P2 ~ Perceptions of PTSD and Alcoholism in One of Our Own

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Immediate Plan

  • Review and update the department’s zero-tolerance policy.
  • Train all members in this policy; emphasize reporting methods for employees.
  • Support a zero-tolerance policy for intimidation or harassment for employees reporting unacceptable behaviors to the department.
  • Ensure workplace and employee safety.
  • Clearly articulate the confidentiality policy to all members.
  • Train department administration and officers on how to conduct an intervention of a troubled employee.
  • Make all members aware of the administration’s reasonable suspicion-testing process. For example, the officer in charge who suspects a member is not fit for duty will immediately relieve the member from duty and shall have the member medically evaluated. No member shall be allowed to drive himself home or to the hospital; no members shall be left alone. The officer in charge will prepare a detailed written report identifying the observed behavior and immediately notify the chief of department and consult with the Human Resources Department.

Secondary Plan

  • Review and update the employee assistance and wellness programs; conduct educational sessions.
  • Clearly identify and make all employees aware of the department’s mental health and medical treatment plans.
  • Define and explain to all employees the long-term workplace mental health and medical issues.
  • Review the current culture, if needed, and adjust it to create and maintain a supportive work environment for returning firefighters.
  • Review and update the management of chronic and mental health conditions impacting firefighters.
  • Have administration and officers complete mental health sensitivity training.
  • Develop/review a comprehensive mental health provider reference list.
  • Disseminate to all members referral (self-referral, employer referral, and family referral) and follow-up protocols.
  • Tie in a drug-free workplace program to the department’s safety plan.
  • Establish/review the department’s process for transferring medical information.

Employment Separation Plan

  • Review the employment separation process with the individual before beginning the process (retirement, benefits, paid time, return of department equipment).
  • Review common symptoms/reactions to employment separation with the firefighter and family members. For example, the employee may become depressed or angry after the separation; family members may notice that the employee may have uncontrolled outbursts. These symptoms/reactions may decrease in time. People respond in different ways and at their own pace.
  • Continually evaluate and make modifications to the separation plan that supports the individual employee and the department.

The goal for labor and management is to work in partnership to develop clear lines of communication as to how and when medical records for the impacted firefighter should be released. Many firefighters have different opinions on what medical records the fire department is entitled to in the event of an injury; a firefighter who is abusing/using alcohol or drugs may feel that the department is not entitled to the medical records. The release of medical records can also extend to the department’s random drug testing. It is common that firefighters released from duty as a result of a drug/alcohol issue are allowed back to work pending participation in a treatment program developed by the medical staff, who must show that the firefighter is attending the treatment and rehabilitation program. In the case Men of Color Helping All Society, et al., v. City of Buffalo, et al., No. 12-3067, 2nd Cir., 2013, the courts looked at the health and safety concerns and weighed them against the employer’s concern for the firefighters working in a high-risk job. The court said that the request for medical records was to demonstrate that treatment for drug or alcohol abuse outweighed the rights of the firefighter’s privacy. The recommendation is that labor and management seek a local legal opinion on the handling of medical records in advance of an incident and disseminate the information to all members prior to an incident to ensure that employees have prior knowledge of the medical records requirements. Leaving this topic to the last minute will often create unfavorable results and additional disagreements between labor and management.

In several cases, the recovering firefighter was at home and received a certified letter from the department ordering him to produce the medical records. The certified letter comes as a surprise and can exacerbate symptoms for the firefighter, especially if the letter is delivered late Friday or Saturday and the firefighter cannot gain access to the administration to answer questions. Again, if the firefighter has prior knowledge that the department will be sending out a request for medical records, the firefighter will view the request differently. The department must balance the legal rights and responsibilities with personnel management.

