company(private) cleaning the ambulances, inside and out, and custodial work. Currently he is still under my supervision and is in EMT school right now. I personally will not let him go past becoming an EMT-B due to the fact he would have access to the drugs that started his criminal behavior. Again I see this from a different angle, most people don't get to see the "change", and sometimes i don't either. Furthermore, I personally feel that from a supervision side (not a personal experience) that drug rehabilitation and treatment, works at an astounding rate. Every SA parolee that I end up having to put back in prison has stopped going to drug treatment at least 1-2 weeks prior. I would like to know from you @MassEMT2012 would being with your family help? Do you think if you where home, instead of at college, having family support would have helped you? I'm trying to get the maximum amount of help i can to my parolees, and SA parolees would be allowed to travel to see families ect, they are a very low risk for leaving (unlike other offenders).
> Thanks,
> Andrew



Portugal faced a major drug problem and in 2001, and decided to deal with it in a way that is completely the opposite of the way we do, but really makes perfect sense: they decriminalized ALL the drugs.

Since then, they've seen drug use remain about the same but overdoses, fatalities, and related crime has plummeted. They spend a fraction of the money that they used to on fighting drugs and have a fraction of the problem. More people seek treatment for drug related problems. Because drug use isn't hidden in the shadows, the average person is more aware and educated about the problems. 

Turns out, almost all of the crime related to drugs has to do with their illegality, not with the effects of the drugs themselves. The stereotype of the violent, strung out junkie robbing strangers and stealing to feed their habit is just that, a stereotype. The vast majority of people in the US who are in jail on drug charges have never done a violent crime, they just got caught selling or possessing a substance that some people in government decided they didn't want us to consume.

Prohibition has never worked, and it usually causes more problems than in solves (in the case of our government's "War on Drugs", I think it causes A LOT of problems and solves none). We artificially make the drug problem much worse and more expensive than it needs to be, by arbitrarily criminalizing human choices that shouldn't be a legal issue at all.


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## NysEms2117 (Dec 13, 2016)

Remi said:


> Turns out, almost all of the crime related to drugs has to do with their illegality, not with the effects of the drugs themselves. The stereotype of the violent, strung out junkie robbing strangers and stealing to feed their habit is just that, a stereotype. The vast majority of people in the US who are in jail on drug charges have never done a violent crime, they just got caught selling or possessing a substance that some people in government decided they didn't want us to consume.
> 
> Prohibition has never worked, and it usually causes more problems than in solves (in the case of our government's "War on Drugs", I think it causes A LOT of problems and solves none). We artificially make the drug problem much worse and more expensive than it needs to be, by arbitrarily criminalizing human choices that shouldn't be a legal issue at all


I agree the war on drugs is a moot point... there are simply too many drugs out there. However, on a fairly regular basis a parolee would come in with the charges of: XYZ drug possession, (possibly XYZ intent to distribute*if the amount fits, varies state by state*), and the one that I am really talking about* possession of a weapon*. I am not saying they intend to use said weapon. I am simply just saying ~~75% of my SA parolees have that charge along with the possession/D&D ect. Granted I am in NY where most things are considered weapons. as George Carlin once said "...hell you can beat somebody to death with a sunday new york times if you really wanted too". However the easiest way I can describe it is the CJS system has a pendulum of "are we going to arrest everybody we see(jaywalkers, drugs everything), or are we overcrowded we need to let some stuff slide. In the 80's the system was super far to the "arrest everybody side" (http://www.druglibrary.org/special/goode/drugpanic.htm), which is also where we are at right now. You can probably google NY drug crisis and it will compare what we are doing now/where we are at, to the 1980's. Again I am not disagreeing with you, I'm just saying what my job is, and I have to do said job. I cant change laws....yet....
Although if this is a topic that interests you I encourage you to look at something called SHOCK incarceration, in NYS. found below. Same result less $. much less $.
https://www.ncjrs.gov/pdffiles/shockny.pdf
http://www.doccs.ny.gov/Directives/0086.pdf


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## Qulevrius (Dec 13, 2016)

1st, we're not supposed to judge. So I won't. You don't know us, we don't know you, chances are it'll stay that way. Pretty ballsy of you to make the entrance that way though.

