Modified: 31st Jul 2019

One of the most common misconceptions about addiction is that it only happens to a specific type of individual. When most people think of addiction, they tend to think of young, reckless substance users who come from low-income or lower-class backgrounds. However, addiction can affect anyone regardless of age, race, gender, economic standing, or occupation. In fact, some of the most respectable people can struggle with substance abuse issues— including medical professionals like nurses. 

Nurses are among the most professional people in the medical elite. Their jobs demand a calm and courteous bedside manner as they tend to the needs of various patients. Moreover, nurses are usually the first (and often the last) to care for patients. So, naturally, nurses build strong relationships with the people they treat.

nurse addiciton

Unfortunately, the extremely personable and high-stress nature of the nursing profession leaves nurses with a high risk of turning to drugs or alcohol to cope with any turmoil they may face at their jobs.

The Nurse Demographic

Nurses, or registered nurses (RNs), make up a significant part of the Healthcare system. There are 3.22 million RNs in the U.S. today. Comparatively, there are 906,000 physicians and surgeons, meaning that RNs outnumber them by almost four-to-one.

This particular medical profession is predominantly female. The most recent census data shows that there are 2.86 million female nurses in the U.S., while there are only 357,000 male nurses. In other words, 88.9 percent of the RN workforce is female.

The average age of RNs is early to mid-forties, and the most common ethnicity for RNs is Caucasian/White.

Overall, the majority of RNs in the U.S. are white, middle-aged women.

This article will be examining the rates of substance use disorder (SUD) among practicing RNs rather than nursing school students unless otherwise specified.

Drug and Alcohol Addiction Among Nurses

“Nurses who abuse substances pose a unique challenge to the profession. The behavior that results from this disease has far-reaching and negative effects— not only on nurses themselves but also [on] the patients who depend on the nurse for safe, competent care.”

National Council of State Boards of Nursing (NCSBN)

According to several studies, the prevalence of SUD among nurses is almost parallel to the prevalence of SUD among the general population, if not slightly less. Even so, substance abuse and addiction is a widespread problem among healthcare professionals. 

Data from various sources, including the American Nurses Association (ANA) and the Journal of Clinical Nursing, have estimated that as many as one in ten nurses struggle with an addiction to drugs, alcohol, or perhaps both. These statistics represent a lingering danger not just for registered nurses but their patients as well.

Nurses who struggle with substance use and addiction are affected both mentally and physically. As such, their work performance could be compromised in any number of ways. For instance, a nurse who is impaired during a hospital shift may show poor judgment or have a slow reaction time, which could be detrimental during an emergency. 

Still, it’s important to remember that addiction is a disease that alters the way people think and perceive the world around them. No one develops an addiction on purpose, and nursing is a high-stress, physically exhausting, and emotionally taxing profession. So, nurses who struggle with substance abuse and addiction usually turn to drugs as a coping mechanism. 

The most common substances of abuse among nurses are prescription drugs and alcohol. However, there is a low percentage of nurses who use and become addicted to illicit drugs like marijuana.

Nurses and Prescription Drug Abuse

Although the rates of substance abuse among nurses are roughly equal to that of the general population, nurses are much more likely than the average person to abuse prescription drugs. This is especially true for female nurses, as they are much more likely than their male counterparts to abuse prescription drugs.

According to data from the National Council of State Boards of Nursing (NCSBN), 40 percent of nurses who were disciplined for substance abuse had initially used prescription medication to treat a chronic pain condition before forming a dependence on the drugs. An additional 42.5 percent of nurses with SUD began abusing substances to cope with emotional problems.

Addiction can affect anyone in the nursing profession. However, statistics from various sources indicate that the rates of prescription drug abuse are highest among nurse anesthetists, in particular. In fact, research findings suggest that anesthesiologists are five times more likely than the general public to abuse opioid drugs.

One study published by the American Association of Nurse Anesthetists (AANA) shows that 9 percent of the 2,700 nurse anesthetists surveyed had used opioids nonmedically in 2006. Since opioids and other controlled substances are easily accessible to those in the nursing profession, these numbers have not changed very much, even today. 

Nurses and Alcohol Abuse

“The use of alcohol… is commonplace in most cultures and is common among health professionals.”

