The Risk Of Substance Use Among Nurses And Nursing Students

Nurses serve a critical role in the United States healthcare system, as care workers that help promote both public health and public safety.

Unfortunately, one of the silent struggles of nurses, as well as students studying to become nurses, is substance abuse and addiction.

While nurses are often praised for the work they do to care for and support others, the truth is that no one is immune to struggles with mental health and substance use issues.

Within this guide, you’ll find:

• risk factors for substance abuse among nurses
• warning signs of substance abuse
• alternative strategies for managing stress
• supportive resources for nurses struggling with substance use

Why Are Nurses At Risk For Substance Use?

Substance abuse in nurses and the general population at large can be influenced by a variety of factors, including biology, genetics, stress levels, and environmental factors.

Well-known risk factors for substance abuse include:

• family history of drug or alcohol issues
• experiences of trauma
• lacking a robust support system
• high stress levels
• history of mental illness
• use of addictive drugs

Nurses, in particular, may encounter a number of issues related to work or one’s personal life that can influence the development of harmful substance use behaviors.

Access To Substances

Research on the prevalence of substance abuse in nurses shows that access to addictive substances, and knowledge of these medications, can contribute to substance use issues.

According to multiple studies, nurses are more likely to use substances when they have easy access to them in the workplace.

Furthermore, having knowledge about these substances can also make a nurse feel more invulnerable to their harmful effects.

Stress

Nurses, who make up the largest section of the health profession, are frequently exposed to stressful situations that can affect emotional, physical, and psychological well-being.

Common sources of stress among nurses include:

• demanding work responsibilities
• insufficient communication from leadership
• inconsistent work schedule
• staffing ratios
• physical labor
• insufficient training
• substandard working conditions
• exposure to infectious diseases

Stress can negatively affect nurses’ ability to deliver quality care for patients, as well as take care of their own health.

While nurses are rigorously trained on how to take care of others in a healthcare setting, this does not always extend to information on taking care of oneself.

Fatigue

Chronic fatigue frequently plagues nurses, who commonly face long shifts, demanding physical labor, and may be required to be available to work unexpectedly on short notice.

After a long shift at work, a nurse may turn to substances to relax, unwind, help them fall asleep, or to relieve symptoms of fatigue, such as headaches or sore muscles.

Physical Pain

Nurses who develop physical pain issues from performing physical labor on the job can be at an increased risk for turning to substances, such as narcotics, to self-medicate and find pain relief.

Back problems, for instance, as well as stiff muscles, ankle pain, and foot pain are common grievances expressed by nurses and can become debilitating for some without treatment.

Physical pain may drive an individual to begin misusing narcotics, including those prescribed by a doctor. Unfortunately, this can lead to a severe cycle of drug addiction without intervention.

Co-Occurring Disorders

Nurses are at high risk for developing mental health issues such as depression, anxiety, and post-traumatic stress disorder—all of which commonly co-occur with substance use disorders.

Drugs and alcohol may be used to:

• relieve anxiety
• numb emotional pain
• escape from reality
• self-medicate grief or sadness

Lack Of Education On Substance Use

Research shows that a lack of education on substance use may also play a role in the development of substance use issues among nurses.

While nurses are educated on how to prepare and administer substances, nurses may not have knowledge of how to identify an alcohol or drug issue in themselves or their colleagues.

Having a poor understanding about substance abuse can also reinforce negative beliefs about nurses with substance use disorders, which may make it harder for nurses to speak up and seek help.

Substance Abuse Risks For Nurses

Substance abuse can place the public, patients, and the nurse struggling at risk for injury or potentially even death. Nurses can also face legal and professional consequences.

Without seeking treatment, a nurse may be at risk for:

• personal health consequences
• making dire medical errors
• losing their job
• suffering injury at work
• negative effects on mental health
• relationship problems
• getting into legal trouble

Even more, colleagues may also feel the burden of this struggle, as nurses have both a legal and ethical responsibility to report any behavior that poses a risk to the best interests of patients.

Signs Of Substance Abuse Among Nurses

According to national survey data, more than 21 million adults in the United States have some form of substance use issue, including addiction to drugs or alcohol.

Nurses are just as susceptible to developing drug and alcohol issues as anyone else. Being able to identify the signs of substance abuse can provide guidance for when it may be time to seek help.

Behavioral Signs Of Substance Abuse

Substance abuse can affect how a person thinks, feels, and behaves. Among nurses and nursing students, this can show up in a variety of ways.

