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Nurses And Addiction: A Quiet Epidemic

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 26, 2019

Addiction is impacting an ever-increasing number of nurses across the country, to the point where many addiction experts are calling it an epidemic of drug use. It is important to understand the influences behind this epidemic, the ways in which you can spot addiction in a nurse, and how it can be treated.

The Statistics Show The Severity

Statistics indicate that drug use in nurses could be high enough to be consistent with the national average. According to statistics, the highest estimate suggests that 10 to 15 percent of all nurses misuse drugs or alcohol. This equates to upwards of 300,000 nurses across the country who are likely struggling with substance abuse or addiction.

Another statistic, reported by the State Of Ohio Board Of Nursing, said that over 50 percent of all problem cases processed each month (typically hundreds) are due to inappropriate drug or alcohol use.

Substances commonly abused by nurses include nicotine, alcohol, cocaine, marijuana, methamphetamine, sleeping pills, morphine, and various prescription drugs. The reasons for using these drugs vary between each person, but likely have a lot to do with the nature of their profession.

Why Nurses May Become Addicted

Various studies have tried to pinpoint exactly what causes this high rate of addiction in nurses. There are many possible explanations, many of which may work together to increase addiction risk and severity. Among the most common influences noted were the following:

  • Job stress – Being a nurse often requires lengthy shifts (8-12 hours a day), high-pressure decisions, sudden emergencies, and watching people get sick and even die. This high level of stress has been connected with drug use in the past, and may partially explain the high rate of addiction in nurses.
  • Easier access to certain medications – Nurses typically have easier access to a variety of controlled substances, such as methadone, painkillers, and even antidepressants. This may make it easier for them to get the drugs they need to fuel their addiction.
  • Pressure to perform – Nursing is a demanding job and it requires a dedicated and professional approach. This may cause some to neglect their personal needs to take care of patients. In fact, it might even fuel drug use (such as taking methamphetamine or prescribed amphetamines, such as ADHD drugs to have the energy or focus to complete a lengthy and demanding shift).
  • Depression and anxiety – The heavy demands of nursing can often create a high level of depression and anxiety which can be hard to beat. This is especially true of nurses who work in areas of a hospital in which death is more common.

These influences can be hard to overcome, especially for certain specialized nurses. More stressful and demanding nursing positions are directly related to an increased risk of substance abuse and addiction. Understanding what types of nurses are at a higher risk is an important way to diagnose a potential problem in yourself or a loved one.

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Certain Types Of Nurses May Be At More Risk

When examining addiction rates among various nursing professions, it becomes clear that more strenuous positions lead to higher rates of addiction. The study “Substance Use Among Nurses: Differences Between Specialties” reported that emergency room nurses were 3.5 times more likely to use cocaine or marijuana when compared to general practice, women’s health, or pediatric nurses.

Other nurses that suffered from high rates of addiction included oncology and administration nurses, who were twice as likely to binge drink as general practice nurses. After comparing all these rates, the study came to the following conclusion:

“Certain nursing specialties were more likely than others to be associated with substance use. The differences were not explained by demographic characteristics.” What this means is that stress and the difficulty of a nursing position were more likely to be an influence than falling into any other demographic. Drug use was, therefore, not centered around a specific race or gender.

Dangers Of Addiction In Nurses

Addiction causes a wide range of behavioral changes that may negatively impact nurses and their job performance. For example, excessive alcohol use may cause confusion, cognitive difficulties, troubles communicating, and problems with coordination. In a delicate healthcare situation, this could be a major problem, such as a nurse fainting or having difficulties making decisions during a serious surgery.

On that note, a survey given in 1990 asked 300 nurses who were recovering from addiction to describe the effects that it had on their job performance and whether or not they were disciplined. Only 23 percent reported receiving any disciplinary action. Others admitted that their performance was impeded in various ways, including making mistakes with medication or falling asleep on the job, however, they said that they were able to recover from the mistake.