—Madeline Naegle, author of “Nurses and Matters of Substance”

Alcohol abuse and alcoholism are more prominent in the nursing workforce than in any other line of work. 

According to the National Survey on Drug Use and Health (NSDUH) and the National Student Nurses Association (NSNA), 83 percent of registered healthcare professionals— mostly nurses— consumed alcohol at least once in 2006. 

That same year, 16 percent reported binge drinking. This is more or less equal to the national average of today.

Nurses and Illicit Drug Use

Compared to prescription drugs and alcohol, illicit drug use and addiction among nurses are quite low. In fact, rates of illicit drug abuse are lower among nurses than among the general population. 

Still, some nurses do use illicit drugs. For instance, a nurse who no longer has regular access to opioids may turn to heroin as a replacement. 

However, marijuana seems to be the most popular. In fact, according to the NSNA, roughly 4 percent of nurses use marijuana anywhere from one to three times per week.

Contributing Factors for Addiction Among Nurses

“Loyalty, guilt, and fear often prevent a nurse from reporting a colleague to the nurse manager.”

—National Council of State Boards of Nursing (NCSBN)

As is the case with any working professional, nurses may have a multitude of reasons for turning to drugs or alcohol. Some nurses may use drugs or alcohol to cope with the daily pressures of being a medical professional in a high-stress work environment. Others may use substances as an escape during their downtime.

Overall, there are a variety of factors that influence a nurse’s decision to start using drugs or abusing alcohol. These are the most common:

Access to Drugs

One of the most noteworthy contributing factors of drug abuse and addiction among nurses is their easy access to addictive substances. Highly sought-after drugs like depressants (benzodiazepines and barbiturates), stimulants (amphetamines and methylphenidate), and opioids (codeine, fentanyl, and morphine) are in stock at virtually every hospital in the U.S.

Nurses work with these and other equally-addictive substances every day. And, since it’s easy for nurses to access these types of drugs, it’s just as easy to steal, use, and become addicted to them.

One study found a correlation between drug accessibility in the workplace and substance abuse among nurses. According to this study, and many following it, nurses were more likely to use drugs when their access to them increased. 

Stress

Nursing is one of the most emotionally and physically demanding jobs that exist today. The responsibilities of a nurse extend beyond caring for patients; they have to provide information, comfort, and support for friends and family, too. Plus, in recent years, the role of “nurse” has undergone some drastic changes.

Today, more than ever, nurses are tasked with responsibilities that were once traditionally performed by physicians. These responsibilities, coupled with long shifts, few breaks, and no room for error, results in high levels of stress for nurses. 

One study published in Nursing Times revealed that 63 percent of the nurses surveyed experienced emotional or physical symptoms of job-related stress. Some even experienced both. Several of the nurses surveyed also disclosed that they usually work upwards of 10 hours of overtime each week.

High levels of stress can contribute to other mental health issues, like anxiety and depression— both of which can lead to substance abuse.

Other Contributing Factors

While factors like work-related stress and easy access to addictive substances play a notable role in drug use trends among nurses, there are a plethora of other reasons why nurses may use drugs or alcohol.

Some common risk factors that influence both the rates of drug use and the rates of addiction among nurses include:

  • Financial pressures (e.g., bills, insurance coverage, mortgages, etc.)
  • Regular exposure to open substance use or addiction in someone else
  • Psychological factors  (e.g., stress, high impulsivity, sensation seeking, etc.)
  • Environmental factors (e.g., physical, mental, or emotional abuse or trauma)

A family history of addiction can also contribute to the likelihood of drug use and addiction among certain individuals. In other words, some people, through no fault of their own, have a genetic predisposition to addiction because of their family members. 

It’s also important to remember that people who abuse legal substances like alcohol or prescription drugs typically get them through family or close friends. According to a 2005 study published in AORN Journal, roughly 80 percent of nurses who struggle with alcoholism have a family member who also abuses alcohol. 

While all these factors have more or less equal influence over the potential for addiction, mental health is one factor that arguably carries the most weight. In fact, mental health disorders and addiction are very closely related.

Mental Health Disorders Among Nurses

“Nurses go from one emotionally and physically demanding situation to another with little time to decompress.”

