“I thought having knowledge of addiction protected me from developing an addiction.

“I thought I was immune,” says Patricia Holloran, RN.

But she was wrong. A recovering drug addict, Holloran has become a strong advocate for other nurses facing the same struggle.

Most nurses think they will never fall into addiction, but, according to Holloran, even as healthcare professionals, nurses are vulnerable.

Look around your unit: You may be surprised to find out that out of the 10 nurses you work with, one may be struggling with or recovering from an addiction. And such addiction not only leads to personal devastation but also to impaired patient care.

Maybe you’re the one trapped in the addiction. Maybe you see a friend or co-worker going down that path. Holloran offers honest insight into the nature of nurse addiction and the road to recovery:

RealityRN: Is there a higher rate of addiction among nurses compared to the general population?

Pat Holloran: Nurses fall into the same range as the general population—about 10 percent. The difference is the ready availability of benzodiazepines and opiates, such as Morphone, Dilaudid, and any form of oxycodone. So nurses don’t have to go through great lengths to get the drugs. They’re sitting right in front of them.

Are certain nurses more prone to addiction than others?

No one can predict who will become an addict.

But many nurses become addicts at the time in their lives when their children are teenagers and their parents are elderly, and, for women, when menopause strikes. Often, dependence occurs in adult life after 11-17 years of service – there is an increased risk of physical injury and emotional pain and fatigue. This may prompt the use of benzodiazepines or alcohol.

Nurses who work off shifts may begin to abuse medications that induce sleep.

Those that work in the ER and other high-acuity areas are susceptible because of the high stress environment. Also vulnerable are high academic achievers with advanced degrees who are accomplished in their fields. They hold demanding jobs, they are respected by colleagues and loved by patients, and they hold themselves to high expectations.

Usage is solitary, not social. Often there’s a family history of chemical dependence and the initial use is not for “kicks”. Nurses don’t use street crime as a way of obtaining drugs.

How do nurses become addicts?

Most nurses become addicts because of chronic pain (for instance, from a back injury) and/or emotional pain. In these cases, pain control medication often is prescribed.

Because they feel that they have to work regardless of the pain (in fact, the profession enables this by rewarding nurses who work sick), nurses begin to abuse the narcotics. Over time, they become physically dependent and some develop addiction without even realizing it.

What follows is self-medication, and, sometimes, diversion of the narcotics on the job.

Why do nurses self-medicate?


It’s called Pharmacological Optimism or excessive faith in drugs. We witness the power of drugs in our day-to-day environment. We see our patients’ misery and how a drug relieves the anguish. Our Pavlovian response is to reach for a pill or a shot to relieve our own pain and suffering. We rationalize that this is the right thing to do for ourselves. After all, it is what we are taught; it is what we see; it is what we do.

It usually occurs without any thought to the risks --and without exploring healthier coping mechanisms.

Does self-medicating lead to diverting?


Sometimes. Nurses who divert usually don’t start out by consciously diverting for their own use. It’s usually by accident at first. During the course of a busy day, nurses continuously put things in their pockets: tape, syringes, alcohol pads, and occasionally a medication that the patient refused to take, or the waste of a med that was used in an emergency situation.
The nurse truly intends to waste the med, but finds it in her pocket when he/she returns home. Eventually, this med becomes “available” when he/she has fought with the spouse, is fatigued by work, is in pain from an injury, or the kids are out of control. The meds provide immediate relief for whatever pain the nurse is experiencing—and life seems so much more manageable.

What are common signs of denial?

Rationalization is what keeps the denial alive. Nurses who find themselves with drugs say, “The next time will be the last time.” or “The drug was going to be ruined anyways.” Nurse addicts truly believe this. They are good nurses who would never consider harming a patient’s well being.

They rationalize that they are in control and can stop whenever they want. In fact, they usually aren’t even aware that they are rationalizing.

What does rationalizing do?

Rationalizing eases the mind and calms down any fear that what they are doing is wrong. My sponsor said it in a way that I understood for the first time: “It had more control over you than you had over it.” I did not understand it until then. I thought I was in control.

How do you break through the denial?

Breaking through the denial usually has to come in the form of an intervention. An intervention should never be done alone and never done without a professional who is schooled in addiction and addictive behaviors. Addiction by its very nature is a suicidal risk.

The fear and shame a nurse experiences when confronted is so strong that many nurses, including myself, have their first thought ever of suicide. Sadly, there have been nurses who went through with it, and those who have come very close.

Where is the hope?

Nurses need to remember that addiction is a disease. When I was just starting my treatment program, I was so confused. I absolutely did not know why I could not stop. I had been able to control so many other things in my life—like quitting smoking. I was a good person. But this addiction grabbed hold of me in a powerful way.

I began to learn about the pleasure-reward system, which teaches us how to survive on the instinctual level. I was taught that addiction biologically hijacks this brain system into a controlling, dominant, and vigorous force that prevails over reason and intellect. It was then that I knew I was sick and not “bad”. Being in healthcare, this rang true to me; it was something I could understand.

A friend once said, “The attitude held toward addiction interferes with the very spirit of nursing.”

When an addict finds and embraces recovery, the denial breaks – and the healing begins. They begin to have choices in their lives. The addiction isn’t driving the bus anymore. Recovery is a lifelong process. They’ll eventually be able to say, “My addiction is not my responsibility, but my recovery is.”