Drug Abuse in Nursing: Causes, Risks, and Recovery

Introduction: Nursing, Stress, and Substance Abuse

Nurses and other medical professionals are tasked with caring for their patients, healing the body, and saving lives. It is the job of these healthcare workers to literally stay death and make the individual well again. They are life givers and life savers. Every day, nurses and doctors go to work knowing that they will witness some form of despair and trauma. A nurse must be both compassionate and competent — capable of feeling for the patient while maintaining enough emotional distance to perform accurately and efficiently. Without that balance, the staff metaphorically bleeds for everyone who is physically doing so.

This profession places men and women in high-stress situations where poor choices can be made. If individuals are able to release their stress in healthy ways — through time with family or personal hobbies — they can function continuously without detrimental effects. However, some people respond to the high stress of the medical profession by turning to self-destructive behaviors. Some individuals succumb to alcohol, others to gambling or promiscuity. Still others succumb to the dangers of drug abuse, often using the narcotics available to them inside the hospital.

Prevalence and Scope of the Problem

According to Hrobak (2001), "Chemical dependency in nursing is defined as a state of psychological and/or physical addiction to a chemical substance or substances. Use of the substances, whether legally or illegally obtained, leads to a professional's inability to perform duties and responsibilities according to nursing standards." The prevalence of drug abuse in the nursing profession first came to the attention of the American Nurses' Association (ANA) in the mid-1980s. Research conducted in 1984 revealed that 8–10% of nurses admitted to having an alcohol dependency and 2–3% admitted to being dependent on drugs (Gnadt 2006, p. 151). In the modern era, this number has increased significantly. Approximately 10% of nurses are currently addicted to some sort of drug (Copp 2009).

Whereas the most frequently abused drug is alcohol, prescription drugs are also frequently abused. Among these are amphetamines, opiates, sedatives, tranquilizers, and inhalants. Not only do nurses in the United States engage in drug use, but the problem has escalated into a worldwide concern.

In the early 1980s, 48 states began investigating the percentages of nurses who were currently or had previously abused drugs and alcohol. The ANA also became interested in formulating and implementing testing and possible methods of rehabilitation for nurses who were addicted (Monroe 2008, p. 156). Drug abuse among nurses and other medical care professionals is an extremely hazardous issue. Besides the danger to the individual, drug addiction represents a breach of professional ethics, places patients at severe risk when they are being treated by someone under the influence, and can damage the reputation of both the individual and the facility where they work (Copp 2009). The use of drugs in the medical profession is an important subject to be understood, and those suffering from addiction must be treated as quickly and efficiently as possible.

Risk Factors and Contributing Causes

Researchers have tried to identify the exact correlations between substance abuse and nursing. By locating what triggers drug dependency, it is hoped that alterations can be made within the profession to alleviate the problem. One notable finding was that nurses were far more likely to abuse alcohol and drugs than other members of the medical profession, such as doctors or surgeons (Raistrick 2008, p. 57).

In order to determine which nurses were most susceptible to drug addiction, researchers Matthew Shaw and his colleagues (2003) examined age, race, gender, specialty within the medical profession, familial history of substance abuse, and access to prescription drugs within the hospital. Shaw's team began their inquiry into drug addiction and nursing with three possible hypotheses for why nurses engaged so frequently in drug abuse:

1. Given that physicians often have greater financial and legal resources, often work alone rather than in teams, and can self-prescribe, their addictions will be more severe than those of nurses by the time they enter a treatment program.
2. Given that nurses often work in caregiving roles and more collaborative environments, they will participate in treatment programs more fully than physicians.
3. Given that nurses are often less empowered within the healthcare system and have less advocacy within their professional organizations, they will experience harsher professional sanctions as a result of their substance use (Shaw 2003, p. 563).

The findings of the research indicated that nurses were not more susceptible to drug abuse in general, but were more susceptible specifically with regard to prescription medication. The researchers also found that nurses who lived in dysfunctional families were both more likely to begin abusing drugs and more likely to relapse after treatment.