—Patricia Holloran, author of “Impaired: A Nurse’s Story of Addiction and Recovery”

Anxiety and depression are the two most frequently cited mental health issues among the general population. In fact, according to the Anxiety and Depression Association of America (ADAA), anxiety affects roughly 40 million American adults, and depression affects more than 16 million.

Numerous mental health professionals have agreed that these mental health issues are exceedingly common among nurses as a result of their profession. One study even found that over 48 percent of nurses surveyed (53 out of 110) met the criteria for anxiety and almost 53 percent (58 out of 110) met the criteria for depression. One participant showed signs of both.

However, depression and anxiety are far from the only mental health issues that nurses face today. Various other studies have shown that nurses have a higher-than-average risk of developing post-traumatic stress disorder and burnout syndrome— usually at the same time.

Nurses and PTSD (and BOS)

Like veterans, nurses are especially prone to post-traumatic stress disorder (PTSD), a condition that might develop following a traumatic event.

One survey from 2009 determined that PTSD is not only common among nurses but is also closely tied with burnout syndrome (BOS), another mental health issue that affects those with high-stress professions.

The study revealed that 73 of the 322 participating nurses (or 22 percent) showed symptoms of PTSD while another 61 (or 18 percent) met the diagnostic criteria for it. Moreover, 98 percent of those who met the criteria for PTSD also tested positive for BOS.

Although this study is a decade old, the statistics have not changed very much. In fact, the issues highlighted in the study are still very prominent among practicing nurses, even today.

Nurses with PTSD, BOS, or both are more likely than their peers to report work-related issues that they feel interferes with their home life. For example, nurses with PTSD and BOS are likely to experience difficulty in:

  • Engaging in fun activities during their time off
  • Doing things at home, such as household chores
  • Maintaining relationships with friends or even family

Overall, PTSD and BOS— as well as the issues that arise from them— put nurses at higher-than-average risk of turning to addictive substances to cope with the stress of work.

The Nurse Demographic and Co-Occurring Disorders (Dual Diagnosis)

Dual diagnosis is exceedingly common in those who struggle with addiction. In fact, those who already struggle with a mental health disorder have a much higher likelihood of developing a substance use problem than those who do not have a mental health disorder. 

The probability is even higher when someone with a mental health issue works in a high-stress profession, like nursing.

One 2014 study examined the medical records of 120 physicians and 30 nurses from 2008 to 2011. Of these participants, the vast majority of them (112, or almost 75 percent) reported having a dependence on alcohol. The study also found that:

  • 24 of them (16 percent) used cocaine
  • 59 of them (39 percent) abused sedatives
  • 15 of them (10 percent) abused other stimulants
  • 16 of them (almost 11 percent) abused opiates other than heroin

Additionally, 61 of the 150 participants (or 41 percent of them) also met the criteria for at least one mental health disorder. Of this group, 42 of them (or 28 percent) were diagnosed with major depressive disorder. 

Overall, the most common dual diagnosis among this group consisted of alcohol dependence and major depressive disorder.

Increasing Demand for Drug and Alcohol Rehab for Nurses

“Early recognition, reporting, and intervention are fundamental for keeping patients safe from harm and helping colleagues recover.” 

—National Council of State Boards of Nursing (NCSBN)

Although the rates of substance abuse among nurses are more or less equal to those of the general population, it is a problem that has been prominent within the medical community for many years. Before SUD was officially classified as a treatable disorder, nurses who were caught abusing drugs or alcohol lost their jobs soon after.

Unemployment (or the threat of it) is usually a consequence of substance abuse, but until recently, nurses almost always lost their jobs as a result of substance abuse. It’s important to remember that an impaired medical professional is significantly more likely to cause issues in the workplace, like patient negligence.

nurse rehab

Naturally, behavior like this usually results in severe disciplinary action from state medical boards. However, since SUD has been classified in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a treatable condition, most state medical boards now offer treatment resources to impaired nurses as an alternative to traditional disciplinary action. 

In other words, most state medical boards will send addicted employees to rehab rather than fire them. Plus, organizations like the American Nurses Association (ANA) have begun providing invaluable information and resources to nurses with SUD.

