Breaking the Silence on Trauma, Substance Use and Suicide in Our Ranks
DR. TOMER ANBAR
CEO
Institutes of Health
September is National Suicide Prevention and Awareness Month, a time when we are reminded that the threats facing our law enforcement professionals often extend far beyond the call of duty. While peace officers are trained to run toward danger, what happens when the danger turns inward?
More peace officers die from suicide than in the line of duty. That jarring fact underscores a deeper crisis that is not always visible in the roll call room: untreated post-traumatic stress and the silent rise of substance use disorder (SUD).
Officers do not become vulnerable because they are weak; they become vulnerable because they are strong. The culture of grit, self-sacrifice and emotional suppression that makes law enforcement resilient in the field can become a barrier to seeking help. For many, substance use begins as a coping strategy to take the edge off after a traumatic shift, to quiet the nightmares or to push through chronic pain. But what starts as self-medication can evolve into dependency, and that dependency can rapidly tighten trauma’s grip.
Among law enforcement officers who died by suicide, research has identified problematic alcohol or substance use in over one-third of the cases, underscoring the dangerous synergy between SUD and suicide risk in this population.1 Studies show that individuals struggling with SUD are up to six times more likely to attempt suicide.2
There is, however, renewed hope. Municipalities across California, particularly the city of San Diego, are embracing advanced, trauma-integrated care models rooted in a transdisciplinary biopsychosocial framework.3 These programs are achieving remarkable success in systematically reversing post-traumatic stress disorder (PTSD) and substance use among peace officers, not only through trauma-informed therapies, but also through cutting-edge clinical frameworks like psychoneuroimmunology (PNI).
PNI examines how trauma impacts neurological, endocrine and immune systems. Repeated high-stress exposures, routine in law enforcement, can disrupt cortisol balance, impair brain function and suppress immune response.4 In the city of San Diego, the application of PNI is not theoretical; it is woven into the treatment paradigm to restore neuroimmune stability, recalibrate stress response systems and strengthen resilience to suicide risk. When paired with trauma therapy and structured peer support, PNI becomes a core tool in breaking the trauma-substance-use-suicide cycle.
These outcomes are not abstract. Officers treated in these programs are not only stabilizing, they are returning to duty and reclaiming meaningful lives. This success reflects a shift in how we understand and treat trauma in those who serve.
It is important to understand that intense and repeated exposure to trauma can have a devastating effect on an individual’s physical and mental well-being. Add sleep deprivation, musculoskeletal injury and a culture of stoic perseverance, and it is no surprise that substances become a sought-after coping mechanism.
But what begins as a method to unwind, sleep or mask pain can quickly spiral into dependency. When PTSD, (undiagnosed, yet reversible) traumatic brain injury (TBI) or chronic pain go untreated, the result is an unrelenting dual diagnosis. Trauma fuels substance use, and substance use deepens trauma’s ironfisted hold.
In these types of situations, another form of injury often emerges: organizational betrayal. Many officers report feelings of abandonment when departments fail to respond with competence or compassion. Some are told to “push through.” Others are referred to programs that do not reflect the realities of their profession. These missteps erode trust and deepen the damage.
To reverse this crisis, clinical care must be culturally competent and biologically grounded. Providers must understand the unique ethos of law enforcement, including its traditions, risks and values. Programs must be tailored for tactical athletes, not generic patients. Only by physically and philosophically vetting treatment programs can department leaders ensure sustainable recovery, not just symptom relief.
This alignment must extend beyond clinical teams to include risk managers, claims professionals and agency administrators. When cities like San Diego made this shift, adopting programs that integrate PNI and other transdisciplinary elements, the results were profound. Officers did not just stabilize; they recovered, returned to duty and resumed leadership roles.
Risk managers, in particular, hold a powerful position in this equation. By directing referrals to culturally and clinically validated programs, they can simultaneously reduce long-term disability, optimize claims and preserve public safety infrastructure.
Programs with validated outcomes are redefining recovery. Nearly all participants in the city of San Diego model resolved their PTSD and SUD diagnoses and reclaimed meaningful roles in service or civilian life. These are not anecdotal wins; they are the new benchmark for care.
The most effective programs include:
- Neurologists to assess and treat undiagnosed brain injuries.
- Addictionologists and psychiatrists to manage detox and dual diagnoses.
- Clinical psychologists and trauma therapists trained in first responder protocols.
- Physical, occupational and chronic pain specialists familiar with tactical injuries.
- Peer support from fellow officers in recovery within a therapeutic community.
- Nutrition and sleep science to restore physiological function.
- PNI protocols to repair and rebalance the neuroimmune system.
This model goes far beyond traditional rehabilitation. It provides a full system reset — physiological, psychological and neurological — creating a foundation for sustained reintegration into life, service and self.
When a peace officer reaches out for help, it is not a weakness; it is a call for backup. Our response determines whether we become part of their trauma, or part of their healing.
The challenges of PTSD and SUD are very real. But so is the strength found in evidence-based care, cultural competence and collective leadership. Now is the time to acknowledge their sacrifice and answer the call.
About the Author
Dr. Tomer Anbar is CEO of Institutes of Health (IOH), specializing in the research and advanced treatment of such epidemics as chronic pain, complex post-traumatic stress disorder, substance use disorder, brain injuries and related conditions. IOH is made up of specialty clinics and institutes with specific focus and mission. The IOH First Responder Institute is a component of the Institutes of Health engineered to recognize and respond to the unique challenges these professionals face. For more information, visit institutesofhealth.org.
References
- Heyman, M., Dill, J., & Douglas, R. (2018). The Ruderman White Paper on Mental Health and Suicide of First Responders. Ruderman Family Foundation. rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty
- Schneider, B., O’Donnell, S., & Dean, R. (2017). Suicidal behavior and alcohol abuse. International Journal of Environmental Research and Public Health, 14(7), 737.
- Powell AC, Sousa J., Picone D., Dawson, G., Anbar, T. Systematically reversing post-traumatic stress disorder and disability among first responders through a biopsychosocial occupational medicine program. Poster presented at American College of Occupational and Environmental Medicine’s American Occupational Health Conference; 2025 Apr 27–30; Austin, TX.
- Ader, R. (2001). Psychoneuroimmunology. Current Directions in Psychological Science, 10(3), 94–98. doi.org/10.1111/1467-8721.00124