Police and Addiction: Treatment for Officers

If you are a police officer weighing whether to get help for drinking or drug use, the hard question is usually not whether there is a problem. It is what happens to your job if you say so out loud. This page answers that part.

It covers why this job pushes people toward drink and drugs, what the federal confidentiality rule protects, what happens if you stop drinking on your own, what federal leave law does and does not do for someone taking leave to get treatment [7], and what an assessment call actually involves. It does not give legal advice. It does not tell you what your department or your state’s certification body requires, because those answers come from your agency’s policy manual, your union representative and a lawyer. Where the honest answer is “ask”, this page says so instead of guessing.

Our page on addiction treatment covers the general ladder of care. This one is about the parts that change when you carry a badge.

Why officers rarely self-refer

The reasons officers give for not calling are about consequences at work, not about doubt over the drinking. That matters, because it changes what a useful answer looks like. You do not need persuading that heavy drinking is a problem. You need to know what a phone call costs you.

Alcohol use disorder is defined by that exact pattern. The National Institute on Alcohol Abuse and Alcoholism describes it as a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences [1]. The word doing the work in that sentence is occupational. Continuing to drink while the job is on the line is not a character finding. It is part of how the condition is defined.

The other thing that keeps people quiet is the belief that one call puts everything in the open. That belief is testable against the actual rules, which is what the next few sections do.

Why officers turn to drink and drugs

Three pressures come with this job, and each of them has a published mechanism behind it rather than a stereotype.

The events. Post-traumatic stress disorder can only develop after a person goes through or sees a life-threatening event, and being injured during the trauma raises the risk [2]. Most police work is not that. Some of it is exactly that, several times in a career, and the exposure accumulates.

The roster. Rotating and night shifts are not just tiring, they are a recognized form of sleep deficiency. The National Heart, Lung, and Blood Institute defines sleep deficiency to include sleeping at the wrong time of day, not only sleeping too little [10]. It links sleep deficiency to heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity and depression, and to a higher chance of injury in adults [10]. Alcohol is the usual self-prescribed answer to a wrecked sleep cycle, and it is the worst one, because it shortens the time to fall asleep and degrades the sleep that follows.

The substances themselves. Alcohol is the one this job runs on socially, and the definition above is where it stops being social. Prescribed opioids after an on-duty injury are a second route in, and the useful thing is not a statistic but a question: if a prescription that started after an injury is still going, say so at the assessment, because it changes what is offered. Anabolic steroids are the third, and they are less talked about. NIDA records that people who use them may develop a substance use disorder, defined as continued use despite adverse consequences, and that anabolic steroids can cause severe, long-lasting and in some cases irreversible damage, including early heart attacks, strokes, liver tumors, kidney failure and psychiatric problems [9]. It also records that stopping steroid use can cause depression, often leading to resumption of use [9].

None of that is a diagnosis, and none of it is destiny. It is an argument for an assessment now rather than another year of watching it.

Trauma exposure, hypervigilance and alcohol

Hypervigilance is a symptom, not a personality trait, and the clinical literature has a name for it. The VA’s National Center for PTSD describes feeling on edge or keyed up as hyperarousal, and says a person may be jittery, or always alert and on the lookout for danger [2]. It puts trouble sleeping and difficulty concentrating in the same cluster, and says a person might act in unhealthy ways, like smoking, misusing drugs or alcohol, or driving aggressively [2].

Two points from that source matter more in this job than in most.

First, timing. Symptoms usually start soon after the traumatic event, but they may not appear until months or years later, and they may come and go over many years [2]. A shift that went badly two years ago is not ruled out as the reason this year is hard.

Second, the threshold. The VA names symptoms that last longer than 4 weeks, cause great distress, or interfere with work or home life as the point at which it might be PTSD [2]. That is a far lower bar than most officers set for themselves.

What happens if you stop drinking on your own

This is the part people get wrong, and it is the part that can kill.

SAMHSA’s consensus panel writes that delirium and seizures are the two most pathological responses seen in alcohol withdrawal, and that the major goal of medical management is to avoid seizures and a special state of delirium called delirium tremens [3]. The signs and symptoms of acute alcohol withdrawal generally start 6 to 24 hours after the last drink [3]. The majority of alcohol withdrawal seizures occur within the first 48 hours after cessation or reduction of alcohol, with peak incidence around 24 hours [3]. Seizures, delirium tremens and dysregulation of body temperature, pulse and blood pressure are outcomes in severe alcohol dependence that can lead to fatal consequences [3].

