HMN 2026: How Doctors and nurses believe their own substance use affects patients

Their job is to protect, promote, and restore human health and lives, but health care workers believe that their own use of alcohol and illegal drugs reduces the quality of care they provide to patients. A recent study suggests that more doctors and nurses struggle with substance use than we are aware of.

A new study published in the International Journal of Nursing Studies shows a clear correlation between health professionals’ use of alcohol and drugs and how they perceive that their substance use affects their work. The more they use, the worse they believe they are at taking care of their patients.

Professionals queried about their substance use

The research is based on data from almost 3,300 doctors and nurses in Sweden, who reported having a problematic relationship with alcohol and illegal drugs. The participants were asked about their use of alcohol, cannabis and psychostimulants, substances that stimulate mental functions and reduce fatigue, thirst and hunger. They are called stimulants because they stimulate the central nervous system, primarily the brain.

Patient safety

In total, 15.9% of the participants reported providing low-quality care. Of these, almost 1 in 3 (28.9%) reported using illegal drugs, while 1 in 4 (25%) reported having a problematic relationship with alcohol, based on the criteria in the study.

“Even small percentages matter. This is about patient safety and what we should be able to expect from a regulated and well-functioning health care system,” said Josefina Peláez Zuberbuhler, an associate professor at Kristiania University of Applied Sciences and lead author of the study.

Health care workers closely link their own substance use to the quality of their work. Even those with low levels of illegal drug use believe it negatively affects their patient care.

Spotlight on the working environment

Emma Brulin, a researcher in occupational and environmental medicine at the Karolinska Institutet, refers to previous research showing that other factors, such as burnout, also lead to employees feeling less capable of performing their work.

“Substance use is a problem where the work environment and working conditions in the health care system need to be improved,” said Brulin, who is also in charge of the health personnel survey LOHHCS (the Swedish Longitudinal Study of Work Environment and Health in Health Care), from which the study’s data were obtained.

Fear, shame and stigma

Professor Siw Tone Innstrand at NTNU’s Department of Psychology is an expert in occupational health psychology. She says substance abuse and drinking habits can reduce attention, and affect memory and our decision-making ability. They can also inhibit our psychomotor speed, which in turn can increase the risk of medical errors and poorer quality health care.

Stigma, shame and fear of losing their job can prevent people from seeking help. Innstrand says this can lead to substance abuse problems only being discovered after mistakes have been identified and reported.

More self-critical a year later

This was a so-called longitudinal observation study, which investigates development and change in a specific group over time. Just over 75% of the 3,280 participants are women. More than half of the participants have more than 15 years’ experience of working in the health care services.

In 2022, they were asked about their own alcohol consumption and related problematic aspects. They were also asked about their use of illegal drugs such as amphetamines, cocaine, ecstasy, LSD and heroin, as well as cannabis. In addition, they were asked to assess the quality of their ability to provide patient care.

Of the respondents, 3.8% reported a problematic relationship with alcohol and 1.3% reported that they used illegal drugs. One year later, this group was about twice as likely as others to rate the quality of their patient care as poor.

Less work experience—more illegal drug use

• The health care workers with the least amount of work experience have a higher use of illegal drugs
• Employees who have been in their job the longest have more problematic alcohol consumption
• Male health care workers, most often doctors, and employees with the most work experience are less likely to see their own substance use as having a detrimental effect on patient care
• Doctors report more illegal drug use than nurses (1.8% compared to 0.9%)
• More nurses than doctors report problematic alcohol use (4.4% compared to 3.3%)

The last two points may be due to systematic differences in gender and age in the two occupational groups. However, Brulin said the researchers found no difference when they adjusted for these factors.

A bigger problem than expected

Research suggests that alcohol and illegal drug use can impair health care workers’ ability to provide high-quality patient care. This study is the first to investigate the correlation by asking doctors and nurses directly.

The researchers asked about the use of illegal drugs, meaning non-prescription medications. It is already known that some doctors prescribe medications classified as narcotics to themselves. In addition, access to drugs in the workplace can increase the risk of illegal use among employees.

“Overall, this suggests that the extent of substance use in the health care services may be greater than reported here,” according to the study, which was conducted after the COVID-19 pandemic.

Substance use can serve as a maladaptive coping mechanism for doctors and nurses to manage high workloads.

Pandemic, pressure and stress

COVID-19 put health care services under great pressure in many countries.

“We know that substance use among health professionals increased during the pandemic. Since then, the pressure on health care services has only continued. Resources are decreasing, while the need for care is increasing. Substance use can serve as a maladaptive coping mechanism for doctors and nurses to manage high workloads. That’s why it’s important that we address this,” said NTNU professor Innstrand.

Must support those who are struggling

The researchers believe they have identified an important link between employees’ health and patient care. They believe health care services must work purposefully on the work environment, prevention, early detection of problems, and providing support to those who are struggling.

“Health care workers are often under huge amounts of pressure involving high workloads, unfavorable working hours and emotional strain,” explained Innstrand.

At the same time, they need to be able to provide the care and medical treatment the job requires. This means they must be given a work situation that is manageable and meets their needs.

“In other words, we must make sure that people ‘are able to put on their own oxygen mask first before helping others,'” Innstrand said.

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