It can be difficult to talk about substance abuse among nurses. Many people seem to see nurses as angelic caregivers who would never compromise their morals. Others think about easy access to medication - and an increasingly drug addicted society - and imagine lots of nurses must be addicts.
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Neither view is accurate. Nurses may not all be angels, but they are no more likely to become substance abusers than the general adult population. In keeping with the rest of the U.S., up to 10 percent of RNs might be dependent on alcohol or other drugs, according to National Council of State Boards of Nursing figures.
The problem may seem worse, the NCSBN points out, because "the behavior that results from this disease has far-reaching and negative effects, not only on the nurses themselves, but also upon the patients who depend on the nurse for safe, competent care. Many nurses with substance use disorder are unidentified, unreported, untreated and may continue to practice where their impairment may endanger the lives of their patients."
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But there's another factor at work here. A full 91 percent of RNs are women according to Health Career Institute. While nurses may not be more prone to substance abuse than the general population, women do tend to get addicted faster than men. Part of this involves female hormones, according to a recent Vanderbilt study. Researchers found women's hormonal cycles can make them more prone to drug addiction, especially when fertility-related hormone levels are high.
Earlier studies also showed women were more likely to relapse than men, perhaps because those same high hormone levels make women react more strongly to environmental cues that can trigger relapse.
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According to Erin Calipari, an assistant professor of pharmacology at the Vanderbilt Center for Addiction Research, the most critical finding of the study might be that while women are a population segment highly vulnerable to substance abuse, studies have focused pretty much entirely on men. Naturally, none of the hormones that can influence addiction or relapse would show up in an all-male pool of study subjects.
Moreover, for nurses addiction may kick off at a hormonal level, but the work environment takes it from there. "Access to potent, addictive medications (opiates, benzodiazepines, etc.) is easy and, therefore, the abuse of illicit drugs is lower among nurses as compared to the general population," according to Dr. Indra Cidambi in Psychology Today. "Nurses can get a doctor to prescribe a drug to them or they can divert medications meant for the patient."
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Addiction to prescription medicines can be further accelerated because nurses are "familiar and fluent with administering addictive medications," Cidambi noted, "which tends to inhibit negative thoughts around self-diagnosis and self-administration."
Women may also have more difficulty accessing drug treatment programs, for reasons that range from being less likely to end up in an emergency room due to substance abuse than men to simply being unable to line up child care during the needed treatment, according to studies surveyed by the National Institute on Drug Abuse.
Other factors at work for all nurses include the ease of being able to take the overnight or holiday shifts that help them avoid detection by management. Nurses trying to hide substance abuse are also able to hide behind working such long hours. After all, no one is surprised when a nurse is fatigued, so no one worries about it potentially signalling addiction.
"Nurses are usually the problem solvers in a patient care setting and they have difficulty asking for, and accepting, medical help," Cidambi added. "This is one of the reasons nurses can sometimes have trouble accepting they have substance abuse issues in the first place. When nurses do seek treatment, they sometimes find it challenging to accept the role of a patient. "
Nursing specialties can also influence addiction rates
The medical establishment at large should also pay attention to another factor that amps up the number of nurses with substance abuse issues: Which specialty they work in.
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A study published in the American Journal of Public Health used an anonymous mailed survey asking a stratified sample of nurses to self-report binge drinking and cocaine, marijuana and prescription drug use. The study found that 32 percent of respondents had used at least one of these substances in the past year.
It also discovered the rate varied, sometimes dramatically, by nursing specialty. After controlling for sociodemographic traits, the researchers still determined that ER nurses were 3.5 times more likely to use marijuana or cocaine than pediatric, women's health or general practice nurses. Nurses who worked in administration or oncology were twice as likely to binge drink.
, according to Dr. Indra Cidambi in
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