Liz Frings

PTSD and Alcohol: Drinking to Cope in the Emergency Services

A few drinks after a bad shift is part of the culture in a lot of emergency services. It brings people together, takes the edge off, and helps you come down when your body is still running at full speed hours after the job is over. For many people it stays at that. For some, especially those living with the after-effects of the work, drinking slowly becomes the main way of coping, and it starts to cause problems of its own.

This guide is for police officers, paramedics, firefighters, call handlers and anyone else in these roles who has wondered whether their drinking has gone beyond unwinding. It isn't here to lecture you. It looks at why drinking and PTSD so often go together, what the UK research shows, the signs worth noticing, and how treatment can work when drinking is part of the picture.

Why drinking and PTSD so often go together

PTSD keeps the body on high alert. Sleep is broken, nightmares wake you, and the mind replays jobs you would rather forget. Alcohol seems to answer all of that, at least for an evening. It slows the body down, makes it easier to drop off, and blurs the memories for a while.

That relief is real, which is why the pattern is so common. In a large US population survey, about one in five people with PTSD said they used alcohol or drugs to relieve their symptoms (Leeies and colleagues, 2010). The charity PTSD UK reports that people with PTSD are almost four times more likely to develop an alcohol use disorder than people without it (PTSD UK).

In EMDR with First Responders (Luber, ed., 2015), David Blore, a UK clinician who has worked extensively with coal miners, describes drinking as "a very natural method of blotting out traumatic memories". He found it unrealistic in many cases to expect very heavy drinkers to cut down before treatment, but was clear that it always had to be talked about.

What the UK research shows

A 2021 UK study compared men in the police service with men in the armed forces (Irizar and colleagues, 2021). Around 4% in both groups had probable PTSD. Harmful drinking, defined in that study as more than 50 units a week, was much more common in the military, at 10%, than among police employees, at 3% (University of Liverpool, 2021). The researchers noted that both organisations have a culture of drinking to bond and destress, and that people with the most serious problems may already have left the service, which would make the figures look lower than they really are.

For comparison, the UK Chief Medical Officers advise not regularly drinking more than 14 units a week, spread over three or more days. A pint of ordinary strength beer is around two units, and a large glass of wine is around three.

Why shift work makes it harder

Shifts add their own pressure. After a run of nights, sleeping in the day is hard enough without your mind replaying the last job, and a drink or two can feel like the only way to switch off. Rest days can turn into recovery days. Missed family time and broken routines add stress at home. None of this means shift workers are bound to drink more, but it helps to know where the pull comes from, so you can plan around it rather than drift into it.

How drinking affects PTSD

  • Short relief, longer cost. Drinking dampens anxiety while you drink, but anxiety tends to come back stronger as it wears off, which makes the next drink more likely.
  • Worse sleep. It can help you fall asleep, but it disrupts the quality of sleep later in the night, so you wake tired and on edge.
  • Lower mood. Alcohol is a depressant, and heavy use is closely linked with low mood.
  • Delayed help. When drinking masks the symptoms, it can be years before anyone, including you, recognises them as PTSD.
  • Knock-on effects. Relationships, health, driving and work can all suffer, and in jobs with vetting and fitness requirements that adds a further layer of worry.

Signs your drinking has become a problem

  • you drink to get to sleep, or to stop the memories, rather than for enjoyment
  • you need more than you used to for the same effect
  • you drink alone after shifts, or hide how much you drink
  • you have tried to cut down and found it harder than expected
  • people close to you have said they are worried
  • you feel shaky, sweaty or anxious in the morning until you have a drink

None of these makes you a bad officer, paramedic or firefighter. They are signs that something which once helped has started to cost you more than it gives.

The AUDIT questionnaire is a short, widely used screening tool, and your GP can go through it with you. If you recognise the last point in that list, read the next section before making any big changes.