Common behavioral signs of substance abuse include:

• making excessive mistakes on the job
• long absences from the unit during a shift
• acting very jumpy
• talking very fast
• arriving very late or early
• unusual changes in energy
• frequent trips to the bathroom
• laughing at inappropriate times
• increased isolation from colleagues
• frequently forgetting things or appearing disoriented

Physical Signs Of Substance Abuse

Physical symptoms of substance use can be some of the most visible signs of a drug or alcohol problem, and may become progressively worse over time.

Physical signs of substance abuse include:

• increasingly disheveled or gaunt appearance
• unusual tiredness
• slurred speech
• dilated or constricted pupils
• shakiness and tremors
• watery eyes
• chronic runny nose
• rapid changes in weight
• impaired balance and coordination
• frequent use of mints or mouthwash

Someone struggling with substance abuse may also become malnourished, which may cause hair loss, dry skin, mental fogginess, and feeling cold very often.

Signs Of Drug Diversion

Nurses with a drug use disorder who are unable to receive substances from a prescriber may turn to the workplace to access or divert drugs.

Signs of drug diversion might include:

• recurrent reports of ineffective pain relief among patients
• offering to administer medicine for coworkers’ patients
• inaccurate narcotic counts
• large amounts of narcotic wastage
• altered medication orders

Another sign that might be noticed by colleagues is variations in controlled substance discrepancies. That is, when things aren’t adding up, literally.

If a nurse is diverting substances, these discrepancies will likely only occur on days when the nurse is working, or during their shifts.

What Can Be Done To Lower The Chances Of Substance Abuse

Alcohol and drug use disorders thrive in isolation, and they don’t develop overnight.

With early intervention, and the provision of a supportive work environment, the chance of developing a serious problem among nurses can be effectively reduced.

Having a strong social support system, engaging in self-care, and having knowledge of available access to mental health and social support services can also help with this.

Stress Management

Stress is a major risk factor for substance abuse. Finding ways to manage stress, whether related to work or other personal issues, can help prevent unsupportive coping behaviors.

Tips and strategies for managing stress include:

• Checking in: Checking in with yourself regularly, and learning how to identify signs of burnout, can give you a starting place for addressing what’s causing your stress.
• Exercise self-compassion: Be kind to yourself. In times of stress, showing yourself compassion can be critical to protecting both physical and emotional health.
• Create a support network: Build a support network of people, such as trusted friends, family, or colleagues that you can turn to in times when you’re feeling overwhelmed.
• Stay nourished and hydrated: Eating a sufficient diet and drinking water regularly to stay hydrated can help prevent health issues that could exacerbate work-related stress.
• Getting enough rest: Getting enough rest between shifts at work can help prevent the effects of burnout and give your body the time it needs to recuperate.
• Joyful movement: Engage in forms of physical activity that feel pleasurable and bring joy to your life. For instance, trying yoga, walking, biking, or dance.
• Schedule time for yourself: Find time outside of work to step away from the noise and find ways to relax, such as reading a book, watching a movie, or listening to music.

Coping With The Physical Aspects Of The Job

Physical pain is a common but treatable grievance among nurses. Nurses spend much of their time bending over, walking, standing, and lifting objects or patients.

Coping with physical aspects of the job can be effectively done through a number of behavioral strategies and lifestyle choices.

Tips for coping with physical demands of nursing:

• Practice regular stretching to help loosen your muscles and relieve stiffness.
• Use proper body mechanics to avoid back injury from improper lifting or transferring.
• Use heat (e.g. a warm bath) or ice to help numb, soothe, or reduce inflammation.
• Find high-quality, supportive footwear to wear for work.
• Talk to your doctor about recommended over-the-counter medications for acute pain relief.
• Ensure you’re getting plenty of rest between shifts to help support your physical and mental health.
• Practice breathing exercises to relax the body and mind.

Can Nurses Get Help For Mental Health And Substance Use?

Prior to the 1980s, many boards of nursing took a punitive approach to substance abuse among nurses that would often lead to nurses being fired or otherwise disciplined.

Nowadays, most state boards favor non-disciplinary programs that promote rehabilitation, to help nurses heal and get back to a place where they can safely return to work.

Getting Help For A Colleague With Substance Use Issues

All healthcare workers have a duty to report issues, such as the substance abuse of themselves or their colleagues, that could pose a risk to the health and care of patients.

According to the National Council of State Boards of Nursing, early intervention, reporting, and recognition of an issue can be critical for protecting the health of both nurses and their patients.

What Type Of Help Is Available For Nurses With Substance Use Issues?

Today, most state boards of nursing offer alternative-to-discipline programs that refer nurses for evaluation and drug or alcohol treatment that can be tailored to meet their needs.

The type of treatment program that is recommended for a person can vary according to the severity of their condition, effects on health, and other personal and health-related factors.

