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Recognizing the Signs of Drug and Alcohol Addictions in Health Care Providers

It is very important that health care providers have the ability to recognize, diagnose and treat drug and alcohol addictions in their patients since addictions affect so many aspects of a patient’s life and may cause or worsen other medical illnesses. It is also important from a patient safety standpoint that health care providers be able to recognize impairment of their colleagues, especially that caused by drug and/or alcohol addiction. Identifying impairment in a colleague is the necessary first step in referral for treatment that may be life-saving for the colleague and for his or her patients. 

Clinical studies have found that health care providers are just as likely to suffer addiction to drugs or alcohol as anyone else with up to 10 percent lifetime prevalence. Certain signs and symptoms may indicate a drug or alcohol addiction. These may include: 
  • Work absences without notification or an excessive number of sick days used
  • Frequent disappearances from the work site and/or having long unexplained absences
  • Making improbable excuses and taking frequent or long trips to the restroom or to the stockroom where drugs are kept
  • Unreliability in keeping appointments and meeting deadlines and work performance that alternates between periods of high and low productivity including mistakes made due to inattention
  • Poor judgment and bad decisions 
  • Confusion, memory loss and difficulty concentrating or recalling details and instructions 
  • Ordinary tasks require greater effort and consume more time than usual
  • Poor interpersonal relations with colleagues, staff and patients
  • Rarely admitting errors or accepting blame for errors or oversights
  • Heavy “wastage” of drugs often indicated by sloppy recordkeeping, ledger entries that are suspect or drug shortages
  • Inappropriate prescriptions for large narcotic doses and large numbers of pills prescribed Insistence on personal administration of injected narcotics to patients
  • Progressive deterioration in personal appearance and hygiene
  • Uncharacteristic deterioration of handwriting and charting
  • Personality change—mood swings, anxiety, depression, lack of impulse control, suicidal thoughts or gestures
  • Patient and staff complaints about health care provider’s changing attitude/behavior Increasing personal and professional isolation
​Any one of these signs or symptoms may not suggest substance addiction, but a pattern of them should heighten suspicion. 

Health care professionals often avoid dealing with drug or alcohol impairment in their colleagues. There is a natural reluctance to approach a co-worker suspected of drug or alcohol addiction. There is the fear that speaking out could anger the colleague, resulting in retribution, or could result in a colleague’s loss of professional practice. Many employers or co-workers become enablers of health care practitioners whose professional competence has been impaired by drug or alcohol use. Addicted colleagues are often given lighter work schedules, and excuses are made for their poor job performance. If they are protected from the consequences of their behavior, this allows them to rationalize their addictive behavior or continue their denial that a problem even exists. 

If you recognize the aforementioned signs or symptoms in a colleague, co-worker or employee, it’s time to demonstrate concern. You may save lives and a person’s professional future by addressing your concerns. Many well educated, highly trained and experienced health care providers lose their families, careers and futures to substance abuse. Tragically, some have even lost their lives to their drug or alcohol addiction, perhaps partially because the people who saw the signs and symptoms of the addiction refused to get involved. 

By becoming involved, you can help someone who is suffering a treatable illness, and just as importantly, protect those patients who may be treated by him or her. ​