First responders requiring an acute impatient psychiatric care have a high rate of untreated substance abuse often revealed for the first time with biological screening. Upon admission to a 12 Bed ward at Deakin Private Hospital consisting of current and ex-serving military, policing, ambulance and healthcare workers, alcohol had been the most prevalent substance and withdrawal has shown the need for careful substance use history, often denied but then physiologically declared. This talk will outline 3 case studies where detoxification resulted in a rapid dysregulation of previous maladaptive but effective coping strategies, revealing the need for early detection amongst current serving first responders to minimise shame compounding PTSD symptomology. Recommendations for treatment biological support using Pharmacogenetic screening for post discharge management is also discussed.