Forced Retirement

Who or what situation terminates the employment determines whether or not the retirement is a forced retirement. A normal retirement is when the individual firefighter decides to retire on his own terms in his own time. Talbott is a great example of a forced retirement; he had a choice to retire early or face disciplinary action (which may have included demotion in rank and up to termination). He decided to retire early. Like so many others, Talbott did not plan to retire when he did; the byproduct of his alcoholism and PTSD resulted in an unacceptable behavior that ended a very productive career way too soon. Though some may say he chose his path, his retirement was the result of an on-the-job injury called PTSD; the retirement board also agreed. Just because Talbott has been granted a work-related disability retirement does not mean he can just sit back and enjoy his retirement. He must deal with the daily events that can exacerbate his symptoms. People with PTSD and alcoholism are engaged in a process to help them keep control of their symptoms so they can perform daily living skills (eating, clothing, bathing, social interactions). Keep in mind that relapse is part of the recovery process for people dealing with alcoholism. The forced retirement can be the answer for some fire service administrations, but the retirement system is not a means for dealing with personnel matters. The administration must make every effort to address the personnel matters internally and not just shift the matter to the retirement system.

Labor and management should develop an educational program for the members who might face an early retirement because of a career-ending injury or illness. A forced retirement can create additional strain on the firefighter and his family. Some of the common stressors faced in forced retirement are financial, emotional, loss of identity for the firefighter, the challenges of being home all the time, relationship conflicts, and how other firefighters may now view the firefighter. The firefighter being forced to retire will struggle with the loss of his career on top of the struggles with the alcoholism or mental health issues. Depending on how the forced retirement is handled, it can have a positive result on the firefighter and allow for recovery, or it can produce the negative result of having the firefighter feel that he was disowned by the department.

The firefighter facing a forced retirement may experience some of the same symptoms experienced with the sudden death of a loved one. Elisabeth Kubler-Ross has written extensively on the process that people generally experience with a death of a loved one.15 We have adopted her common symptoms of death and dying to the forced retirement process and the death of a career. What the firefighter is experiencing is the sudden death of his career. The firefighter may experience some of the following symptoms with a forced retirement:

Denial and Isolation. The firefighter may isolate himself from others or may have trouble accepting the reality that the firefighter career is over.

Anger. The firefighter may be angry at others for forcing the early retirement or at himself for making poor choices that resulted in the death of his career. The anger stage is often exemplified by the firefighter’s filing a wrongful termination suit in the court system.

Bargaining. The firefighter may attempt to bargain with the department for another chance.

Depression. The firefighter who experiences one of the above symptoms or becomes stuck in one of the areas may become depressed. Depression left unmonitored can lead to a complicated recovery process or result in a relapse. One problem is, socially, people view retirement with positive thoughts, so the signs of depression may be hard to understand in the forced retirement individual. This, then, might lead to more separation from others who could be supportive.

Acceptance. The final stage is reached when the firefighter comes to terms with the forced retirement and accepts that his career is over and that he must start moving forward. To achieve the acceptance stage, the firefighter must not still be in one of the prior stages of the grieving process.

•••

The impact of alcoholism and mental health issues remains a social issue in the United States and has taken a toll on the fire service across the country. Regardless of the type or size of your department, you stand the chance of having an alcohol- or mental health-related personnel issue that, if not addressed, could result in someone’s being hurt or killed. The sooner we can identify the firefighter struggling with an alcohol or mental health issue, the sooner the firefighter can seek professional help, offering the best chance of his returning to work. Allowing the code of silence to take control provides a disservice to the affected firefighter. Waiting only decreases the chance that the firefighter can obtain the needed professional help and return to work to a rewarding career. Fire departments that create a culture of open, honest, and respectful communication on these issues provide a means for their members to understand the illness, become knowledgeable on reporting steps, have a respect for zero tolerance for substance abuse, and support firefighters seeking the professional help they need to perform in their position.

In many cases, how the administration handles the employment separation process can have a direct and significant impact on how the firefighter processes the death of his career. In the case of Talbott, he was in the acceptance stage of grieving the loss of his career. He is at peace with the poor decisions he made in his life, which were his and only his, that resulted in his forced retirement. However, keep in mind that Talbott every day must work to control his symptoms and that recovery is a process. He deserves a high degree of credit for telling his story so others can learn from his experience.

Many firefighters will be facing the same challenges, but we have not affixed a name or department to those who are suffering. More names and departments will be attached to incidents in the future if we do not take a proactive approach to the risk of alcoholism and mental health issues in the fire service. Keep in mind that there are many firefighters who have faced a forced retirement, have been labeled as a drunk or a “nut case,” who to this very day struggle with the symptoms. Many more will continue to follow this path unless the fire service takes the needed steps to minimize the impact, help the troubled firefighter obtain professional help, and support a path to recovery.

