Robin Kroll, PsyD, Clinical Psychologist and Director of Interventions, Dr. Robin Kroll, Inc., Chicago, Illinois

Consider, for instance, the following scenarios:

When Officer Mike returned home from work, the last thing he expected was a “Dear John” note from his wife. He knew his marriage was toxic; he knew his drinking attributed to their issues; he knew he didn’t know how to be alone. Turning to his typical coping behavior, he drank himself into a blackout. The next thing he knew, the police were breaking down his door, and he spent the next three days at a psychiatric unit sobering up. Immediately after his discharge, he was stripped of duty. As the fog began to lift, Mike remembered pieces of that night, which included putting his gun to his head. It wasn’t until he noticed the bullet hole in the ceiling that he realized he had attempted to end his life.

Officer Gary was the first to respond to a car accident involving three teenagers, and he witnessed them burn alive as they pleaded for help. He couldn’t get to them in time. He finished his shift, went home, hugged his kids, and found himself sitting in front of 23 beers the following day.

Officer Lori lost her partner to a line-of-duty death and blamed herself for being off duty the night it happened. Drinking was the only way to alleviate her sense of guilt.

After being injured on the job, Officer Steve was reliant on his pain medication, even after his on-duty injury healed. When his prescriptions ran out, he began purchasing opiates on the streets.

The stories above demonstrate the many links between alcohol/substance abuse and law enforcement. One of the greatest factors stems from the reality that officers are exposed to stressors that surpass the typical range of human emotions. For some officers, alcohol is an acceptable response in dealing with those emotions.

While these scenarios may sound drastic to some; there are a number of officers who have heard of similar situations or witnessed their peers succumb to these methods of “coping.” Research suggests that officers consume alcohol at greater rates than the general population; in law enforcement, cumulative stress is associated with an increased risk of alcohol abuse with an odds ratio of approximately 3 to 1.¹ Law enforcement officers drink in greater quantities and have higher rates of binge drinking compared to non-officers. This drinking is not always off the job—25 percent of officers report having consumed alcohol while on duty.²

In a 2011 study, 18.1 percent of male officers and 16 percent of female officers described “adverse consequences” from alcohol use, and 11 percent of male and 16 percent of female officers admitted to engaging in at-risk levels of alcohol use during the previous week.³ In another recent study, 33.9 percent of law enforcement students indicated excessive alcohol use compared to 26 percent of other students, and, in a study by Peter Weiss, 44.8 percent of the lowest performing officers of the 632 surveyed exhibited “alcohol issues.”⁴

Alcohol and suicide in law enforcement are also closely linked. A 2010 study found the presence of alcohol in over 95 percent of police suicides. It is estimated that a peace officer commits suicide every 17 hours.⁵

What Links Addiction in Law Enforcement

It is common to learn that officers admit they were alcoholics or have abused alcohol prior to their police work and, of course, minimized their drinking habits at pre-employment screenings. It is also common to discover that there often exists a history of alcoholism in an officer’s family. Alcoholism is a progressive, deteriorating disease, so officers with the addiction will likely decline with time, due to cumulative stress, dealing with extremes, and the negativity and violence they experience on the job, as well as the negative perception that some of the public and media have toward law enforcement. Officers also often experience unhealthy sleep cycles due to work shift changes and rotations that regularly switch from days to nights or assignments to special units that require putting in long hours, which can contribute to stress and unhealthy lifestyles. In addition, officers are notorious for working side jobs, not only to support their families, but to support their addiction habits as well, leading to further sleep deprivation and perpetuating the cycle.

For new recruits who don’t necessarily enter the force with an addiction issue, the acclimation to police culture can engender habit-forming behaviors. New officers want to fit in, so they may start hanging out at local police bars, and, eventually, the realities of law enforcement’s social milieu become part of the recruits’ lifestyles.

Elevated drinking can occur as the result of a critical incident or post-traumatic stress disorder (PTSD). While officers can develop PTSD from their jobs in law enforcement, some officers admit to joining the department with existing PTSD from the military or from childhood trauma, with symptoms that are activated by the experiences they face in the line of duty. Officers’ training teaches them to be guarded; showing emotions on the streets or jails can imply vulnerability. They can often forget to let their guard down when they go home to their families; as a result, they shut down communication, creating relationship issues for which alcohol becomes an unhealthy solution. Officers are also reluctant to obtain professional help in fear of administrative consequences up to and including termination.

