By some estimates, six to eight percent of nurses currently have substance-abuse problems. That shouldn't surprise you: Access to prescription-type drugs is unique to healthcare professionals, and nurses have high rates of musculoskeletal injuries and work-related stress. Although substance abuse in general is no more prevalent among nurses than among other occupations, nurses are, however, more likely than the general population to misuse pharmaceutical drugs??more likely to use them without prescriptions, use more than prescribed, or use them for other than what they are prescribed to manage. Of course, when a nurse has a drug problem and his or her judgment is impaired as a result, the safety of patients, along with the well-being of co-workers, is placed at risk.

Why then, is there an alarming lack of resources to deal with this problem? Half of the states in the US do not offer drug treatment/monitoring programs for addicted nurses, although physicians in all 50 states have access to this form of treatment. The policies in these states is simply to fire (or jail) such nurses. This strategy is short-sighted, as access to treatment usually comes through health insurance obtained in the workplace: No job, no treatment, little hope for recovery.

Studies show that when nurses receive treatment for drug addiction, the vast majority recover and return to practice. The most useful approach is to provide nurses with access to programs designed to treat addiction and monitor the recovery process. Usually conducted through state boards of nursing, such programs, often in the form of peer-assistance projects, provide monitoring, drug testing, and counseling to drug-addicted nurses, while promoting the goal of returning to work. Success stories mean that the workplace investments made in training and educating these nurses need not be wasted.

It is important to realize that the availability of support for addicted nurses actually helps all nurses. In a nationwide survey of nurses, substance abuse, and working conditions that I conducted in 1994?1995, many nurses in "treatment states" commented, "If you are concerned that another nurse might have an addiction, just call the confidential toll-free number...and it will be handled." This response suggests that when nurses have a mechanism for addressing this problem and know that it will be handled constructively, they will report concerns they have about other practitioners.

Compare the above comments with those from nurses in punitive states, where an addicted nurse might be jailed or fired. Typically they were something like, "If anyone knew I was talking about this, I could lose my job!" When nurses in punitive states become concerned about a colleague, they say nothing, for fear of jeopardizing the other person's job. This jeopardizes everyone, by putting patients in danger, threatening licenses, and placing tremendous stress on the healthy nurses who cover for impaired colleagues.

The solution is to identify drug addiction in nurses early and offer treatment and monitoring to those individuals, which will in turn encourage reporting by colleagues. But we must start by bringing attention to this problem. The topic should be part of nursing curricula, to increase understanding and erase the stigma of drug addiction. In the workplace, clear policies and procedures should be in place regarding reporting and handling of the problem. We need to recognize that nurses can develop substance-abuse problems, and then construct a safety net that is worthy of us all.

Dr. Trinkoff is a professor at the University of Maryland.