Treatment for substance abuse may involve:

• drug or alcohol detoxification
• behavioral therapy
• individual and group counseling
• medication management
• stress management
• mental health treatment
• relapse prevention planning
• aftercare support

Chronic or severe addiction may require a higher level of care for treatment, such as an inpatient or residential treatment program.

For nurses with mild substance use issues, a peer assistance program or recovery monitoring program, coupled with outpatient treatment services, may also be suitable.

Once the safety of a nurse’s ability to practice is established, they may be able to return to work with a supportive monitoring program in place.

Peer Assistance Programs For Substance Use

Peer-assistance programs are advocacy and support group programs that serve to help nurses succeed in addiction recovery. This is not the same as a treatment program.

Peer assistance is a type of program exclusively for nurses. It primarily involves attending peer support group meetings, which are free, confidential, and facilitated by nurses.

The primary focuses of peer-assistance programs include:

• promoting personal growth in recovery
• helping nurses safely reenter the workforce
• guiding nurses toward community resources
• offering education about substance abuse and its effects

Peer assistance may be recommended after, or in conjunction with, a substance use treatment program.

What’s Important To Understand About Substance Use In Nurses

For decades, negative stereotypes about substance use issues among nurses kept nurses from seeking help or being able to identify a serious problem in colleagues.

What’s important to understand about substance use issues among nurses:

• Having a drug or alcohol issue is not a moral failing.
• Substance abuse is not a personal weakness.
• Addiction can affect anyone, regardless of age, race, ethnicity, or gender.
• Seeking help for a substance use disorder is a sign of strength.
• Getting help can help protect the best interests of yourself, your colleagues, and your patients.
• Addiction is a chronic illness, but it can also be successfully treated.
• Recovering from a substance use disorder is a lifelong journey, not a race, that requires patience, self-compassion, and understanding for life’s curveballs.

Mental Health And Stress Management Sources For Nurses

Drug and alcohol use can often serve a role of self-medicating or coping with difficulties in one’s life.

Early intervention through treatment and other supportive resources can help prevent a problem from becoming worse and more debilitating over time.

Support resources for nurses:

• American Nurses Association: Mental Health Help for Nurses
• Mental Health America: Frontline Workers Information And Resources
• American Psychiatric Nurses Association: Managing Stress & Self-Care During COVID-19: Information for Nurses
• Nurse Journal: Top Tips From Nurses on Dealing With Burnout
• Centers for Disease Control and Prevention: Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers
• National Alliance on Mental Illness (NAMI): Healthcare Professionals
• Emotional PPE Project: Free Counseling For Health Care Professionals

Resources for nursing students:

• National Alliance on Mental Illness (NAMI): Student Guide to Mental Health
• Premier Nursing Academy: Nurses Students’ Guide to Maintaining Good Mental Health

Nursing students may also have access to mental health services, including counseling and psychiatric services, through their college or university.

Information about finding counseling through a university or college can typically be found on the website of the institution or through the institution’s student health center.

Free And Confidential Support Helplines

If you’re feeling stressed, overwhelmed, or just need someone to talk to, here is a list of free and confidential helplines that can offer assistance:

• Substance Abuse And Mental Health Services Administration (SAMHSA)
  • Disaster Distress Line: 1-800-985-5990
  • National Helpline: 1-800-662-HELP (4357)
• National Suicide Prevention Helpline
  • Call 1-800-273-8255
  • For Spanish speakers: Call 1-888-628-9454
• National Alliance on Mental Illness (NAMI)
  • Call 1-800-950-NAMI (6264) from M-F 10 a.m. to 8 p.m
  • Text NAMI to 741-741
• Crisis Text Line (Available 24/7)
  • Text HOME to 741741 to connect with a crisis counselor

If someone is in an immediate crisis, call 9-1-1 for emergency assistance.

Forums And Support Groups For Nurses And Nursing Students

Having the knowledge that you’re not alone in the struggle, and being able to talk about struggles openly and honestly, can be a useful tool for maintaining mental health.

Chats, support groups, and forums for nurses and nursing students:

• American Holistic Nurses Association: Compassionate Listening Circles
• Nurse Groups: Resilience Groups for Nurses
• The Well-Being Initiative: Nurses Together: Join a Conversation
• PeerRXMed: No One Cares Alone Peer Support Program
• Mental Health America: Mental Health Support Group And Discussion Community
• Anxiety & Depression Association of America: Anxiety and Depression Support
• American Academy of Experts in Traumatic Stress: Online Support Groups for Emergency Responders and Healthcare Workers

If you’re a nurse struggling with a substance abuse issue, or know someone who is, you’re not alone. The road to recovery begins with a single step forward. After that, comes the rest of your life.

Written by the Addiction Resource Editorial Staff