So, today, nurses with SUD have access to various treatment options that save not only their health but also their careers.

Drug and Alcohol Treatment Options for Nurses

Although the rates of substance abuse and SUD among nurses is on par with those of the general population, nurses are much more likely to seek treatment. Moreover, nurses have a much higher recovery success rate and a much lower relapse rate than the general population.

Generally, nurses in recovery participate in all four primary levels of addiction treatment since they each offer benefits that address specific aspects of the disease. The four levels of care in addiction treatment are:

Peer assistance services are also widely available to nurses in recovery. Like the levels of care listed above, these comprehensive support programs help nurses overcome all physical, mental, and emotional aspects of drug or alcohol abuse.

Peer assistance programs typically involve:

  • education
  • drug monitoring
  • community resources
  • comprehensive evaluations
  • individual case management
  • therapy for colleagues, supervisors, family, etc.

Overall, the specialized programs available to nurses with SUD are designed to address addiction and dual diagnosis, all while also focusing on ongoing recovery and sober living.

Outcomes for Nurses in Recovery

Today, more than ever before, nurses who struggle with SUD are getting the help they need to get and stay sober. 

For more information about rehab and drug recovery options for registered nurses, contact us here or call us at (833) 369-6443.

References:

Centers for Disease Control and Prevention (CDC). (n.d.). CDC – Fact Sheets-Binge Drinking – Alcohol. Retrieved from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

Cidambi, I. (n.d.). Nurses Addicted to Drugs. Retrieved from https://www.psychologytoday.com/us/blog/sure-recovery/201803/nurses-addicted-drugs

DATA USA. (n.d.). Registered Nurses. Retrieved from https://datausa.io/profile/soc/291141/

DATA USA. (n.d.). Physicians & Surgeons. Retrieved from https://datausa.io/profile/soc/physicians-surgeons

Dunn, D. (2005, October). Substance abuse among nurses–defining the issue. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16370231

Ford, S. (n.d.). Exclusive: Stress levels at work making nurses ill, finds survey. Retrieved from https://www.nursingtimes.net/exclusive-stress-levels-at-work-making-nurses-ill-finds-survey/5077537.fullarticle#

Mealer, M., Burnham, E. L., Goode, C. J., Rothbaum, B., & Moss, M. (2010, August). The prevalence and impact of post-traumatic stress disorder and burnout syndrome in nurses. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919801/

Naegle, M. (2006, November). Nurses and Matters of Substance. Retrieved from https://pdfs.semanticscholar.org/dc4a/b6e783e7a5227bdc2e0f90c863baea5eb08a.pdf

National Council of State Boards of Nursing, Inc. (2013). Substance Use Disorder Guidelines for Nurses – Video Transcript. Retrieved from https://www.ncsbn.org/transcript_SUD.pdf

The Anxiety and Depression Association of America (ADAA). (n.d.). Facts & Statistics. Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics

Trinkoff, A. M., Zhou, Q., Storr, C. L., & Soeken, K. L. (2000). Workplace access, negative proscriptions, job strain, and substance use in registered nurses. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10768584

Tsaras, K., Papathanasiou, I. V., Vus, V., Panagiotopoulou, A., Katsou, M. A., Kelesi, M., & Fradelos, E. C. (2018, February). Predicting Factors of Depression and Anxiety in Mental Health Nurses: A Quantitative Cross-Sectional Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789556/

Wright, E. L., McGuiness, T., Moneyham, L. D., Schumacher, J. E., Zwerling, A., & Stullenbarger, N. E. (2012, April). Opioid Abuse Among Nurse Anesthetists and Anesthesiologists. Retrieved from https://www.aana.com/docs/default-source/aana-journal-web-documents-1/opioidabuse-0412-p120-128.pdf?sfvrsn=807a48b1_8

Article Reviewed by Dr. Keerthy Sunder, MD, DFAPA

Dr. Keerthy Sunder, MD, DFAPADr. Keerthy Sunder, MD is an accomplished and internationally recognized expert in the field of addiction. He has earned diplomates from the American Board of Psychiatry and Neurology, the American Board of Addiction Medicine, and the Royal College of Obstetricians and Gynecologists.