The panel also says who should not be trying this outside a medical setting: people with a history of severe withdrawals, multiple withdrawals, delirium tremens or seizures are not good candidates for a non-medical program [3]. And it names the safer default — for alcohol, sedative-hypnotic and opioid withdrawal, hospitalization or some other form of 24-hour medical care is generally the preferred setting for detoxification [3].

If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.

So drying out quietly over a set of rest days, to avoid making a phone call, is the plan with the highest downside. Our page on medical detox explains what supervised withdrawal involves and why it exists as its own level of care.

Confidentiality, POST certification and duty status

Federal law puts a separate, stricter rule around substance use disorder treatment records than the one covering the rest of your medical file. Under 42 CFR Part 2, the restrictions on use and disclosure apply to records that would identify a patient as having or having had a substance use disorder and that contain substance use disorder information obtained by a federally assisted program [4].

One clause in that regulation is written for exactly this reader. It states that the restriction on use or disclosure of information to initiate or substantiate any criminal charges against a patient, or to conduct any criminal investigation of a patient, applies to that information [4]. That is the rule as written, and it names the statute behind it.

None of that means nobody will ever know anything. Part 2 is a set of restrictions with conditions attached, not a seal. How it applies to your situation, your agency and your state is a question for a lawyer, and this page is not one. What is fair to say is that these records sit under a rule written specifically for this kind of care, and that an employer usually learns something because a person authorized it. Our page on rehab confidentiality goes further into what a treatment record is and is not.

Certification is a separate question with a separate answer. Peace officer standards and training requirements are set state by state, and this page does not tell you what yours says. Your union representative, your agency’s policy manual and a lawyer can. Asking them before you call a treatment center is a reasonable order of operations, and it is not the same thing as doing nothing.

Peer support and critical incident debriefing

A debriefing after a critical incident is a workplace process. It is not an assessment and it is not treatment, and treating it as either is how a problem gets missed.

Two findings from the VA’s page make the distinction concrete. Support genuinely helps: stress can make PTSD more likely, while social support can make it less likely [2]. But timing defeats any single conversation, because symptoms may not appear until months or years later [2]. A debriefing held in the same week cannot rule out something that has not started yet.

Peer support has the same shape. Talking to someone who has worked the same calls is worth a great deal, and it is still not a clinical assessment. The two are not competing. The useful sequence is to keep the peer contact and add an assessment, rather than to let the first stand in for the second.

If you want to know what the clinical side involves, our page on counseling approaches used in treatment describes the methods, and our page on careers and groups most affected by addiction covers occupation as a factor.

What our campuses publish, and what to ask about a cohort

A cohort means being treated alongside people who do the same work. It changes who is in the group room. It does not change which levels of care exist, and those are worth knowing by name before any call.

SAMHSA’s placement chapter sets out five adult detoxification levels of care [5]. They run from ambulatory detoxification without extended onsite monitoring, through ambulatory detoxification with extended onsite monitoring, to clinically managed and medically monitored residential settings [5]. Our page on levels of care puts the same ladder in plainer terms, and our page on inpatient rehab covers what living on site involves.

On an occupational cohort, here is the honest position. What our campuses publish on their own pages is their levels of care. Group programming is set campus by campus and changes with who is admitted that week, so it is a question for the admissions call and not for a web page. Ask it as a direct question — “who else will be in my group, and do you have officers in treatment now” — and you will get a direct answer.

One campus in our family is built around a single occupation, and it is not this one. The IAFF Center of Excellence in Upper Marlboro, Maryland says on its own page that it offers treatment exclusively for fire fighters, dispatchers and first responders. That is a different service from policing, so it is not the number for an officer to call — unless you are also a fire fighter, dispatcher or paramedic in the IAFF, in which case start there. Our nationwide directory lists our campuses by state.

Firearms, medication and the practical questions

The honest answer about a duty weapon is that this page will not give you one. Whether it can be carried while someone is in treatment, or while taking a particular medication, is governed by your agency’s policy and by law that varies. Getting that wrong in either direction has consequences a web page should not be creating. Ask your agency, your union representative and a lawyer. A vaguer answer here would be worse than no answer.

