Substance Abuse in Nursing: Recognizing the Signs and Finding Help

How Common Is Substance Abuse in Nursing?

Nurses are at a higher risk of developing certain mental health conditions:¹²

• Post-traumatic stress disorder (PTSD)
• Depression
• Anxiety

It’s very common for anyone with these diagnoses—including nurses—to self-medicate with drugs or alcohol. And in the short term, substances can help manage or numb your symptoms. But over time, that behavior often leads to addiction. 

Increased Access to Medications 

Nurses also have access to medications that most non-healthcare workers don’t. Studies show this increased access may make nurses more vulnerable to substance abuse.¹³ What’s more, nurses are at a higher risk of addiction to prescription medications than the general public. 

It’s common for healthcare professionals to diagnose and treat themselves.¹⁴ But without a supervising prescriber, you’re responsible for monitoring your own drug use. This makes it all too easy for nurses to take drugs in secret, leading to a higher likelihood of substance abuse amongst nurses.

Signs and Symptoms of Substance Abuse in Nursing Professionals

Many nurses know how to hide their drug and alcohol use.¹⁵ And without specialized training, many healthcare professionals miss the signs of substance abuse in their colleagues. It’s important to learn how to recognize these symptoms to keep both patients and nurses safe.

Many nurses show behavioral changes as their addiction develops:¹⁶

• Mood swings
• Withdrawal from colleagues, friends, and family
• Increased absences and tardiness
• Defensiveness or dishonesty
• Aggression
• Changes in appearance
• Frequent use of gum or mints
• Heavy intoxication at work events like holiday parties
• Expressing paranoia, feelings of pain, or depression

You might also notice physical symptoms:¹⁷

• Dilated pupils or bloodshot eyes
• Slurred speech
• Unsteady gait
• Rapid weight changes
• Lack or excess of energy
• Runny nose
• Tremors

In more severe cases, nurses with addiction show signs of impaired practice:¹⁸

• Frequent errors in administering, ordering, recording, or disposing of medications 
• Patients complaining about reduced pain relief
• Consistently offering to administer medication for other nurses
• Showing up at work on days off
• Frequently leaving to use the bathroom, or go to the parking lot

If you notice signs of addiction in a colleague, it’s important to report it. Often, nurses will only receive treatment after a colleague does this. In many U.S. states, for example, state boards require healthcare professionals to report any signs of substance abuse¹⁹ from a coworker. 

What Happens When a Nurse Develops a Substance Use Disorder?

Nurses with substance use disorders face unique consequences and barriers to treatment. 

Patient Care From Nurses Experiencing Addiction

In healthcare settings, nurses provide most of the direct care to patients.²⁰ Because a patient’s condition can change at any time, nurses have to be ready to make clinical decisions at a moment’s notice. When you’re drinking or using drugs, your judgment is limited. You can’t react as quickly, think as clearly, or notice as many details. In many situations, that can put a patient’s health at risk.

Addiction Stigma in the Healthcare Industry

Unfortunately, many healthcare professionals harbor negative beliefs about people experiencing addiction.²¹ So nurses that develop addiction may fear how their colleagues will judge them. They also may feel shame about using substances despite being a healthcare professional. 

Because of this stigma, nurses don’t always report their suspicion of a colleague’s addiction.²² They may fear social backlash at work, or fear what will happen if their colleague gets fired. Some hospital administrators even ignore reports of impaired care. In the short term, this can seem like a way to avoid malpractice lawsuits or staff shortages. But it can also be a barrier to treatment for nurses with addiction.

Barriers to Treatment for Nurses With Addictions

For many nurses, stigma delays treatment for substance abuse.²³ Healthcare professionals are unlikely to get help until their substance use is severe enough to have serious consequences.

Nurses also face other barriers to drug and alcohol treatment:

• The belief that they can stop on their own because of their medical training
• Fear of legal and professional consequences like losing their license
• Financial concerns about how to pay for rehab, especially if they lose their job

Resources for Nurses Seeking Help With Substance Abuse

Government and national nursing organizations recognize that substance abuse harms both nurses and patients. So some U.S. states now offer certain resources to nurses seeking addiction treatment.²⁴ Many of these programs protect you from professional discipline if you follow certain rules. 

Alternative to Discipline (ATD) Programs 

Alternative to Discipline (ATD) programs are a common treatment option²⁵ for nurses with substance use disorders. They are state board-run, confidential, and not mandatory. In most U.S. states, a nurse’s employer will refer them to an ATD program as soon as they learn of the nurse’s addiction. If you stay in that program you might be protected from prison time, losing your license, or getting fired.

The idea behind these programs is that most nurses will choose to get help if they can do so safely. Studies show that ATD programs effectively help nurses avoid relapse,²⁶ return to work, and improve patient care.  

When you’re in an ATD program, you’ll usually sign a return-to-work agreement²⁷ to uphold certain standards for a set period of time:

• Complete a recognized treatment program 
• Work less intensive hours, such as avoiding overnight shifts
• Avoid situations where you’d work alone, like home healthcare
• Refrain from handling or administering narcotics 
• Submit to random drug tests or alcohol screenings
• Attend regular support groups meetings or 1:1 therapy sessions
• Check in with administrators on a regular basis
• Disclose addiction and treatment plan to future employers

Some nursing specialities require stricter standards.²⁸ For example, anesthesia nurses must have 1 year of sobriety before they can return to work.

Employee Assistance Programs (EAPs)

Some employers have in-house programs for employees with substance misuse.²⁹ These employee assistance programs (EAPs) vary widely across institutions. However, most EAPs are employer-paid and confidential. 

Some EAPs only offer health promotion and awareness activities. Others can refer you to a treatment center or provide treatment themselves. Once you’ve completed treatment through an EAP, they’ll likely monitor your progress with check-ins and random drugs tests. 

To find out if your employer offers an EAP, you can get in touch with a human resource manager. You can also look through the employee handbook or orientation materials if you’re not ready to talk to a colleague. 

Peer Support Groups for Nurses

Sobriety support groups³⁰ can supplement more formal substance abuse treatment. And nurses can attend support groups just for other nurses and healthcare workers in recovery:

• Nurses Peer Support Network offers in-person meetings in Minnesota and online meetings.
• She Recovers Support for Healthcare & Allied Professionals Group hosts online meetings every Saturday night.
• International Doctors in Alcoholics Anonymous is open to nurse practitioners and registered nurse anesthetists.

Some hospitals also offer 12-Step meetings for employees. There, you can connect with other people who understand the unique challenges of nursing while you’re in recovery. And you’ll be able to find mentors who have successfully returned to work while staying sober.

Residential and Outpatient Rehab Programs for Nurses

Some rehabs have treatment programs specifically for nurses and other healthcare professionals. You might access them through an ATD program or an EAP, or you can attend on your own. Depending on your employer’s requirements, you can choose between outpatient or residential treatment. 

Some outpatient programs may allow you to work during treatment. But if your substance use is more severe, you might need to start recovery in residential rehab.

Learn more about getting time off for addiction treatment here.

You’ll have access to a variety of treatment options, depending on your rehab program:

• Individual therapy to work through personal or secondary trauma and learn new coping methods
• Medication-assisted treatment
• Family therapy to repair your relationships with loved ones
• Holistic therapies that address your mental, physical, and spiritual wellbeing

These therapies can help you work through triggers and address the root cause of your substance misuse. If and when you return to work, you’ll be able to keep everyone safe—both yourself and your patients.
To get the specialized care you need, explore rehab for professionals to learn more about pricing, insurance coverage, and therapy options.

Frequently Asked Questions About Substance Abuse in Nursing