Substance Use Disorder and Mental Illness in Nursing

Substance Use Disorder (SUD) is a progressive and chronic disease that affects an estimated 8.4% of the U.S. population. If left untreated, substance use disorder can be fatal.

Registered nurses are not immune to substance use disorder. Nurses may be particularly susceptible to SUD due several workplace risk factors including:

  • job stress,
  • available access to controlled substances,
  • enabling behavior by reluctant colleagues, and
  • lack of education regarding SUDs

Mental illness, such as major depression, bi-polar disorder, and schizophrenia is not a prevalent, but also may affect a registered nurse’s ability to practice safely.

If mental illness or substance use disorder problems are left untreated, they may eventually jeopardize patient health and safety. They can also threaten the life of the person afflicted.

Signs and Symptoms of Substance Abuse/Impaired Practice

Unfortunately, most people suffering from substance use disorder or mental illness deny the problem. Many times they are the last to recognize and admit that they need help. Patient safety depends on early identification of those registered nurses who misuse substances.

Signs and Symptoms of SUD

  • Increased isolation
  • Avoids eye contact
  • Defensive
  • Excessive absenteeism
  • Verbally/physically aggressive
  • Rapid change in weight
  • Dilated or pinpoint pupils
  • Lethargic or jittery
  • Slurred, rapid, pressured speech
  • Sweats/seizures

Signs of Impaired Practice

  • Smells of alcohol or marijuana
  • Narcotic discrepancies (frequent errors)
  • Changes in drug ordering patterns
  • Patient complaints about reduced pain relief
  • Offers to administer meds for other RNs
  • Volunteers for extra shifts
  • At facility on days off/at odd hours
  • Leaves worksite frequently to use the restroom, lounge or to the parking lot
  • Bizarre behavior
  • Poor work performance

Help and Hope for Nurses Inflicted with SUD and/or Mental Illness

The Intervention Program can help nurses inflicted with substance use disorder or mental illness. The Program does this by assessing each nurse’s individual recovery needs, referring nurses to appropriate treatment based on those needs, monitoring each participant’s success in recovery and returning the nurse to work in a safe manner.

If you are an RN needing assistance, or if you are seeking help for an RN in need, please call Maximus at 1-800-522-9198.

For more information about the Intervention Program, please also refer to General Information page.

NCSBN Informational Video: Substance Use Disorder in Nursing


For additional resources for nurses and employers, please also refer to Additional Resources page.