Medication is a question for a prescriber who knows your history and your job. Medications are used in the treatment of opioid and alcohol use disorders, and whether one suits a particular person is a clinical decision rather than a general rule. Our page on medication assisted treatment describes what these medications are for. Raise the duty question with the prescriber at the assessment rather than after admission, because the answer can change which level of care makes sense.

Underneath both questions is the same worry: who gets told what. The confidentiality section above is the answer. The treatment program’s records sit under a federal rule written for this kind of care [4], while what your employer learns is mostly a function of what you authorize and what your agency’s own policy requires.

Return-to-duty and fitness evaluations

A fitness-for-duty evaluation and a treatment assessment are different appointments with different audiences. Confusing them is the most expensive mistake in this area.

A treatment assessment is clinical, and its output is a level-of-care recommendation for you. A fitness-for-duty evaluation is arranged by an employer, and its output is a report for that employer. Before you attend one, ask in writing who receives the report and what it will contain. That is a routine question and a fair one.

Leave is the other half of the return-to-duty picture. The Family and Medical Leave Act allows eligible employees of a covered employer to take job-protected, unpaid leave for up to a total of 12 workweeks in any 12 months [6]. An employee generally has a right to return to the same position or an equivalent one, and an employer may require certification to substantiate the leave [6].

The regulations then treat this care specifically, in the statute’s own wording. FMLA leave may only be taken for treatment for substance abuse by a health care provider, or by a provider of health care services on referral by a health care provider; absence because of the employee’s use of the substance, rather than for treatment, does not qualify [7]. The same section says an employer may not take action against the employee because the employee has exercised the right to take FMLA leave for treatment, and that an employer with an established policy, applied in a non-discriminatory manner and communicated to all employees, may terminate an employee under that policy whether or not the employee is presently taking FMLA leave [7]. Both halves are real, and a reader deciding what to do deserves both.

Getting an assessment quietly

The first call is an assessment, not an admission, and you can end it without committing to anything.

What it covers is predictable. What you are using and how much, what has happened at work and at home, your medical history, and the level of care that points to. It is also where insurance gets checked. All Marketplace plans cover mental health and substance use disorder services as essential health benefits, including behavioral health treatment such as psychotherapy and counseling, and mental and behavioral health inpatient services [8]. An employer plan is a different contract, which is why verification exists instead of a published price list. Our pages on whether insurance covers rehab and on what rehab costs cover the rest.

Time the call for a rest day if the call itself is the part you are dreading. Our page on how to get into rehab sets out the whole sequence, our page on what the rehab process is like covers the arc, and our page on outpatient rehab covers the tiers people do while still working, which is the question most officers ask second.

Ask about leave, records and group programming on that call, and write the answers down. The reason to get them from admissions rather than from a page like this one is that they are specific to a campus and to a date. Anything printed in advance is out of date by the time you use it.

Frequently Asked Questions

Sources

1. National Institute on Alcohol Abuse and Alcoholism. Understanding Alcohol Use Disorder. National Institutes of Health. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
2. National Center for PTSD. PTSD Basics. U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/understand/what/ptsd_basics.asp
3. Center for Substance Abuse Treatment. (2006). Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Detoxification and Substance Abuse Treatment, TIP Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
4. Legal Information Institute. 42 CFR § 2.12 — Applicability. Confidentiality of Substance Use Disorder Patient Records. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/2.12
5. Center for Substance Abuse Treatment. (2006). Chapter 2: Settings, Levels of Care, and Patient Placement. Detoxification and Substance Abuse Treatment, TIP Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64109/
6. Legal Information Institute. 29 CFR § 825.100 — The Family and Medical Leave Act. Cornell Law School. https://www.law.cornell.edu/cfr/text/29/825.100
7. Legal Information Institute. 29 CFR § 825.119 — Leave for treatment of substance abuse. Cornell Law School. https://www.law.cornell.edu/cfr/text/29/825.119
8. Centers for Medicare & Medicaid Services. Mental Health and Substance Abuse Health Coverage Options. HealthCare.gov. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
9. National Institute on Drug Abuse. Anabolic Steroids and Other Appearance and Performance Enhancing Drugs (APEDs). National Institutes of Health. https://nida.nih.gov/research-topics/anabolic-steroids
10. National Heart, Lung, and Blood Institute. Sleep Deprivation and Deficiency. National Institutes of Health. https://www.nhlbi.nih.gov/health/sleep-deprivation

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village