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Doctors and nurses believe their own substance use affects patients
A recent study suggests that more doctors and nurses struggle with substance use than we are aware of.
The study shows a clear correlation between healthcare workers' 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.
Asked 3,300 people about their substance use
The research is based on data from almost 3,300 doctors and nurses in Sweden. These participants reported having a problematic relationship with alcohol and illegal drugs.
The participants were asked about their use of alcohol, cannabis, and stimulants.
They were also asked how they believe this affects the quality of care they provide to their patients.
"This is about patient safety"
In total, 15.9 per cent of the participants reported providing low-quality care.
Of these, almost 1 in 3 (28.9 per cent) reported using illegal drugs, while 1 in 4 (25 per cent) reported having a problematic relationship with alcohol according to the study's criteria.
“Even small percentages matter. This is about patient safety and what we should be able to expect from a regulated and well-functioning healthcare system,” says Josefina Peláez Zuberbuhler.
She is an associate professor at Kristiania University of Applied Sciences.
Healthcare 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 patient care.
Focus on the working environment
Emma Brulin, a researcher in occupational and environmental medicine at Karolinska Institutet, refers to previous research showing that other factors, such as burnout, make employees feel less capable of performing their jobs.
“Substance use is a problem where the work environment and working conditions in the healthcare system need to be improved,” says Brulin.
She also leads the healthcare personnel survey Swedish Longitudinal Study of Work Environment and Health in Healthcare.
The study's data were obtained from this survey.
Fear, shame, and stigma
Professor Siw Tone Innstrand at NTNU’s Department of Psychology is an expert in occupational health psychology.
She says that substance abuse and drinking habits can reduce attention, affect memory, and our ability to make decisions.
It can also impair our psychomotor speed, which in turn can increase the risk of medical errors and poorer quality healthcare.
Stigma, shame, and fear of losing their job can prevent people from seeking help. According to Innstrand, this can lead to substance problems only being discovered after consequences have already appeared and been reported.
More self-critical a year later
The study examines development and change within a specific group over time.
Just over 75 per cent of the 3,280 participants are women. More than half of the participants have over 15 years of experience working in healthcare.
In 2022, they were asked about their own alcohol consumption and problematic aspects related to it. They were also asked about their use of illegal drugs such as amphetamines, cocaine, ecstasy, LSD, heroin, and cannabis.
In addition, they were asked to assess the quality of their own patient care.
3.8 per cent reported a problematic relationship with alcohol. 1.3 per cent reported using 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
Among other things, the study shows that:
- Healthcare workers with the least amount of work experience had a higher use of illegal drugs.
- Employees who have been in their job the longest had more problematic alcohol consumption.
- Male healthcare workers, most often doctors, and employees with the most work experience were less likely to see their own substance use as having a detrimental effect on patient care.
- Doctors reported more illegal drug use than nurses (1.8 per cent compared to 0.9 per cent).
- More nurses than doctors reported problematic alcohol use (4.4 per cent compared to 3.3 per cent).
The last two points may be due to systematic differences in gender and age between the two occupational groups. However, Brulin says 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 healthcare 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's 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.
According to the study, which was conducted after the Covid-19 pandemic, the extent of substance use in healthcare may be greater than reported here.
Pandemic, pressure, and stress
Covid-19 put healthcare services under great pressure in many countries.
“We know that substance use among health professionals increased during the pandemic. Since then, the pressure on healthcare services has only continued. Resources are decreasing, while the need for care is increasing," says Professor Innstrand.
She believes substance use may serve as a maladaptive coping mechanism for doctors and nurses to manage high workloads. That’s why it’s important that we address the issue.
Must support those who are struggling
The researchers believe they have identified an important link between employees’ health and patient care.
They believe the healthcare services must work systematically on the work environment, prevention, early detection of problems, and providing support to those who are struggling.
“Healthcare workers are often under huge amounts of pressure with high workloads, unfavourable working hours, and emotional strain,” says 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 manageable work situation that 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’,” says the researcher.
Reference:
Zuberbuhler et al. Associations between healthcare workers’ substance use and quality of care: Findings from a one-year Swedish follow-up study, International Journal of Nursing Studies, 2026. DOI: 10.1016/j.ijnurstu.2025.105276
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Read the Norwegian version of this article on forskning.no
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