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State of recovery in South Carolina: substance abuse and/or dependence among nurses.

The Diagnostic and Statistical Manual, 4th edition, revised defines substance abuse as a recurrent use of substances that results in failure to fulfill major role obligations and/ or the use in situations in which it is physically hazardous e.g. being the nurse who comes to work under the influence and/or recurrent substance-related legal problems and continued use despite having persistent or recurrent social or interpersonal problems. The manual defines substance dependence (addiction) as evidence of tolerance and withdrawal symptoms, the substance being taken in larger amounts or over a longer period of time, a persistent desire or unsuccessful efforts to cut down or control use, social, occupational and recreational activities given up or decreased and a great deal of time spent obtaining, using and recovering from the substance (APA, 2000). Substance abuse among nurses has been identified as a potential threat to patient safety (Sidlinger, Hornberger, 2008).

According to the American Nurses Association (Copp, 2009) approximately 10% of nurses are dependent on drugs with alcohol being the most widely abused substance followed by narcotics. The Substance Abuse and Mental Health Services Administration report identified that during the period from 2002-2004 some 17,000 nurses reported illicit drug dependence or abuse (0.8%) over the past year and 82,000 reported alcohol dependence or abuse (4.0%) over the past year (SAMSHA, 2007). However, more recent data showed different values. The numbers just for the past month showed different values. Over this time span the illicit drug use percentage was up to 4.6% or 95, 000 registered nurses, for marijuana use the percentage was 3.3% or 68,000 registered nurses, and for the past month heavy alcohol use was up to 2.2% or 46, 000. Heavy alcohol use is defined as three or more drinks per day. This gives a total number of nurses at 209,000. Healthcare agencies should note that marijuana remains in the system for weeks and this could lead to problems of mental and physical efficiency impacting job performance and patient safety.

Substance abuse and/or dependence is one of the leading causes of licensure suspension and revocation especially if the nurse diverts drugs meant for patients, falsifies prescriptions or comes to work impaired. The problem of addiction in nurses is twofold. First is denial on the part of the impaired nurse. In part this is due to the knowledge nurses have about drugs and the belief they can control the use or that they will not become dependent on the drug. The second is denial on the part of the impaired nurse's colleagues. Nurses often have a difficult time accepting that a colleague is abusing drugs or alcohol or is working impaired. Both of these are still the strongest arguments for dealing with substance abuse.

So how do we go about identifying a chemically impaired nurse? In terms of absenteeism this is often centered around the drug of choice or where they get their drug of choice. If the drugs are obtained at work then there is little absenteeism. If the drug is gotten or used at home then there can be a high rate of absenteeism particularly around days off. Other things to look for are: excessive time spent near the drug supply, showing up at work when not scheduled, frequent disappearances during work, "heavy" wastage of drugs, volunteering to administer other nurses' patients medications, always using maximum p.r.n. dose, patient complaints that pain medications dispensed by a particular nurse are not working, deterioration in hand writing, sloppy record keeping, frequent breaks and spills of drugs, isolating self, and personality changes all could indicate a potentially impaired nurse (DeClerk, 2010).

There are workplace programs that were started to help workers who were abusing/dependent on drugs or alcohol. They are called Employee Assistance Programs. Employee Assistance Programs are generally established to provide short-term counseling and problem-solving and may provide a greater deterrent to illicit drug and alcohol use then educational information and written policies (Larson, Eyerman, and Foster, and Gfroerer, 2007, pg. 42). Another type of program to help addicted persons is peer assistance programs. Peer assistance programs were established by the ANA. In South Carolina this program is called Peer Assistance Program in Nursing (PAPIN). This program provides support for nurses recovering from addiction. The focus is to help the nurse deal with their recovery and the goal is to return the nurse to professional practice if this is possible. The PAPIN program works in conjunction with the Recovery Professional Program (RPP) to help a nurse maintain his/her recovery and livelihood. Here in the state of South Carolina according to RPP (2009), there are 339 nurses who are actively enrolled in the program of recovery. PAPIN is a support group and is not a treatment group. There are active PAPIN support groups in Columbia, Myrtle Beach, Florence, Spartanburg, and Charleston. The 24 hour emergency hotline for RPP is 1-877-349-2094 or if a nurse is struggling with the demons of addiction he or she can self refer to RPP for confidential help.

PAPIN wants to educate all nurses as to the vulnerability of addiction and abuse and provide the following warning signs: neglecting your responsibilities, taking risks, experiencing legal or work difficulties, problems in your personal relationships, increased tolerance for drugs or alcohol, drinking to avoid withdrawal symptoms, loss of control over your usage, making excuses for your behavior, life revolving around your usage, giving up on pleasurable activities, using despite negative consequences, increased absenteeism, engaging in secretive or suspicious behaviors, change in appearance, sleep patterns, and appetite. PAPIN wants all nurses to know that they are here to help though confidential caring and support.


American Psychiatric Association, (2000), Diagnostic and Statistical Manual, 4th Edition, Text Revised Copp, M. A. B., (2009), Drug Addiction, RN, April 2009, 40-44.

DeClerk, P. (2010), Recognizing the Chemically Impaired Nurse, Arkansas Board of Nursing Publication, Retrieved from May 2010.

Larson, S. L., Eyerman, J., Foster, M. S., & Gfroerer. J. S. (2007) Worker Substance Use and Workplace Policies and Programs, DHHS-SAMHSA, Office of Applied Studies, 1-204.

Sidlinger, L. & Hornberger, C. (2008), Current Characteristics of the Investigated Impaired Nurse in Kansas Nurse, 83(1), 3-5.

Fredrick Astle, PhD, APRN, PMHCNS-BC,

David Hodson, EdD, APRN, PMHCNS-BC.
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Title Annotation:PAPIN... Here to Help, Here to Heal
Author:Astle, Fredrick; Hodson, David
Publication:South Carolina Nurse
Geographic Code:1U5SC
Date:Jan 1, 2011
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