Substance Abuse and Addiction Among Healthcare Providers

Healthcare Providers and Substance Abuse

 Drug Use By Health care Professionals,Alcoholism Among Nurses,Substance Abuse and Job Stress,Workplace Factors and Drug Abuse.

Drug Use By Health care Professionals 

    Drug use by health professionals has a long history but became the focus of public health concerns in the 1980s. Illicit drug use peaked in the 1970s and alcohol use by more than half of Americans resulted in significant prevalence of alcohol and drug related problems. 

    These were paralleled in physicians, nurses, pharmacists, and others, causing concern based on the public trust vested in these professionals. Research on substance use/abuse among registered nurses emerged in response to a death of accurate data on nurses' drug use and addiction problems, which committed the development of policy and educational initiatives in this area. 

    The climate of social concern and the visibility of substance-related problems within the profession prompted the American Nurses Association (ANA) and several specialty nursing associations to support research and develop positions on the issue. 

    The American Nurses Association House of Delegates in 1982 passed a resolution on impaired practice, defined as “nursing practice which does not meet the professional ethical code and standards of nursing practice because cognitive, interpersonal, and/or motor skills of the practitioner are impaired by psychiatric illness or excessive use of alcohol and/or other drugs.” 

    A policy statement, Addictions and Psychological Dysfunctions: The Profession's Response to the Problem, followed (ANA, 1984). Research related to the origins of impaired practice by registered nurses' dates from the 1980s, and focuses on patterns of drug and alcohol use; nurse and nursing student attitudes (Engs, 1982; Haack & Harford, 1984).

    The course, recovery, and relapse of illnesses linked with alcohol and/or other drug problems among registered nurses (Hutchinson, 1986; Sullivan, E., 1987); and more recently, potential contributing factors to the development of addiction ( Trinkoff &Storr , 1998a, 1998b).

Alcoholism Among Nurses

    An estimate of alcoholism at 2% among nurses was first extrapolated from a small descriptive survey by Bissell and Haberman (N=407) of nurses in Alcoholics Anonymous (AA). Although these findings were limited by the size of a small, primarily Caucasian, convenience sample of survivors of addiction, they quickly became normative. 

    Nurses in AA and recovery reported that 55%-63% had used narcotics and between 20% and 64% had used marijuana (Sullivan, E., Bissell, & Leffler, 1990). The estimate of drug and alcohol-related problems first adopted by ANA was 6%-9%, based on estimates from the National Household Drug Survey on alcohol and illicit drug use rates in the female population at large. 

    The first findings of alcohol or drug use and abuse, the primary predispositions to addiction in registered nurses, were those of Trinkoff , Eaton, and Anthony (1991). The Epidemiologic Catchment Area Study (ECA) sponsored by the National Institute of Mental Health (NIMH) was a multisite probability sample, which included 142 nurses working full or part-time. 

    These researchers found that nurses in the study and control group members had similar rates of illicit drug use: nurses 32.9% and non-nurses 31.5% (marijuana, cocaine, heroin, other opiates, psychedelics, tranquilizers, and amphetamines). Non nurses had a much higher prevalence of alcohol abuse, with 3.8% reporting heavy use and 8.8% reporting pathological use. 

    Nurses' parallel rates were 0.7% heavy use and 4.9% pathological use ( Trinkoff , Eaton, & Anthony). Despite the self-report and retrospective nature of data collection, these findings moved forward efforts to delineate the scope of the use/abuse problem. Blazer and Mansfield's (1995) randomized

Substance Abuse and Job Stress

    Descriptive survey (N = 1,525), measuring substance abuse in relation to stress and job outcomes, compared 920 nurses with other female employees. They found low levels of use of illicit drugs and alcohol for all subjects, with the lowest prevalence of smoking among nurse subjects and about 79% reporting moderate alcohol use. 

    The same factors which predispose members of the general population to addiction also predispose nurses. These include family history of substance abuse, stress in various life realms, or sexual and/or emotional abuse. Workplace/ occupational factors, much as they in- crease risk for personal stress, have been recently studied in an effort to understand the likelihood that nurses will develop addiction. 

    One factor, access to controlled substances through prescribing and/or dispensing, such as hypnotics and analgesics, have been linked, for nurses and other health professionals. 

    Findings of The Nurses' Worklife and Health Study, an anonymous, national survey of a stratified sample (4,438 registered nurses with a 78% response rate), indicated alcohol and illicit drug use similar to those of the general population, but higher prescription drug use rates for nurses. 

    Smoking and cocaine / marijuana use was lower than in the general population and binge-drinking rates were comparable ( Trinkoff &Storr , 1998a, 1998b). The prevalence of past-year substance use for all substances was 32%; for marijuana/cocaine, 4%; prescription drugs, 7%; cigarette smoking, 14%; and binge drinking, 16%. Male nurses were more likely to misuse prescription drugs , and of drugs misused, opiates were used most frequently ( 60.3%), and tranquilizers (44.6%) next. 

    This research confirmed the link be tween easier workplace access and higher rates of substance use and provided direction for further analyzes of substance use by nursingspecialty. On further analyses, nurses in certain specialties were found to have much greater like- lihood of substance use. 

    Critical care and emergency nurses were more likely to report marijuana or cocaine use, oncology nurses were more like to report binge drinking, and smoking rates were highest among psychiatristsric , gerontology, and emergency nurses. Trinkoff and Storr (1998) further examined workplace issues in relation to the potential demands and stressor of schedule variations (rotating shifts and overtime). 

    This analysis of the Nurses' Worklife and Health Study revealed that work schedule characteristics were associated with the prevalence and odds of substance use. Working a few days overtime, working shifts longer than 8 hours, and working one or two weekends per month all increased the likelihood of using alcohol. 

    In addition, smoking was more prevalent among night-shift workers and those working several weekends per month, a factor that was also associated with increased drug use. While the survey data used in the foregoing analyzes were self-reports of drug use, such data have been found to be valid, although use may be somewhat underestimated.

 Workplace Factors and Drug Abuse

    The trend to correlated workplace factors such as job demands and access to substances represents a new direction from original efforts to estimate prevalence of actual illness by profession. On the whole, health professional groups have been unable to verify the prevalence of addiction to drugs and/or alcohol by profession . 

    Indirect data have been obtained by the review of reasons for disciplinary action, or through the study of nurses participating in peer assistance monitoring programs (Finke, Williams, & Stanley, 1996 ) . Research is just beginning to emerge on the patterns and progress of recovery in programs with various characteristics. 

    A recent survey of nurses returning to work (N = 622) describes the challenges and obstacles faced by these professionals (Brown, J., Trinkoff , & Smith, 2003). These current trends suggest a research emphasis on preventtion by determining contributing workplace conditions, such as easy access, and assisting nurses with addiction to return to health and optimal professional performance.