The code of silence is a short-term action. We need to work on finding a long-term solution to the challenges of alcoholism and mental health issues in the fire service. We will only cause more harm by waiting and hoping that the problem goes away.

REFERENCES

1. Antonellis, P & Mitchell, S. (2005). Post-Traumatic Stress Disorder in Firefighters: the Calls that Stick with You. Ellicott, MD: Chevron Publishing.

2. Fullerton, CS, McCarroll, JE, Ursano, RJ, and Wright, KM. (1992) “Psychological Responses of Rescue Workers: Firefighters and Trauma,” Am J Orthopsychiatry, 62(3), 371–378.

3. McCarroll, JE, Ursano, RJ, Fullerton, CS, Liu, X, and Lundy, A. (2002). “Somatic Symptoms in Gulf War Mortuary Workers,” Psychosomatic Medicine, 2002, 64(1), 29–33.

4. National Institute on Alcohol Abuse and Alcoholism (2011). Alcohol Facts and Statistics. Retrieved: http://www.niaaa.nih.gov/publications/brochures-and-fact-sheets.

5. Kohan, A & O’Connor, BP. (2002). “Police Officer Job Satisfaction in Relation to Mood, Well-Being, and Alcohol Consumption,” J of Psychology, 136(3), 307.

6. Lucero, MA & Allen, RE. (2006). “Implementing Zero Tolerance Policies: Balancing Strict Enforcement with Fair Treatment,” SAM Advanced Management Journal (07497075), 71(1), 35-41.

7. Johnsen, E & Herringer, LG. (1993). “A note on the utilization of common support activities and relapse following substance abuse.” J of Psychology, 127(1), 73.

8. Witkiewitz, K & Marlatt, G. (2004). “Relapse Prevention for Alcohol and Drug Problems: That Was Zen, This Is Tao,” Am Psychologist, 59(4), 224-235. doi:10.1037/0003-066X.59.4.224.

9. Mehay, S & Webb, NJ. (2007). “Workplace drug prevention programs: does zero tolerance work?” Applied Economics, 39(21), 2743-2751. doi:10.1080/00036840600749532.

10. Goff, J. (1990). “Corporate Responsibilities to the Addicted Employee: A Look at Practical, Legal, and Ethical Issues,” Labor Law Journal, 41(4), 214-221.

11. Gedro, J, Mercer, F, & Iodice, JD. (2012). “Recovered alcoholics and career development: Implications for human resource development.” Human Resource Development Quarterly, 23(1), 129-132. doi:10.1002/hrdq.21118

12. Lehavot, K, Stappenbeck, CA, Luterek, JA, Kaysen, D, & Simpson, TL. (2014). “Gender differences in relationships among PTSD severity, drinking motives, and alcohol use in a comorbid alcohol dependence and PTSD sample.” Psychology of Addictive Behaviors, 28(1), 42-52. doi:10.1037/a0032266.

13. Simpson, TL, Stappenbeck, CA, Luterek, JA, Lehavot, K, & Kaysen, DL. (2014). “Drinking motives moderate daily relationships between PTSD symptoms and alcohol use,” J Abnormal Psychology, 123(1), 237-247. doi:10.1037/a0035193.

14. Ménard, KS & Arter, ML. (2013). “Police officer alcohol use and trauma symptoms: Associations with critical incidents, coping, and social stressors,” Intl J Stress Management, 20(1), 37-56. doi:10.1037/a0031434.

15. Men of Color Helping All Soc’y, Inc. v. City of Buffalo, No. 12-3067-cv 20 (2013) (United States Court of Appeals for the Second Circuit.)

16. Kubler-Ross, Elisabeth (1997). On Death and Dying. New York, NY: Touchstone.

PAUL J. ANTONELLIS JR. MA, Ed. D. (ABD), is an assistant professor in the Management Department at Merrimack College, North Andover, Massachusetts. He has taught more than 85 undergraduate and graduate level courses in the past eight years. He has lectured to emergency service professionals nationally and internationally on various topics. Antonellis is a 20-plus-year veteran of the fire service, retiring at the rank of chief of department. He is working on his dissertation for his doctoral of education with a specialization in educational leadership and management. He has a master’s degree in labor and policy studies, with a concentration in human resource management and an undergraduate degree in fire service administration. He has authored and published more than 30 articles and three books. His most recent book is Labor Relations for the Fire Service (PennWell Publishing, 2012). Antonellis has presented at FDIC for several years.