Stopping safely

If you drink heavily every day, don't stop suddenly on your own. Withdrawal from heavy drinking can be dangerous, and PTSD UK warns that people who are physically dependent may face severe health risks if they stop abruptly. Speak to your GP first. They can help you cut down safely and refer you to your local NHS alcohol service, which you can often contact directly too.

Cutting down

If you are not physically dependent and want to drink less, small practical changes add up.

  • Track it for two weeks. Write down what you drink and when. Most people are surprised by the total, and the pattern often shows when drinking is doing a job for you, such as after nights or before bed.
  • Have several drink-free days a week. The NHS Drink Free Days app can help you keep track.
  • Find another way to come down after a shift. A shower, a walk, food, a call with a mate or a few minutes of slow breathing can do some of what a drink was doing.
  • Don't drink to get to sleep. It feels like it works, but it makes the second half of the night worse.
  • Tell someone. Saying you are cutting down makes it more likely to stick, and gives someone the chance to support you.

If cutting down turns out to be harder than you expected, that is useful information, not a failure. It usually means the drinking is holding something back, and that is the point to get help with what lies underneath.

Can you have EMDR if you drink?

Usually, yes. NICE's guideline on PTSD says people should not be excluded from treatment based solely on drug or alcohol misuse (NICE NG116). Instead, both problems should be assessed and treated.

How the two fit together is a matter of judgement. In the same book, clinicians writing about military personnel note that views differ. Some believe trauma-focused work should wait until someone has been sober for months, because processing painful memories can increase the urge to drink. Others point out that drinking may be a way of coping with memories that haven't been dealt with, and may not settle until they are. In practice, many people do best when the drinking and the memories of trauma are worked on side by side, with the pace adjusted as things change.

If you do mention drinking to a therapist, it shouldn't shock them. Drinking to cope affects a great many people who still need help, and a good therapist won't judge you for it. It may simply change how a particular session is approached.

The preparation phase of EMDR also builds other ways of settling your body and mind, so drinking isn't the only tool you have. EMDR side effects and shift work describes one of these, the container exercise, and EMDR for emergency services staff explains how treatment is shaped around these jobs.

Where to get help with alcohol

  • Your GP, who can assess both your drinking and your mental health, and refer you on
  • Your local NHS alcohol service, which many areas let you contact without a referral
  • Drinkline, the national helpline, free on 0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm)
  • The charities for each service: Police Care UK, The Ambulance Staff Charity (TASC) and The Fire Fighters Charity

If you are holding back because you worry your service will find out, is counselling confidential? sets out what stays private when you seek help. If you are not sure whether what you are living with is PTSD, PTSD in emergency services workers sets out the signs. If you are worried about someone else's drinking, helping someone with PTSD is written for partners and families.

Frequently asked questions

Does drinking make PTSD worse?

Over time, it usually does. It may ease symptoms for an evening, but it tends to worsen sleep, mood and anxiety, and it can delay getting treatment that works.

Should I stop drinking before starting therapy?

Not necessarily. Many people start therapy while they are still drinking and work on both together. If you drink heavily every day, talk to your GP before cutting down, because stopping suddenly can be dangerous.

Will my employer find out if I tell a therapist about my drinking?

Private therapy you arrange yourself is confidential, within some legal limits. If treatment is arranged or paid for through work, ask before you start what information, if any, goes back to them.

What kind of experiences lead to heavy drinking?

There is no single kind. Repeated exposure to distressing jobs, guilt about outcomes, broken sleep and a culture that expects you to carry on can all play a part. What matters more than the cause is noticing the pattern and getting support for both the drinking and the trauma behind it.

How much drinking is too much?

The UK guideline is no more than 14 units a week, spread over several days. But the amount matters less than the reason. If you are drinking to stop memories, to sleep or to get through, that is worth talking to someone about, whatever the number.

Talking to someone

I'm a BACP registered counsellor offering EMDR therapy and person centred counselling in Nottingham and online. If drinking has become part of how you cope with the job, you can get in touch to talk it through, without judgement and without committing to anything.

Sources

More about EMDR therapy