Addiction in EMS providers: Always see the human side
Drug, alcohol and other addictions impact every family, including our EMS family; we need to know how to respond to and support an addict
I have been writing for EMS1 roughly since its inception. I have written about how EMS and the law share the same universe and I have (and will continue to) offer more information and guidance on the subject. My intent is the protection of EMS providers, the improvement of patient care and the professionalization of EMS all around.
For this article, however, I hope you will indulge me if I take a brief sidestep to follow up on an issue that speaks more to the human side of EMS than the legal: addiction.
The effects of untreated addiction on an EMS career can summed up in a single sentence: Untreated addiction can cost you everything.
It does not take a rocket scientist to see that the same could be said of addiction in every context — job, family, life.
Recently, I received an email from a captain in an EMS service in response to a column I wrote regarding addiction. The email described his battles and how they have affected his career; rehab, probation and a "last chance contract" with his agency. I am happy to report that from the email the captain seemed to be committed to his recovery and securely positioned for success — one day at a time.
His email, though, was a reminder that addiction in society, as well as in EMS, is an issue derived from many sources and the proximity to one’s intoxicant of choice makes recovery that much more challenging. Add to that the unique stressors EMS providers face and the battle is uphill to say the least.
Like pretty much everyone else in America, addiction has touched my family and, like most everyone else, we managed it privately. In doing so, I have learned plenty about addiction from the perspective of a regular person — what addicts sometimes refer to as a "normy".
Likewise, my legal practice has brought me face-to-face with individuals who are/were suffering seriously, and I have had to learn how to help navigate addicts through various aspects of the legal system.
Advice for the addict: Admit, acknowledge and accept
Make no mistake, though, I am no expert on the subject of addiction. Any advice I offer comes from my own experiences, not from formal addiction training. My advice for EMS providers who are addicts comes with the singular intent of protecting EMS providers.
Everyone knows, especially the addict that before one can receive help, one must admit there is a problem — if only to oneself at first. If the demon (as described in my previous column) is illegal to purchase or possess, you can stop right there: It’s a problem. If acquiring the demon is illegal, stop: Admit it’s a problem.
In many cases, though, the demon is hidden behind legal activities in which the addict engages irresponsibly. Alcohol, gambling and even sex are at the top of this list.
There is the alcoholic who drinks every day; who hides it well and does not function unless some ETOH is on board. Then there’s the "I don’t drink every day" person, who when drinks reaches the point of blackout every time. This is the "binge drinker".
There's the gambler who gambles every day; begs, borrows or steals to make another bet. There’s the gambler who only gambles occasionally, but when he does, he will risk every penny to which he has access; mortgage money, college funds or retirement accounts.
Where one engages in any activity to the point where other areas of one’s life are adversely affected, there is a problem. When drinking or gambling or sex or video games or anything else consumes so much of your life that your ability to function is impaired, there is a problem and, although the whole world may be able to see it clearly, relief cannot and will not come until the addict admits that there is a problem.
Once the very painful and (probably) humiliating admission is made, acknowledge those around you who are willing to help — and let them.
I am told by people who know, that recovery is not a solo endeavor. Recovery is the product of the addict’s own hard work combined with the support of those who care about and love the addict; the people who have walked the road before the addict and can offer guidance; the systems and programs developed to enable and promote life without the demon.
The most difficult thing — I am told by people who experienced it — may be to accept life without the demon.
People don’t simply wake up addicted to anything. Addiction takes practice and time and repetition for the body and brain to sync up and develop either the psychological or physical need.
Whether the addiction was a long-time brewing or the result of the third hit on a crack pipe, accepting life without that addictive thing is very, very, very difficult. Life without that addictive thing must be newly accepted every day — one day at a time.
When the addict is willing to do the work, the natural consequences are ultimately all positive. While recovery is a constant process, recovering addicts enjoy prosperous and productive lives; many times helping others down their own path toward recovery.
However, when the addict is unwilling to admit, unable to acknowledge or ill-prepared to accept, then acceptance takes on a whole new meaning: when the addict is unwilling, unable or ill-prepared, he/she will be forced to accept the negative consequences, whatever they may be.
Advice for the EMS agency: See and support before you surrender
Life in EMS is much like life in any other dysfunctional family. We live together, work together, play together; we share meals, we share housing and we share experiences that nobody outside EMS could possibly imagine.
Addiction is not evil, it is a disease and it is present in every corner of society, including EMS agencies everywhere. If EMS is truly a family, addiction within it must be treated the same way; a sick loved one needs help.
An EMS family sees each other at their best and at their worst — together.
An EMS family member is in a potentially unique position to see characteristics and behaviors of addiction sooner than a nuclear family might notice.
When you notice the kinds of changes or behaviors that cause concern (in this context), do what a good, caring, loving family member would: reach out and address it.
Think of it like this: Ignoring the issue or, worse yet, making light of it because it’s easier to laugh than to cry, makes you part of the problem — and that’s not what friends or family are supposed to do. Friends and family are supposed to have the tough conversations because the tough conversations are worth having.
From the outside, addiction looks very different. It looks like reckless, careless, thoughtless behavior — and maybe to some extent it is. However, it is widely accepted in the medical community that addiction is a disease process and, if not to understand and help fight against disease (and injury), what are we doing in EMS?
I see it as the agency’s responsibility, when confronted with a member who is battling this disease, to offer as much support as the individual will accept; counseling, rehab, and whatever other mechanisms may be suitable.
Don’t throw the addict out with the trash because it is easier or more convenient — or because some ice-water-veined lawyer said so. Do the work, walk the road, join in the fight against the demon for as long as the member is willing to fight.
Reality check: Not everyone who needs help is ready, willing or able to accept it.
Sometimes, tragically, the member of your department battling addiction cannot crawl from the hole the demon has dug.
Sometimes, tragically, an agency must cut its losses and remember that the duty to providing the best possible patient care in all circumstances is and must remain the priority.
Sometimes, tragically, the agency must surrender when the member has given up the fight.
As it is with patient care, once every reasonably possible thing has been done to save a life and the body simply will not respond it’s time to call it.
If that time should come regarding the addict in your agency, let it be after every effort has been made to retrieve that member from the demon’s grasp. Then, and only then, you must part ways.
One last thought
As the captain referenced above told me in his email, and as I have seen with my own eyes, addiction may not be curable, but it is manageable. Managing addiction takes courage, strength, and tenacity. So does being an EMS provider.
Addiction does not have to mean the end of an EMS career when sobriety can be the beginning of a life well lived.
Author’s note: This column is not intended to promote or endorse any particular treatment or recovery method. If you or a loved one is suffering addiction, there are a variety of programs available to help.
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