A direct link has been established between the home environment and familial support of the nurse and the likelihood of developing an addiction. Logically, the higher the pressure of the job, the greater the likelihood that the person will turn to drugs (Shaw 2003, p. 562). Other potentially detrimental factors include whether the nurse has a consistent or erratic work schedule and how easily the individual can acquire prescription medication without having to formally record its removal. Some hospitals require pass codes or computerized entries to access medications, and these facilities are less likely to experience unreported removal of prescription drugs by staff members.

Hand in hand with familial support is the value of community. Even people who have an imperfect home life can abstain from drug and alcohol abuse when they have an external and supplemental support system (Gnadt 2006, p. 151). People who are highly religious and heavily involved in their religious communities are less likely to become addicted to drugs. Similarly, individuals who are engaged in activities outside of the hospital or medical facility at which they work are at lower risk. Both factors provide further evidence that people who have effective outlets for work-related stress are far more likely to avoid drugs and alcohol.

George Kenna and Mark Wood (2005) performed a study to determine the relationship between a familial history of drug abuse and the likelihood of nurses becoming addicts themselves. Family history of drug use (FHPD) has been established as a major factor in drug and alcohol addiction across many populations. One study reported that 62% of drug-dependent nurses had a family history of dependency (Kenna 2005, p. 226). It should be noted that FHPD is a strong factor in addiction and dependency in fields other than nursing as well.

It is also believed that the longer a nurse is on the job, the more likely the person is to become a victim of substance abuse. However, cases have been reported of young men and women succumbing to addiction even while still in nursing school. More attention has been given to this population in recent years, as researchers and medical officials want to determine where the risk for addiction is highest. Within nursing school communities, at least a third of students were declared to be "at risk" for drug addiction and more than 20% were considered "at high risk" (Gnadt 2006, p. 152). Many schools report high percentages of students at risk for potential drug use due to the high pressures of college-level work. The proportion of nursing students at risk for present or future drug use is only slightly higher than that of other students in the United States.

A steady and supportive home life can be the most effective weapon against drug use. Usually, a loving family helps relieve stress rather than compound it (Shaw 2003, p. 562). Nurses who are going through a divorce or are involved in dysfunctional relationships are more likely to engage in substance abuse. Research also found that families of nurses are more likely to function as enablers for those suffering from addiction. Knowing that their loved one works in a high-stress profession, they are more likely to dismiss behaviors that, in any other context, they would recognize as odd or uncharacteristic. Without others noting changes in behavior or character, the addict will almost certainly continue their drug abuse.

Works Cited

Copp, Mary Ann (2009). "Drug Addiction Among Nurses: Confronting a Quiet Epidemic." Modern Medicine.

Gnadt, Bonnie (2006). "Religiousness, Current Substance Use, and Early Risk Indicators for Substance Abuse in Nursing Students." Journal of Addictions Nursing. 17. 151–58.

Hrobak, Mandy L. (2001). "Narcotic Use and Diversion in Nursing." University of Arizona.

Kenna, George A. (2005). "Family History of Alcohol and Drug Use in Healthcare Professionals." Journal of Substance Use. 10:4. 225–238.

Maurer, Frances A. (2005). Community / Public Health Nursing Practice. Elsevier: Philadelphia, PA.

Monroe, Todd (2008). "Procedures for Handling Cases of Substance Abuse Among Nurses: A Comparison of Disciplinary and Alternative Programs." Journal of Addictions Nursing. 19. 156–61.

Raistrick, D. (2008). "A Survey of Substance Use by Health Care Professionals and Their Attitudes to Substance Misuse Patients." Journal of Substance Use. 13:1. 57–69.

Shaw, Matthew F. (2003). "Physicians and Nurses with Substance Use Disorders." Journal of Advanced Nursing. Blackwell. 47:5. 561–571.

Tompkins, Al. (2009). "Pro Publica Investigation Looks at Nurses Who Abuse Prescription Drugs." Los Angeles Times.