CAROL STABEN-BURROUGHS is a licensed clinical professional counselor in private practice in Bozeman, Montana. She provides individual, couple, and family counseling on a wide variety of issues and often works with law enforcement and other emergency services professionals and their families. She is a trainer for the International Critical Incident Stress Foundation in the Basic and Advanced Group Crisis Intervention courses and the Individual Crisis Intervention course. She is on the faculty at Montana State University, where she has taught for more than 25 years. She is the clinical director of the Gallatin County CISM team and is on the Montana CISM Network board. She was recently appointed to the Montana Board of Social Work Examiners and Professional Counselors by Governor Steve Bullock.


Battling Alcohol Abuse: One Firefighter’s Story

BY CHARLES TALBOTT

As long as I can remember, I wanted to be a firefighter. My grandfather worked for Taunton (MA) Fire Alarm as a lineman, so I was exposed to the fire service at an early age. I was always amazed by the teamwork, the camaraderie, and the challenges these people faced. As soon as I turned 18, I joined the local fire department where I lived in Vermont. Shortly thereafter, I moved to Brewster, Cape Cod.

I learned that the town had a paid on-call fire department. On July 1, 1987, I joined the Brewster Fire Department. I spent almost the next five years there. The department provided me with fire training and sent me to emergency medical technician school and eventually to paramedic school. Those early years were some of the best years of my life.

In early 1992, I took the entrance exam to become a full-time firefighter with the Yarmouth (MA) Fire Department. There was a lot of competition for jobs back then, and I was fortunate to do well enough to be offered a job. On May 14, 1992, I started my full-time career with the Yarmouth Fire Department. I was excited and didn’t quite know what to expect. It was a different department then, smaller and close knit with a lot of very experienced older guys on the job. I was told to keep my mouth shut, eyes and ears open, and maybe, just maybe, I might learn something. At the time, I had no idea of what post-traumatic stress disorder (PTSD) was, and critical incident stress debriefing (CISD) consisted of getting together with guys from the shift and discussing bad calls over a few beers, sometimes many beers.

My department is the busiest on Cape Cod, now running more than 6,000 calls annually. Early on in my career, I was exposed to significant and very unpleasant calls. At first, these calls didn’t seem to bother me. I worked hard and “played” hard. Drinking was a big part of the culture back then, and I certainly did my share. At the time, it didn’t seem to affect my work at all; showing up with the occasional hangover was the norm, but I was always able to perform my job to my superiors’ expectations.

Inside, however, I was feeling more and more empty and depressed. I didn’t feel like I could talk to anyone about how I was feeling. I was drinking more and more to escape from myself and what I was feeling. In 1998, I attempted suicide for the first time. I wanted to escape from everything going on in my life. The police found me in my car with a hose connected to the exhaust. I was taken to the hospital and then to a psychiatric facility for evaluation. I was diagnosed with depression, placed on medication, and cleared to return to duty. I actually stopped drinking for a while and completely immersed myself in my work. On the outside, it looked like I had turned the corner. I bought a house and a nice car, and I was in a good relationship.

On the inside, however, I was still lonely, anxious, and depressed. It seemed the only thing I truly enjoyed was work. I really felt that I was making a positive contribution to my community. When promotional exams came up, I studied hard and always did well. I was fortunate to get promoted to senior private and then lieutenant. My professional successes, however, didn’t change the feelings I had inside. It seemed like the more success I had at work, the worse I felt about myself. Bad calls were still happening, and I just kept bottling up the unpleasant thoughts and images inside. I also started drinking again.

In 2004, I attempted suicide again. I was sent to another psychiatric facility and given the same diagnosis: depression. I was again given permission to return to duty; however, I was demoted to the rank of firefighter. This was devastating to me. However, I looked at it as a positive motivator and became determined to get my rank back. I curtailed my drinking, worked, and studied hard. When promotions were given, I was again promoted to the rank of lieutenant by the same chief who had demoted me. I had proven myself.