The study indicated that many of the nurses in the survey were able to successfully hide their addiction and avoided making any dangerous mistakes or decisions. However, the risk of mistake is too high when a life hangs in the balance, which makes it important to know how to spot the signs and symptoms of addiction in a nurse.

Signs And Symptoms Of Addiction In Nurses

A few common signs and symptoms of addictions in nurses, as identified by the National Council of State Boards of Nursing, include:

  • Incorrect count on controlled substances – may indicate that they are taking them for their own use
  • Coming to work on days off and asking for overtime – may indicate financial problems associated with drug use
  • Confusion and agitation about minor mistakes – could indicate lack of emotional control or focus caused by addiction
  • Disappearing from work for lengthy periods during breaks – may be using substances off-site or even in their vehicle
  • Smells common with covering up drug or alcohol use – heavy use of breath mints and perfume may be a sign of hiding the smells of substance use
  • Trouble remembering commonly filled meds – forgetting med counts or making simple mistakes could indicate cognitive impairment caused by addiction
  • Weight gain or weight loss – substance abuse can cause weight gain or weight loss, depending on the substance used

If your loved one is a nurse and shows evidence of these symptoms, it is important to talk to them immediately and address the problem. Convince them of the importance of treatment, even if an intervention is necessary. The dangers addiction poses to nurses and their patients is too high to let it stand untreated.

Treating Addiction In Nurses

One possible method of treating addiction in nurses is prevention. The International Journal of Mental Health And Addiction published an article titled “Treating Nurses And Student Nurses With Chemical Dependency: Revising Policy In The United States For The 21st Century,” which looked into the best ways to prevent and treat nurse addiction. They stated:

“After reviewing policies for both practicing nurses and those still in training, the authors recommend that all states adopt nonpunitive policies and that nursing schools develop alternative approaches for students that parallel and expand upon the procedures applied to practicing nurses who have a chemical dependency.”

Their conclusion states that they believe teaching preventative measures (such as healthy stress relieving techniques) as an alternative to punitive measures may be the most sucessful tactic. In example, rather than firing them or making it a legal problem, rehab would be the best option. Many rehab opportunities exist for nurses, including inpatient treatment which allows them to stay on-site, and outpatient, which lets them fulfill their work duties if they’re mentally and physically able to do so.

A typical rehab program will include medically-monitored detox to help clean the body and mind of addictive substances. Once all physical health problems have been addressed and managed, psychological and behavioral adjustment techniques can be implemented. These are designed to treat any co-occurring disorders and make addiction easier to manage. Aftercare techniques, including sobriety groups like 12-step programs, are another way to promote sobriety.

Another option for nurses is executive or luxury rehab. These centers include comfortable living conditions and a variety of electronic communication items that lets a nurse stay in contact with the hospital or doctor. In this way, it is easier to track the health of their patients and to feel immersed in their work environment.

Whatever type of treatment is used, it is important to make sure that it is fine-tuned for the individual needs of the nurse. Addiction is a slippery problem and one that varies between those it affects. As a result, not every program or treatment method is appropriate for everyone.

Need Help?

If you or someone you love is a nurse who needs help beating an addiction, please contact us today at We have the resources you need to educate yourself about your or a loved one’s addiction, and about how you can find a rehab center near you. We look forward to hearing from you.

National Council of State Boards of Nursing - Substance Use Disorder In Nursing

Patient Safety and Quality: An Evidence-Based Handbook for Nurses - Chapter 26: Work Stress And Burnout Among Nurses: Role Of The Work Environment And Working Conditions

Minority Nurse - Depression In Nurses: The Unspoken Epidemic

National Center for Biotechnology Information - Substance Use Among Nurses: Differences Between Specialties

International Journal of the Addictions - Drug Use And Disciplinary Actions Among 300 Nurses

International Journal of Mental Health and Addiction - Treating Nurses And Student Nurses With Chemical Dependency: Revising Policy In The United States For The 21st Century

Substance Abuse and Mental Health Services Administration - Substance Use And Substance Use Disorder By Industry

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