426 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
SUBSTANCE ABUSE IN
HEALTH PROFESSIONALS
Physicians, dentists, and nurses have far higher rates
of dependence on controlled substances,such as
opioids, stimulants, and sedatives, than other profes-
sionals of comparable educational achievement such
as lawyers. One reason is thought to be the ease of ob-
taining controlled substances (Jaffe, 2000c). Health
care professionals also have higher rates of alcoholism
than the general population.
The issue of reporting colleagues with suspected
substance abuse is an important and extremely sen-
sitive one. It is difficult for colleagues and supervisors
to report their peers for suspected abuse. Nurses may
hesitate to report suspected behaviors for several rea-
sons: they have difficulty believing that a trained
health care professional would engage in abuse, they
may feel guilty or fear falsely accusing someone, or
they may simply want to avoid conflict. Substance
abuse by health professionals is very serious, how-
ever, because it can endanger clients. Nurses have an
ethical responsibility to report suspicious behavior
to a supervisor and in some states a legal obligation
as defined in the state’s nurse practice act. Nurses
should not try to handle such situations alone by
warning the coworker; this often just allows the
coworker to continue to abuse the substance without
suffering any repercussions.
General warning signs of abuse include poor
work performance, frequent absenteeism, unusual
behavior, slurred speech, and isolation from peers.
More specific behaviors that might indicate sub-
stance abuse include the following:
- Incorrect drug counts
- Excessive controlled substances listed as
wasted or contaminated - Reports by clients of ineffective pain relief
from medications especially if relief had been
adequate previously - Damaged or torn packaging on controlled
substances - Increased reports of “pharmacy error”
- Consistent offers to obtain controlled
substances from pharmacy - Unexplained absences from the unit
- Trips to the bathroom after contact with
controlled substances - Consistent early arrivals at or late depar-
tures from work for no apparent reason
Nurses can become involved in substance abuse just
as any other person might. Nurses with abuse prob-
lems deserve the opportunity for treatment and re-
covery as well. Reporting suspected substance abuse
could be the crucial first step toward a nurse getting
the help he or she needs.
SELF-AWARENESS ISSUES
The nurse must examine his or her be-
liefs and attitudes about substance abuse. A history of
substance use in the nurse’s family can influence
strongly his or her interaction with clients. The nurse
may be overly harsh and critical, telling the client that
he or she should “realize how you’re hurting your fam-
ily.” Conversely the nurse may unknowingly act out
old family roles and engage in enabling behavior such
as sympathizing with the client’s reasons for using
substances. Examining one’s own substance use or the
use by close friends and family may be difficult and
unpleasant but is necessary if the nurse is to have
therapeutic relationships with clients.
The nurse also might have different attitudes
about various substances of abuse. For example, a
nurse may have empathy for clients who are addicted
to prescription medication but disgusted by clients
who use heroin or other illegal substances. It is im-
portant to remember that the treatment process and
underlying issues of substance abuse, remission, and
relapse are quite similar regardless of the substance.
Many clients experience periodic relapses. For
some, being sober is a life-long struggle. The nurse
may become cynical or pessimistic when clients return
for multiple attempts at substance use treatment.
Such thoughts as “he deserves health problems if he
keeps drinking” or “she should expect to get hepatitis
or HIV infection if she keeps doing IV drugs” are signs
that the nurse has some self-awareness problems that
will prevent him or her from working effectively with
clients and their families.Points to Consider When Working
With Clients and Families With
Substance Abuse Problems- Remember that substance abuse is a chronic,
recurring disease for many people, just like
diabetes or heart disease. Even though
clients look like they should be able to con-
trol their substance abuse easily, they cannot
without assistance and understanding. - Examine substance abuse problems in your
own family and friends even though it may
be painful. Recognizing your own back-
ground, beliefs, and attitudes is the first step
toward managing those feelings effectively so
they do not interfere with the care of clients
and families. - Approach each treatment experience with an
open and objective attitude. The client may
be successful in maintaining abstinence after
his or her second or third (or more) treat-
ment experience.