Defining and Identifying the Problem

Alcoholism in law enforcement is an ongoing concern, and one that is often ignored in small, medium, and large agencies alike. Loyalty to the “brotherhood” hinders officers of all ranks from addressing the issue. This code of silence becomes an enabling behavior, and officers with alcoholism may deteriorate until the problem is too big to ignore—such as involvement in a domestic altercation, causing a fatality while intoxicated, or suicide. However, it’s possible to identify officers who may be struggling with alcohol or substance abuse before a crisis occurs. Officers with addictions may show signs of the disease in a variety of ways, including the following symptoms:

• Noticeable decay in performance
• Abuse of medical leave and faking injuries (may indicate needing time to recoup from a binge on alcohol or other substances)
• Taking time off on the first day returning to work
• Coming in late for roll call
• Displays of disgruntled attitude, argumentative behavior, and disobedience of direct orders
• Mishandling offenders or inmates; demonstrations of aggressive behavior, low tolerance, or repeated use of excessive force
• Unkempt uniforms and poor hygiene
• Increased involvement in accidents
• Inability to stay on task; incomplete paperwork or cases; and requests for other officers to take over assigned duties
• Noticeable signs of withdrawal, such as shaky hands, sweating, flushed face, bloated and swollen features, vomiting, complaints of insomnia, nausea, anxiety, and headaches

Treatment

When officers struggle with addiction, it is critical that they take time away from the job. Medical leave allows officers to fully concentrate on recovery, which includes gaining insight to the root of their addiction, learning new healthy coping strategies, and identifying triggers that have led or could lead to a relapse. An officer may need to be off a minimum of three months to complete inpatient and outpatient treatment. A collaborative approach, utilizing a team of unified support systems, will give the officer the greatest outcome. Support and treatment options include the following:

• Employee Assistance Program (EAP) services
• Peer support services
• Inpatient treatment
• Intensive outpatient treatment
• Individual therapy
• Group therapy
• Family therapy
• Alcoholics or Narcotics Anonymous (AA or NA), sponsorship, and fellowship
• Psychiatric treatment
• Police chaplain unit
• Sober house

Peer Support Units and EAP

Peer support units and EAP are good places for an officer to begin the process of getting help with an addiction. Some of these units’ duties include the following:

• Responding to calls for assistance from officers and family members, supervisors, and peer support personnel
• Carrying out workplace and family interventions
• Stabilizing living environment
• Providing initial assessment
• Identifying the problem
• Referring to treatment
• Keeping the officer engaged after treatment
• Ensuring follow-up with human resources and union representatives
• Being a resource for future questions and direction⁶

Inpatient Treatment

For most people with addictions, an inpatient program is the best start to recovery, but it is also one of the most difficult steps for an officer to take. For an officer, entering an inpatient facility may feel similar to incarceration, which is contrary to what the law enforcement profession represents, and giving up control goes against everything officers are trained to do. Their training has also provided them with a hyper-awareness of external surroundings—it is not uncommon for officers entering treatment centers to scan their surroundings and mark their exits the way they do on the streets or in jails.

Officers may need to tour the facility immediately upon admission to feel comfortable and safe. They are often perceived as being “clinically” paranoid because civilian patients do not display extensive guardedness to the degree shown by law enforcement officers. Defense mechanisms kick into high gear, and officers can be difficult in the early stages of inpatient treatment. The difficult behaviors can include noncompliance, being “closed off,” hesitancy in offering clinical history, heightened suspicion of staff and patients, and secrecy about what they do for a living. Law enforcement officers are gifted in their ability to run the show and do things their way, and it takes a strong staff to keep officers integrated in the treatment program. They often feel very different from the other patients, and it takes time to assimilate. Once this integration is achieved, officers can then focus on their recovery with success. Placing an officer in a treatment program that has a first responders track is preferable because clinicians who understand law enforcement culture will better understand how to work with the officer.

Intensive Outpatient Program

An Intensive Outpatient Program (IOP) is recommended to transition an officer who is in recovery, and it is typically structured as a group setting. As an outpatient, the officer can reside at home or in a recovery house to strengthen his or her recent sobriety while making the adjustment to living a sober lifestyle. Some officers may be able to maintain their normal commitment to family and work while doing IOP. Outpatient treatment usually begins five days a week and decreases to three days, then two days, and eventually to one day aftercare. The process can be open-ended, and participation is a decision that is made between the officer and treatment facilitators.