But 2nd, I personally do not understand how the survival instinct doesn't kick in. I can understand alcoholism, God knows I've had some moments when booze was badly needed; then a week, maybe 2 down the bottle, and I'd start getting *really* scared, because it's so damn easy to lose yourself. But drugs, well, that's an entirely different beast. It's not just scary, it is borderline panic attack.


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## sack jears (Feb 9, 2017)

This is exactly what I needed to read. I have bipolar disorder and a hx of drug abuse in the past. It's important to surround you love you. it's a struggle. But it can be strong. Message me if you ever want to talk. It will help us both out. Stay safe brother


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## Carlos Danger (Feb 9, 2017)

Qulevrius said:


> God knows I've had some moments when booze was badly needed; then a week, maybe 2 down the bottle, and I'd start getting *really* scared, because it's so damn easy to lose yourself.
> 
> But drugs, well, that's an entirely different beast.



Umm.....you do know that alcohol IS a drug, right?


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## Qulevrius (Feb 10, 2017)

Remi said:


> Umm.....you do know that alcohol IS a drug, right?



Having a bad day, bud ?


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## Carlos Danger (Feb 10, 2017)

Qulevrius said:


> Having a bad day, bud ?


Not in the least. Why do you ask?

And why don't you answer my question?


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## Qulevrius (Feb 10, 2017)

Remi said:


> Not in the least. Why do you ask?
> 
> And why don't you answer my question?



Just felt that way. Trying to spark a debate on a subject of comparison between alcohol and opiate addiction, isn't what I'd expected you to do. Glad you're feeling ok though


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## Carlos Danger (Feb 11, 2017)

Qulevrius said:


> Just felt that way. Trying to spark a debate on a subject of comparison between alcohol and opiate addiction, isn't what I'd expected you to do. Glad you're feeling ok though



I have no interest in having a debate over anything so obvious. The point is that if you meant what you wrote in the post that I first quoted, you have a serious lack of understanding of the facts surrounding drug and alcohol abuse.


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## MassEMT2012 (Feb 11, 2017)

sack jears said:


> This is exactly what I needed to read. I have bipolar disorder and a hx of drug abuse in the past. It's important to surround you love you. it's a struggle. But it can be strong. Message me if you ever want to talk. It will help us both out. Stay safe brother



Glad my story could be of some help man, stay strong.  If you ever feel like you need a break from EMS to deal with mental health or addiction issues, there is no shame in taking one then coming back to it later, thats what I have been doing the past few months.  Definitely better to do that rather than risk getting in trouble or getting yourself or someone else hurt because of either substance abuse and/or mental health problems.  I'm happy to say I'm starting back up in a few weeks at a new company in the Boston area!  I think mental health and addiction problems (whether it be something like heroin or even alcohol) are alot more prevalent in healthcare overall than alot of people realize.  With all the tough skin needed to survive in this line of work, people tend to not talk about it at all until its too late.  So I'm definitely an advocate for more awareness and support for all providers mental health. 

Message me if you ever wanna chat man.


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## sack jears (Feb 15, 2017)

Thanks man. Stay strong brother


MassEMT2012 said:


> Glad my story could be of some help man, stay strong.  If you ever feel like you need a break from EMS to deal with mental health or addiction issues, there is no shame in taking one then coming back to it later, thats what I have been doing the past few months.  Definitely better to do that rather than risk getting in trouble or getting yourself or someone else hurt because of either substance abuse and/or mental health problems.  I'm happy to say I'm starting back up in a few weeks at a new company in the Boston area!  I think mental health and addiction problems (whether it be something like heroin or even alcohol) are alot more prevalent in healthcare overall than alot of people realize.  With all the tough skin needed to survive in this line of work, people tend to not talk about it at all until its too late.  So I'm definitely an advocate for more awareness and support for all providers mental health.
> 
> Message me if you ever wanna chat man.


anks


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## Jorge Chavez (Jul 15, 2018)

You can do anything if you have a strong , fully dedicated lifestyle of recovery brother.


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