Addiction in Nursing Both alcohol and drug abuse are a serious issue plaguing the nursing profession. Drug abuse in nursing includes both illegal drugs and prescribed medications. Not only do they acquire these drugs from dealers on the streets, but also through diverting it from patient prescriptions. This paper will discuss the root causes of this serious problem. The statistics of the number of addicted nurses will be presented. Lastly, what can be done to address this problem will be overviewed.

Nurses are on health care's front lines. Their hard work, compassion and passion are in increasing demand. Increasing healthcare costs, an increasing aged population, high unemployment and poverty levels, and a variety of other societal factors have all resulted in increasing challenges for the nursing profession and an increasing reliance on their patient care skills. Disturbingly, there are also an increasing number of nurses who have an addiction problem.

Both alcohol and drug abuse are a serious issue plaguing the nursing profession. Drug abuse in nursing includes both illegal drugs and prescribed medications. Not only do they acquire these drugs from dealers on the streets, but also through diverting it from patient prescriptions. This paper will discuss the root causes of this serious problem. The statistics of the number of addicted nurses will be presented. Lastly, what can be done to address this problem will be overviewed.

Causes of Addiction:

When a person takes drugs, the pathways inside the brain are altered. In addition, nerve cells are physically altered as well, by the drug. Neurons communicate with one another, releasing neuro-transmitters that facilitate addiction ("Causes," 2010). Over time, anatomical changes occur in the brain that controls self-control and decision-making. In addition, drugs also simultaneously send pleasure signals to the brain and is experienced as a reward for taking the drug (Voiland, 2007). These same chemical changes occur in the brains of nurses.

Nurses abusing drugs or alcohol jeopardize the safety of their patients, according to Copp (2009), through slower reaction times, impaired judgment, neglecting patients, diverting drugs from patients, and making mistakes. Larson (2008) asks the questions, "Why might nurses -- people whose job is to promote health -- find themselves abusing alcohol or using a banned substance or diverting medications from patients? Why would they risk their licenses and livelihoods for a 'high?'" The answer isn't a simple one. The causes of addiction for nurses are as varied as addiction in any other population.

Larson (2008) cites Dianna Phares, Ph.D., FNP in explaining that addiction isn't a character flaw, but instead a disease. In fact, some may have genetic tendencies towards addiction. Nurses who have had parents that struggled with drug addiction or alcohol abuse are more susceptible to addiction or abuse themselves. This genetic component of addiction accounts for up to 60% of a nurse's vulnerability to addiction. In fact, Dunn (2005) notes family history of emotional impairment, drug use, alcoholism, emotional abuse, low self-esteem, overwork, and over-achievement are significant factors leading to substance addiction in nursing. However, as Louisa Stark, director of the Genetic Science Learning Center at the University of Utah notes, this genetic susceptibility does not mean addiction is inevitable (cited in Voiland, 2007). The genetic disposition for addiction doesn't come from just a single gene, but instead multiple interactive genes that result in vulnerability.

The stress from the nursing profession, and the sometimes life altering decisions nurses must make, also often factor into the high rate of addiction in nursing. Copp (2009) relates the story of Patricia Holloran, RN, as an example of how the stress of the nursing profession can result in drug addiction. Holloran was prescribed the nasal spray butorphanol (Stado), for her migraines. As a nurse, Holloran often administered the injected form of the drug to women in labor. In instances when the patient didn't require the full dose, Holloran would use the remainder of the dose, justifying it by telling herself it would help her sleep, after an extended night shift. In addition to helping Holloran sleep, it also helped her cope with the stress from extra shifts, being the primary family breadwinner, stealing entire vials from the dispenser. The stress from long hours, a difficult job, and caring for an extended family was a primary reason for Holloran's abuse.
No matter what their practice specialty, most nurses experience stress from long shifts, shift rotation and mandatory overtime. These are not only physically taxing elements of the job, but also strain family relationships and friendships. In addition to these physical stresses, nurses also must deal with emotional stresses. They are often required to internalize their emotions, in order to make life-and-death, split-second decisions. Nurses go from one stressful situation to the next and have very little time in between to decompress (Copp, 2009).

The ease of availability of drugs at work, as well as the understanding that drugs can be used to help people perform and feel better, increases the risk of drug abuse in nurses. Nurses see on a daily basis that drugs can solve problems for people. This increased access and familiarity may make nurses feel comfortable about using them without a prescription. A nurses skills and knowledge may give them the false belief that they are able to self-medicate, without the danger of addiction (Copp, 2009). Regretfully, this often proves to be untrue, as demonstrated by the high rate of addiction in the profession.

Nursing Addiction Statistics:

Addiction in nursing is a startlingly high occurrence. In a career where professionals are educated in health and well-being and committed to improving the health of their patients, it would seem hypocritical to even think that addiction is a problem in nursing. However, there is an increasing number of addicted nurses putting patients' lives in danger, on a daily basis and casting a pall on the profession in general. In some reports, it is estimated that one in three nurses suffer from addiction. This is significantly more than the addiction rate of one in five persons, in the general public ("1 in 3," 2006). In Texas, there are 600 to 700 nurses enrolled in their nursing rehabilitation program at any given time, and this is just nurses who have been caught using drugs or have sought help voluntarily (Kraft, 2010).

Dunn (2005) notes that there are disagreements on the exact statistics concerning addiction. Dunn cites a 1999 National Household Survey on Drug Abuse that indicated 13.1% of the employed population, in America, were substance abusers. Dunn than cites a National Institute on Alcohol Abuse and Alcoholism report that indicated one out of every 13 adults abused alcohol, with millions more engaging in heavy or binge drinking that can lead to alcoholism. A third cited source stated that one third of employees reported being affected by coworkers with substance abuse problems.

In regards to the nursing profession specifically, WLWT-TV report that, "of the thousands of complaints to the Ohio and Kentucky Boards of Nursing, more than 50% deal with impairment" ("1 in 3," 2006). The report also cites the Ohio Board of Nursing as stating their belief that nurses do reflect the general population. The primary difference is nurses have easier access to drugs.

Drugs of Choice:

Dunn (2005) notes that prescription medications are one of the more commonly abused substances. Addiction to cocaine, marijuana and other street drugs is lower in the nursing profession, when compared to the general population. Dunn continues to note that alcohol is the most frequently abused substances, in nursing, followed by prescription amphetamines, opiates, tranquilizers, sedatives, and inhalants.

Nurses often obtain their drugs in the healthcare setting. They may request that a doctor writes them a prescription. They may steal a prescription or forge the script themselves. Diverting drugs from patients by only administering a partial dose is another popular method of obtaining drugs. Nurses may also ask a colleague to sign off on a narcotics record that a drug was disposed of, without them actually witnessing the disposal of the drug. "Some nurses have signed out medications for patients who have been transferred to another unit or obtained as-needed medications for patients who have refused or not requested them" (Copp, 2009).

What Can be Done to Address Addiction:

Addressing the issue of addiction in nursing begins with recognizing the signs of an impaired nurse. These signs, according to Copp (2009), include: frequent job changes, a preference for night or off-shifts where there is more access to medication, due to less supervision, glassy-eyes, pinpoint pupils, excessive use of breath mints or mouthwash, or smells of alcohol. Impaired nurses also often fall asleep during meetings, have trouble focusing on work, have a history of chronic pain, and form good relationships with doctors who prescribe the drugs. They often have family problems, volunteer to administer drugs to patients, yet those patients may complain that they still have pain. Addicted nurses often have incomplete charts and errors, they're eager to work extra shifts and overtime, and they can be moody, lethargic, high-strung, or seek isolation.

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