Risk Factors for Alcohol and Drug Use by Healthcare Professionals
Healthcare professionals work in an extremely stressful environment. They face immense work responsibilities, manpower shortages, sleep deprivation, and constant exposure to illness, death, and trauma. Not surprisingly, many healthcare professionals turn to alcohol and drug use to self-medicate and cope with their work-related stress. Here are some of the risk factors for drug and alcohol abuse among the healthcare profession.
Increased Access to Prescription Drugs
It is likely that an increased access to prescription drugs contributes to higher rates of misuse and dependence among healthcare professionals. Along these lines, studies of self-prescribing behaviors indicate that 87% of physicians prescribe themselves medications and over half of healthcare professionals with a prescription for painkillers have written the prescription themselves.1
Instead of self-prescribing, some healthcare professionals will resort to drug diversion to appease their addictions. Anesthesiologists and nurse anesthetists, who are always in close proximity to highly addictive drugs in the operating room, have the highest rates of substance abuse among all specialties.2 Another risk factor for addiction among anesthesiologists and nurse anesthetists is the second-hand aerosolized intravenous anesthetics that they are constantly exposed to in the workplace. This exposure can sensitize their brains to these highly addictive drugs, thereby promoting subsequent opioid abuse.3
Healthcare Professional Burnout
Work-related stress can take an emotional toll on healthcare professionals and lead to burnout, a complex condition characterized by emotional exhaustion and feelings of reduced sense of personal accomplishment.4 The Medscape Physician Lifestyle Survey shows that 44% of physicians meet criteria for burnout compared to 28% of the general United States workforce.5 It is estimated that 1 in every 3 physicians is experiencing burnout at any given time.6 While many doctors try to deal with burnout in isolation, many develop harmful coping strategies such as alcohol and drug use.5
Healthcare Professional Characteristics
A study conducted by the Center for Alcohol and Addiction Studies at Brown University delineated the characteristics of healthcare professionals associated with alcohol and drug use. According to results from a self-report survey sent to a large sample of dentists, nurses, pharmacists and physicians, the characteristics of healthcare professionals linked to increased risk of substance abuse include:7
- Moderate (or more) frequency of alcohol use
- Professional invincibility (feeling immune to the addictive effects of drugs)
- Being in situations when offered alcohol or drugs
- Socializing with substance abusers
Other studies have found additional healthcare professional characteristics linked to substance abuse. Some of these include:8-9
- Early first use of alcohol or tobacco
- Genetic predisposition
- Previous experimentation with controlled substances
- Coexisting psychiatric illness
- Family history of a substance use disorder
- Social stigma of being a healthcare provider with an addiction
Another key characteristic increasing the risk of substance abuse is the unwillingness to report incapacitated colleagues. Within the healthcare field there is a reluctance to refer one’s peers to treatment for substance abuse. This may be in part out of fear of professional repercussions the individual with addiction may face. A study published in the Journal of the American Medical Association reported that only 67% of physicians who personally knew an impaired or incompetent physician within their circle actually reported their incompetent colleagues to a relevant authority.10
- Merlo, L., & Gold, M. (2008). Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harvard Review of Psychiatry, 16(3), 181–94.
- Skipper, G.E., Campbell, M.D., & Dupont, R.L. (2009). Anesthesiologists with substance use disorders: a 5-year outcome study from 16 state physician health programs. Anesthesia and Analgesia. 109(3), 891–896.
- Gold, M.S., Graham, N.A., & Goldberger, B.A. (2010). Second-hand and third-hand drug exposures in the operating room: a factor in anesthesiologists’ dependency on fentanyl. Journal of Addictive Diseases, 29(3), 280-281.
- Drummond, D. (2015). Physician burnout: its origin, symptoms, and five main causes. Family Practice Management, 22(5), 42-47.
- Berg, S. (2019). Physician burnout: Which medical specialties feel the most stress.
- Shanafelt, T.D. (2009). Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. Journal of the American Medical Association, 302(12),1338–1340.
- Kenna, G.A., & Lewis, D.C., (2008). Risk factors for alcohol and other drug use by healthcare professionals. Substance Abuse Treatment, Prevention, and Policy, 3(3), 1-8.
- Berge, K. H., Seppala, M. D., & Schipper, A. M. (2009). Chemical dependency and the physician. Mayo Clinic Proceedings, 84(7), 625–631.
- Domino, K. B., Hornbein, T. F., Polissar, N. L., Renner, G., Johnson, J., Alberti, S., & Hankes, L. (2005). Risk factors for relapse in health care professionals with substance use disorders. Journal of the American Medical Association, 293(12), 1453–1460.
- DesRoches, C.M., Rao, S.R., Fromson, J.A., Birnbaum, R.J., Iezzoni, L., Vogeli, C., & Campbell, E.G. (2010). Physicians’ perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. Journal of the American Medical Association, 304(2), 187-193.