Individual Therapy

When an officer completes inpatient care, it is advisable to see a licensed clinician, specifically, one who has experience working with law enforcement as an interventionist. Police psychologists or other clinicians with experience treating law enforcement officers are better prepared to address field-specific issues and concerns. For instance, a psychologist unfamiliar with law enforcement may react poorly to the presence of a weapon, even if the officer carries it as a matter of course, or might not fully understand the pressures of the job that could lead to addiction.

When an officer seeks individual therapy, defensive behaviors can surface. As with most people who struggle with addiction, trauma is typically a co-occurring issue. Trust and safety are key factors for a person who has an addiction, especially officers whose finely tuned training teaches them not to trust. Being patient and using the first few therapy sessions to get acquainted allows the officer to gain assurance that the clinician can be trusted. Officers sometimes worry that others will see them visiting a therapist, especially due to the cultural stigma that can surround mental health issues. A psychologist experienced in working with law enforcement may be able to help the officer’s comfort by scheduling sessions during a time when no one else will be present in the waiting room or near the office. In addition, officers who have addiction issues stemming from a traumatic incident or who have heightened sensitivity to unfamiliar environments from their training may take multiple visits to feel safe in the office, and a skilled police psychologist will be sensitive to those types of fears. Officers are intuitive, and they will sense a clinician’s discomfort, which will, in turn, create discomfort for them. Once trust is established, an officer’s treatment can be extraordinary and sustained sobriety likely.

How Clinicians Can Work with an Officer

While clinicians can’t always accommodate every officer’s request, some reasonable accommodations or considerations might include the following:

• Give new law enforcement clients the first appointment of the day, an after-lunch appointment, or the last appointment to reduce the chance of encounters with other clients or officers.
• When setting up the appointment, ask if the officer has any concerns that he or she would like to address prior to the first visit.
• Some officers like to text the clinician to confirm that the office is clear before entering—it is recommended to allow this.
• If there is an extra room, allow the officer to go in there and shut the door until the office is clear of other people, if he or she wishes. Once officers are comfortable with therapy, they usually stop worrying about concealing their identities.
• Don’t push too much too soon—obtaining a thorough clinical history may have to wait until the officer is comfortable.
• Answer questions openly and honestly; officers easily recognize insincerity.
• Use language officers can relate to; don’t be too clinical.
• Officers may test a clinician’s ability to handle them; use an approach that is assertive without being controlling.
• Understand addiction and AA and the 12-step program, and be mindful of supporting these steps if the officer is working on them with his or her sponsor.
• Get consent from the officer to maintain communication with his or her other support systems, if possible. If communication is open, the clinician and other supporters may be able to identify the point at which the officer might be slipping away from the recovery program (e.g., missing appointments with the psychiatrist, EAP representatives, peer support unit, or not going to AA meetings).
• Remind officers that furloughs need to be structured and to increase their support system during time off; officers can relapse during vacations when their routines change.
• Develop a relapse prevention plan, and identify triggers and cycle behaviors that cause relapse. Officers’ triggers can come from the three key areas of their lives: (1) stress on the streets or in the jails, (2) stress from the organization, and (3) stress from their personal lives.
• Help officers develop healthy coping strategies to replace drinking, as well as being mindful of not replacing the addiction with other unhealthy behaviors such as gambling, sex, spending, and so forth.
• Officers with addictions who respond to calls that evoke emotions typically use alcohol or drugs as numbing agents to deal with the impact of the experiences. Remind them to use their new coping strategies (reaching out to support systems) to prevent relapses.

A return-to-work plan is important since the officer has most likely been on medical leave. Officers in recovery often face anxiety about returning to work for a variety of reasons: What will they tell their peers about why they’ve been off? Will they be bumped to another district or work shift? Is there new technology that they have to learn? Having officers visit their departments once or twice prior to their actual return date will reduce this anxiety. If they wear a uniform, having them put it on at home to reconnect with their identity can also be helpful, as can encouraging officers to go to the gun range, as they are likely going to have to re-qualify.

