“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.”
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December 27th, 2007 at 11:42 pm
As a nurse working with addictive behaviours (in some cases) I find the similarities between nurses and ‘general population’ to be of no major difference, save for the identified difficulties of nurses having easier access to such substances. The same dilemma exists for doctors who also have such open access and is cited as responsible for the high rates of suicidality amongst medical staff. Self-medicating is used as a means of remaining functional, or escape.
What I would promote on the basis of this article is recognition that there are two main issues at stake:
1. When a nurse becomes addicted, there is a need and an availability for treatment. Such options were described in previous posts and appear to recognise a need to be more supportive than punitive.
2. The causality of addiction in nurses occurs from a variety of issues. However, the underlying issues always come back to the well-being of the nurse. Be that work, life or personal health related; it can be recognised that nurses who become addicted are not all that different to nurses who suffer burn-out, or retire early from nursing, or simply move from clinical care to a less physically/emotionally stressful arena such as management or research (tho this is not a ‘bad’ thing, it can result in the loss of a “good pair of hands” to the clinical field). All that differs is the modality (or behaviour) in which the nurse deals with their dilemma. As I understand, nurses with addiction actually become so to remain functional in work (and life), they do so in quiet suffering, and in order to sustain themselves as useful functioning members of a caring profession.
I strongly advocate for the nursing profession to take more care of itself (because generally we are so abysmal at it) and would hope that the current supportive approaches, such as ‘clinical supervision’ that recognise these issues as being important to the ‘restorative’ aspect of the nurse, includes nurses with addiction as much as it does those who suffer other fatigue-based syndromes.
An informative and useful article. Thank you Patricia. 🙂
August 19th, 2008 at 12:44 pm
Thank you for continuing the education of the general public on a disease that has a very high success rate compared to other mental illnesses; especially among nurses and doctors. I have worked in the field of chemical dependency treatment for 25 years and witnessed thousands of lives changed for the better, which impacts their families and patients. We all benefit.
December 21st, 2009 at 11:49 pm
I am a recovering addict and I want to become a nurse, I have a lot of nay sayers even myself thinking I will not be able to work once people find out I’m in recovery, or even be allowed to do the clinical part of the program, I want to hear what you think because If doctors and nurses at the treatment centers and everywhere else say we can and do recover, I want to see how my story will turn out.Will they look at my past and say no or will they look at my present?
August 26th, 2011 at 12:01 am
If I did not know better I would think you were speaking about me. Along with losing my job I also had legal issues. There also is a very good chance that the board is going to revoke my license. I could use a support group fro revoked nurses too. I am findng it hard to find a recovering meeting of NA or AA that I could attend. I would prefer NA because I do not drink. And I think at a nurses group, they would know exacty what I was talking about. I am going to keep looking for a group. If you happen to have any advice, please feel free to e-mail me or if you know a good group in the Medina, Ohio vicinity
August 30th, 2011 at 1:58 am
ia am posting to state that upon reading this blog i felt as if someone was explaining my life step-by-step. i beame addicted to perscription narctiocs approx 2 years ago. Although i have never diverted medication from the die bold i can relate to this article. i was recently tested “for cause” at work and tested positive for benzo’s. i do not have a problem with this type of medication. only took my husbands xanax to help with sleep because i am in a detox program. iam and have been on suboxone for 6 months. i did not tell my employer. as the months went on i have been experiencing poast addiction issue which one of these is problems sleeping. i took a xanax in effort to help with sleep. i believe my employer tested due to my post addiction behavior. i have never diverted medications from diebold. however, i have an addiction to narcaotic due to chronic pain. my employer sent me a letter of termination due to my positive drug screen. i have 5 days to self repot to the maryland board of nursing. i need to know if i should self report or let them. also’ should i get a lawyer to represent me. adn last, should i enroll in there alternative to disapline program before i report. i have been clean of narcotics for 6 monts. at which time they did not test me. like i said earilier i think my post addiction behavior is showing since I never informed them of my problem. i love nursing and give my patience the very best care that i can. i graduated with a 4.0 in collage and put all my heart and soul into this profession that i love so dearly. my father is a quadraplegic, which is what first peeked my interest. i have had a passion for this all my life. I am willing to do whatever is necessary to clear my license. anyone with info please reply. thanks
May 7th, 2012 at 1:15 pm
Thanks for a great article. To Jody, looking for a group. Google caduceus. This is a group for health care professionals in recovery. I am a canadian nurse in recovery and attend Caduceus weekly. They discuss problems common to doctors and nurses with addictions, such as licensing issues and work related issues. I find it extremely helpful. To Jane Doe, Sorry for your troubles. In my experience, the board will look favorably on you if you self report as opposed to being reported. If you can enroll in an alternative to discipline program before you report, it will show your commitment to recovery. If you do not have an addictionologist, I suggest that you get one. I’m assuming that you need education about addiction and maintenance for the following reasons. #1 you should know that taking benzo’s with suboxone can be deadly.
#2 anyone who has an addiction, can easily replace one addiction for another, so you should abstain from other potentially addictive medications.
#3 self-medicating (without a doctors knowledge) is a sign of relapse. You should never take someone elses medication. Nor should you take any medication without the advice of your doctor. If you are truly “in recovery”, you should never take any drug that is not prescribed.
Congrats on being clean from narcotics for six months, that is a great accomplishment. I would suggest to you, that you try recovery as a way of life, instead of merely abstinence. I don’t say that to be condiscending. I say it because I don’t know what information you have been given. It sounds like your doctor maybe just gave you suboxone to help you get off the narcotics, and didn’t give you any information about how to live in recovery and what resources are available. I am also on suboxone and I know that it has changed my life. If you are having trouble sleeping, maybe your dose needs to be increased and you could take it at night??? I’m on suboxone but I am also in recovery. I attend weekly caduceus meetings as well as NA/AA and I see a psychiatrist as well. Suboxone is not the answer for me, but it sure helped with cravings and depression (which was why I was using). I would love to chat further, feel free to email me at [email protected]. I have experience on the canadian side with my governing body and may be able to tell you what i would do here and you can make some decisions from there. Thanks for sharing your story.