By Kelly Phillips, feature writer
Nurses are as
likely as anyone else to abuse drugs or alcohol. But the shame and guilt may be
multiplied because of the deception they may carry out to feed their habit when
they are supposed to be administering care.
“On average, nurses have problems with addiction at the
same rate as anyone else,” said Dr. James Lea, chief of medical services and
director of the health professional treatment program at Hazelden Springbrook in
Newberg, Oregon.
“That would be 12 to 14 percent of the nurse population
could be diagnosed as alcoholic at some point in their life, not any one
point,” he added. “The lifetime prevalence for drug abuse or addiction is 6
to 7 percent.”
Nurses do differ from the rest of the population, though in
that “the kinds of drugs they use are better quality drugs,” Lea said.
Those include opiates and Vicodin, a brand of hydrocodone,
which Lea called “by far the drug of choice” among nurses.
“I see the problem of nurse addiction to be a
particularly difficult one because their access is so profound,” Lea said.
“The doctor may order the controlled substances, but the nurse is the one who
has it in her hot little hands.”
Barbara Vieu, RN,
CD, and Hazelden Springbrook’s manager of health services, agreed.
“It’s drugs
that are available and accessible” that addicted nurses may abuse, Vieu said.
Job stress
certainly can contribute, she added.
“The stress and
pressures of the job set them up for it,” Vieu said. “If they don’t have a
support system—ways of coping with those stressors—oftentimes they’ll turn
to [drugs].”
Lea agreed that
working conditions can be less than optimum for a nurse on the path to
addiction.
“Nurses are under terrific stress right now—more work,
higher patient load, less help,” Lea said. “I think that’s awfully
stressful. The stress of being asked to do more than they feel they can do
safely is real common.”
Other common
origins are using narcotics for pain relief, then becoming addicted, or
self-medicating for depression.
“Nobody starts
out to be or feels they would ever become addicted,” Vieu said.
Like anyone else, a
nurse may begin drinking after work as a stress reliever, and “before they
know it, about 15 percent of people that drink become alcoholic,” she said,
adding that “a far greater number” of those using and abusing narcotics
become addicted.
Elizabeth Moran
Fitzgerald, ARNP, LMFT, Ed.D., cited an American Nurses Association statistic
that one in 12 nurses in the United States has an alcohol or drug problem severe
enough to affect his or her practice.
“The scope of the
problem is big,” said Fitzgerald, who sees recovering women, many of whom have
lost their children because of their addiction, in her consulting business, Dr.
Elizabeth Moran Fitzgerald Inc.
When it comes to
intervention, the earlier the better, she said.
“A lot of times I
see people lose everything before getting help,” Fitzgerald said. “The
nurses I have worked with personally lost everything—their job, their family,
their children. They were at the point they had to do something.”
Lea called addiction in nurses “a terrible problem,
mostly because of patient care issues.”
Among actions that can place patients in jeopardy are
diversion of controlled substances—“basically drug theft,” Lea said—and
inaccurate charting.
An addicted nurse also forces coworkers to carry a bigger
load and “there’s just the general chaos in the workplace that surrounds
someone in active abuse,” Lea said.
Lea said he has continually been struck by “the
incredible power” of addiction to lead people to do things that are so out of
line with their normal behavior.
There can be an
added stigma for nurse addicts.
“Nurses are
looked at as the helper, the caregiver,” Vieu said. “There’s so much shame
and guilt around the use of narcotics, pain medication.”
The feelings of
shame and guilt are multiplied when nurses take medication from patients, maybe
administering a half-dose while keeping the rest for herself.
“Guilt,
rationalization, justification, denial—all those things play into it,” Vieu
said.
Nurses may be more
reluctant to admit they have a problem and seek help—if they even realize
there is a problem—for “fear of their license being on the line if it’s
found out,” Vieu said.
But getting quality
care is important for nurses because “they have real complex…treatment needs
that may go unaddressed or underaddressed,” Vieu said. Depression, eating
disorders and other underlying issues are common with addicted nurses, she said.
Nurses feel “incredible shame” because “they not only
violated their own personal code of ethics, but they also violated their
professional code, and that seems to be more distressing,” Lea said.
Nurses also may have financial issues that make it harder
to get access to the highest quality care, Lea said.
While nurses may be abusing the same “attractive” and
“hard-to-get-away-from” drugs as doctors and dentists, nurses don’t have
the same earning potential to put toward recovery, Lea said.
“It takes particularly strenuous treatment for these
people to have the best chance of recovery,” he said. “I think in general
nurses do just as well as anyone else in treatment and recovery.”
Still, the same
access issues that help fuel the problem can become an issue during recovery.
“Unless someone is in very good recovery, being around
those drugs is problematic,” Lea said.
Many states have
programs aimed at helping a nurse or doctor keep their license. Random urine
checks, required attendance at meetings and other forms of monitoring are
usually included.
Nurses who are monitored by a state board “tend to have
close to double the long-term recovery,” meaning addiction is still absent
five years later.
“It’s very important for health professionals to
understand they have the same problem as anyone else—maybe higher quality
drugs and sterile techniques—but the disease is exactly the same,” Lea said.
For more information on Hazelden’s health professional
programs, click here.
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