Substance Abuse Among Nurses: A Silent Epidemic

People turn to drugs for a variety of reasons, and there are many risk factors for substance dependence. Many people who struggle with addiction have at least one underlying comorbid mental health issue, like depression, anxiety, or bipolar disorder. Chronic low mood, feelings of helplessness and desperation, and chronic stress can all lead people to self-medicate with mood altering substances that carry a high risk of dependence. Nurses are no exception.

Access to Drugs, Occupational Stress, & Underlying Predispositions: The Perfect Storm

Nurses have a high-stress and often underappreciated job, and for people with low stress tolerance or underlying mood disorders, this can begin to take a major toll on the person’s well-being. Nurses, along with physicians, are also in an occupational position that gives them higher potential access to drugs than the general population. As early as 1962, opioid dependency was identified as an occupational risk for nurse anaesthetists. The combination access to scheduled substances, underlying genetic and personality factors, and work-related stress can come together to put a person at high risk of developing a substance dependence disorder.

When substance abuse begins, it’s often a way to cope. The mood-altering effects of opioids, which can create a sense of warmth, well-being, and profound relaxation, are pleasant, and often “cover up” underlying psychological problems. But over time, the neural mechanisms of addiction take their toll on a person’s ability to experience normal pleasure through the brain’s reward systems.

Opioid and other substance abuse progresses through stages. It begins with initial use, although contrary to what 1980s PSAs may have told you, you’re not hopelessly addicted all of a sudden after trying a drug once. Rather, it’s a gradual process. Repeated use of a drug, in pursuit of the recreational and pleasure aspects of its effects, eventually expands into excessive daily use. Eventually, especially in the case of opioids, it stops being a matter of “getting high.” Long-term neurochemical changes eventually lead to a physical need for that substance in order to “feel normal,” and sudden cessation produces incredibly unpleasant withdrawal effects. At this point, a person cannot simply make a decision to stop using drugs. Intervention and rehabilitation are essential.

Prevention, Awareness, and Non-Punitive Approaches to Rehabilitation

It’s hard to find accurate statistics regarding substance dependence because it’s often silent and invisible until it’s too late. In 2009, the ANA estimated that as many as 10% of nurses may be dependent on drugs.

Traditionally, drug addiction was often approached in a disciplinary manner. However, it’s important to recognize that substance dependence is a mental health issue, and should be treated as such. Since the 1970s, nursing boards have adopted non-disciplinary approaches that focus on treatment and rehabilitation.

Adopting an organizational climate of transparency, and cultivating widespread awareness of the risk of addiction among nurses, can help reduce the rates of dependence. Regular drug testing is also a means of identifying at-risk nurses, who could become a danger to their patients. Fortunately, when addicts are referred to the right treatment programs, they can overcome their substance addiction.

Substance addiction is an age-old problem. While nurses will always be at higher risk of prescription drug dependence due to their occupation, awareness programs and educational initiatives–combined with compassionate, science-based treatment initiatives for addicts–can help address the widespread issue of opioid and other drug dependence in the nursing community.