When officers return to work, they should still see a psychologist at least once a week for the first few months, then once every two weeks for a couple of months. If they are doing well transitioning back to work and have a strong AA or NA schedule, having them check in monthly for the first year back at work will help maintain quality support. AA or similar fellowship meetings will be a life-long commitment, and it’s essential that officers in recovery learn to be mindful of finding a balance in life, making sure that their identity isn’t solely about being police officers, and finding activities that include their civilian community and friends.

Therapeutic Approaches

An integrated approach is beneficial as it avoids restricting the officer to a single perspective. A partnership of orientations and approaches can elevate the level of therapeutic success.

• Bring in family members to support and educate officers about addiction being a family disease. When family members are involved, they often find themselves united in the officer’s recovery.
• Neurofeedback training is excellent for anxiety, trauma, addiction, sleep disorders, peak performance training, and more. Neurofeedback training entails the self-regulation of brainwave activity in real time, allowing officers to re-train their central nervous systems to function more efficiently.⁷ Discovering a new baseline that identifies a calming sensation will allow officers to gain greater control and stability over behaviors as they navigate their tours.
• Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories.⁸ It has been proven an excellent approach to treating PTSD.
• Stress management and relaxation training can be extremely useful techniques for officers who regularly experience chronic stress, officers with addiction issues, or officers with ties to trauma and have a co-occurring diagnoses of anxiety disorders. Teaching officers how to control levels of personal stress by identifying internal resources can prevent them from looking for unhealthy external aides such as alcohol or drugs. Utilizing relaxation techniques regularly can improve an officer’s everyday functioning.
• Motivating an officer to be conscientious of healthy eating and exercise can only enhance a well-rounded recovery program.
• Developing dual diagnosis police groups and AA or NA police meetings are a great way to give officers in recovery continued support. It doesn’t take much; a facilitator can consist of a police clinician or a representative from a community law enforcement agency. The structure should be relaxed with the understanding that “what’s said in group stays in group.” Police groups allow officers to discuss issues that they wouldn’t bring up in a regular civilian meeting. The safety and comfort of the group relies on its special bond—no need for records or dues, just support and encouragement.

RESOURCES American Addiction Center (The Colony, Texas): (214) 731-4037 Genesis House (Palm Beach County, Florida): (800) 737-0933 Mirmont Treatment Center (Philadelphia, PA): (610) 744-1400 ACOEM Guidelines for the Medical Evaluation of Law Enforcement Officers: www.acoem.org DOT The Substance Abuse Professional Guidelines: http://www.dot.gov/sites/dot.gov/files/docs/ODAPC%20SAP%20Guide%20Aug09.pdf American Board of Addiction Medicine: www.abam.net American Society of Addiction Medicine: www.asam.org

Additional Support Systems

Psychiatrists: Seek a psychiatrist who specializes in addiction and, if possible, one who has experience working with first responders and is mindful of the law enforcement agency’s policy on medications. The American College of Occupational and Environmental Medicine (ACOEM) Guidance for the Medical Evaluation of Law Enforcement Officers addresses medication use for law enforcement.⁹

Police chaplains: Police chaplains are a wonderful resource for officers, as they add a component of faith that is a significant theme in recovery. Being mindful of when to connect the officer to a spiritual resource is important. It is not unusual for officers to be angry and resentful in the beginning stages of recovery, especially at God. Blaming everyone but oneself is a defense mechanism that allows a person with an addiction to avoid responsibility and accountability. Once the officer stops using denial as a shield, bringing in faith (as the officer knows it) can add strength to the recovery process.

Sober house: Placing officers in a sober house can be as difficult as or worse than getting them admitted to a treatment center, and it is understandable why that is. Officers are uncomfortable with halfway houses; they have concerns that the other house members will resent them, and there is the potential of running into a house member whom they arrested. But for some officers, it is the only way they can maintain sobriety; in other cases, the officer may not be allowed to return home if the family won’t allow it. Living alone is not advisable because it will be easy for the officer to become isolated, which often leads to relapse. Developing a relationship with a sober house that supports officers is worthwhile, and knowing that trusted resources (such as psychologists or peer support units) are familiar with the house manager can be of comfort.

How Police Agencies Can Support Their Officers

First and foremost, agencies need to remove the stigma of seeking counseling and support their officers in taking care of themselves and each other. Law enforcement organizations shouldn’t hesitate to reach out to mental health professionals in the community who understand the culture or addiction and trauma; it is an honor for them to assist the agencies and their officers. Training at the academy level and continued training throughout an officer’s career is also essential. This includes education not just about alcohol and drug awareness, but about related issues such as potential critical incidents and elevated use, PTSD, and suicide prevention. Developing wellness programs that include stress management training, family days, and spousal awareness seminars throughout the year will be a continued reminder to maintain emotional stability.