Again, on the outside, things looked good, but on the inside, things were still the same. My relationship ended because of my drinking, even though at the time I just wrote it off as our being incompatible. I still felt empty and lonely, and it seemed the only thing that gave me purpose in life was my job. I stopped going out with the guys and began spending more and more time alone. I spent a lot of time fishing by myself and drinking by myself. When people would ask how I was, I would always say I was fine and did my best to present myself as happy and enjoying life. I thought I was so smart that I was able to fool everyone. That didn’t last long.

In July 2011, I was promoted to captain/shift commander. I was responsible for three stations and 14 personnel. I had finally achieved my professional goal. I always tried to better myself to prepare for this role. I went to the National Fire Academy for at least a week every year to better myself and prepare for this position. I was not prepared for the added stress and wear that came with this position. I found myself becoming more and more irritable with my shift and other people. It seemed I felt angry all the time, and I began to isolate myself more and more. I stopped doing the things I enjoyed and started using more and more vacation and sick time. I also began to drink heavily. Guys on my shift knew that something was up with me, but I made it very difficult for them to approach me. I spent more and more time in my office with the door shut. My world was becoming very small, and I didn’t have any idea why.

In October 2012, I hit bottom again and ended up seeking treatment at a facility that had a program for firefighters, police, and military personnel. It was at this facility that I was first diagnosed with PTSD. Prior to that, all I knew about PTSD was that it was something combat soldiers experienced. I was resistant to the fact that I could be experiencing this. I couldn’t accept the fact that I had somehow been damaged and wasn’t coping well with the things I had experienced during my career-that I was somehow weaker than everyone else. I had failed to see or chose to ignore all the warning signs. I completed the program and was once again allowed to go back to work.

During this entire period, the department and my local union were very supportive, but the department was in uncharted waters. No one really was sure of what to do, including me. Unfortunately, the fire service tends to be reactive to issues rather than proactive. I did my very best to show that things were better. Inside, things weren’t. I continued to drink heavily off duty; by this time, I only drank alone in my house. I was embarrassed by how much I was drinking and lied to everyone about my drinking. My off days were spent home alone drinking and being miserable and increasingly angry at everything. When I was on duty, people were afraid to confront me about my off-duty drinking. I was the boss, and I am sure they feared some type of retaliation if they brought it up. Things were just getting worse.

Finally, I crossed the line. While off duty and drunk, I texted a couple of members of my shift. I was critical of their performance and threatened them with a loss of overtime and shift transfers. I have no recollection of even sending these texts. They, rightfully, took these texts first to the union president and then to the deputy chief. I was placed on administrative leave.

At the urging of my union president, our union lawyer, and a good friend from the Boston Fire Department, I went to a 30-day inpatient facility in Pennsylvania that specializes in dual diagnosis for public safety personnel. There, I got a better understanding of what PTSD is and how it was affecting me. I completed this program and came home knowing I was facing disciplinary action for what I had done prior to going to the facility.

The situation was worse than I had thought. More members came forward about how I was acting when I was at work. I thought everything was fine when clearly it wasn’t. I wasn’t fooling anyone. This put the department and the union in a difficult position. They had to protect the members, but they also had an obligation to help me. After many discussions. I decided I had lost the ability to lead. I needed to put the needs of the department and my shift ahead of my own.

On September 11, 2013, I officially retired from the Yarmouth Fire Department. That had to be the saddest day of my life. I didn’t notice or chose to ignore all the warning signs. By doing this, I was eventually consumed by them. I filed for a disability retirement and continued to drink heavily. I went to a few more inpatient facilities, but I was lost. Finally came the day when I had to just give in and accept what I was and get some help. My only other alternative was to drink myself to death. I chose to get help.

I am still battling with my PTSD and my drinking, although I have been sober for a while now. I am on a new medication that helps with the nightmares and the other symptoms of PTSD. I also am an advocate of early recognition of the signs and symptoms of PTSD. I urge all departments and personnel to take a proactive approach to this increasing problem. Hopefully, by sharing my story, I can help at least one member to avoid going through what I went through.

CHARLES TALBOTT is a retired captain, shift commander/paramedic in the Yarmouth (MA) Fire Department.

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