Substance Use Disorder in Nurses
January 27, 2017 | Healthcare Risk, Quality, & Safety Guidance
SUD, a disorder initially recognized in the 2013 Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), comprises what were previously two separate disorders: substance abuse and substance dependence, also known as addiction. In the previous version of the manual, substance abuse of a drug, including alcohol, was defined in terms of the harmful social consequences of repeated substance use, such as failure to meet family or professional obligations. Addiction, or substance dependence, was defined by the presence of physiological and behavioral symptoms relating to tolerance, withdrawal, and patterns of compulsive use (APA).
Today, SUD is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by two or more of the former substance abuse and substance dependence criteria—a total of 11 criteria in 4 categories—occurring within a 12-month period (APA).
The DSM-5 criteria for SUD are categorized as follows (APA):
Although there is increasing use of the term SUD, less agreement exists regarding the term "impaired" in the context of nurses with SUD. For example, the National Council of State Boards of Nursing specifically avoids the term "impaired" because "a person with a substance use disorder is not necessarily impaired; that is, always functioning poorly or incompetently." (NCSBN "Substance") However, the American Nurses Association explicitly references "impaired practice," in this context defined as "diminished competence, as evident in changes in work habits, job performance, appearance, or other behaviors" (ANA "Code"). Because much of the clinical literature on substance use predates the DSM-5, the terms "abuse," "addiction," and "dependence" appear throughout this guidance article as used in cited sources. For this guidance article, "nurse impairment" refers only to substance use impairment. Nurses may also be impaired by age-related conditions, disease, or other physical or mental disabilities or conditions.
Although this guidance article is about nurses, any healthcare worker may have an SUD. See Substance Use Disorders in Physicians for a...