Regardless of the size of the agency (small, medium, or large), building support units such as police chaplain programs, critical incident teams, and strong peer support units is possible with a modest budget. Small police agencies can join forces with other community police departments to develop these units and look for volunteers in the police community who are willing to come to the aid of their brothers or sisters in need. Reach out to officers in recovery—they are proud of who they’ve become and their lifestyle encourages giving back: “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.”¹⁰

Conclusion

Supporting officers in taking care of themselves and each other can make the difference between life and death when it comes to addiction. The need for police agencies to remove the stigma of seeking counseling and treatment will give officers a second chance—probably their only chance. Officers in recovery often return to work new and improved, and this freshness becomes very apparent to superiors and colleagues alike. Their new outlook on life often allows them to advance in rank and responsibility, and many become peer support members as a way of giving back. They view recovery as a gift.

Officers put their lives on the line daily to protect their communities. Supporting them in their recovery is a sense of duty and honor that agencies and clinicians can bestow upon them in return—a community of public servants serving each other. ♦

Dr. Robin Kroll is a clinical psychologist with an independent practice with offices in Chicago and Lake County, Illinois, suburbs. Dr. Kroll is the Director of Interventions and specializes in Police Psychology. Her concentration includes working with police officers in individual, group, and family therapy for issues related to addiction, mood disorders, work-related matters, and post-traumatic stress disorder. She has experience in fitness for duty treatment and assessment, police arbitration, and expert testimony. Dr. Kroll speaks at police and public safety conferences and implements stress management seminars for law enforcement agencies.

Notes:
¹Robyn R. M. Gershon, Susan Lin, and Xianbin Li, “Work Stress in Aging Police Officers,” Journal of Occupational and Environmental Medicine 44, no. 2 (2002): 160–167.
²Jeremy D. Davey, Patricia L. Obst, and Mary C. Sheehan, “Developing a Profile of Alcohol Consumption Patterns of Police Officers in a Large Scale Sample of an Australian Police Service,” European Addiction Research 6, no. 4 (2000): 205–212.
³James F. Ballenger et al., “Patterns and Predictors of Alcohol Use in Male and Female Urban Police Officers,” American Journal on Addictions 20, no. 1 (2011): 21–29.
⁴M. Kevin Gray, “Problem Behaviors of Students Pursuing Policing Careers,” Policing 34, no. 3 (2011): 541–552; Peter A. Weiss et al., “The Personality Assessment Inventory Borderline, Drug, and Alcohol Scales as Predictors of Overall Performance in Police Officers: A Series of Exploratory Analyses,” Policing & Society 18, no. 3 (2008): 301–310.
⁵Jean G. Larned, “Understanding Police Suicide,” Forensic Examiner 19, no. 3 (2010): 64–71.
⁶Robin Kroll and James Morrison, “Liquid Courage: Treating Officers with Alcoholism—A Path to Recovery” (presentation, 119th Annual IACP Conference, San Diego, CA, September 29, 2012).
⁷John N. Demos, Getting Started with Neurofeedback (New York: Norton and Co. Publishers, 2005).
⁸Francine Shapiro, “Efficacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories,” Journal of Traumatic Stress 2, no. 2 (1989): 199–223; Francine Shapiro, “Eye Movement Desensitization: A New Treatment for Post-Traumatic Stress Disorder,” Journal of Behavior Therapy and Experimental Psychiatry 20, no. 3 (September
1989): 211–217.
⁹American College of Occupational and Environmental Medicine, Guidance for the Medical Evaluation of Law Enforcement Officers (Elk Grove Village, Il: Knowledge Centers), http://www.acoem.org/leoguidelines.aspx (accessed August 1, 2014).
¹⁰Alcoholics Anonymous, “Step Twelve,” in Twelve Steps and Twelve Traditions (AA Grapevine, Inc. and Alcoholics Anonymous Publishing, July 2012): 106, http://www.aa.org/assets/en_US/en_step12.pdf (accessed August 1, 2014).

Please cite as:

Robin Kroll, “Managing the Dark Side: Treating Officers with Addiction,” The Police Chief 81 (September 2014): 48–51.

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