There is a clear correlation between health professionals' 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 3300 professionals about their substance use
The research is based on data from almost 3300 doctors and nurses in Sweden, who reported having a problematic relationship with alcohol and illegal drugs. The participants were asked about their use of alcohol, cannabis and psychostimulants, and how they believe it affects the quality of the care they provide to their patients.
About patient safety
In total, 15.9 per cent of the participants report providing low-quality care. Of these, almost 1 in 3 (28.9 per cent) report using illegal drugs, while 1 in 4 (25 per cent) report having a problematic relationship with alcohol, based on the criteria in the study .
"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," said Josefina Peláez Zuberbuhler, associate professor at Kristiania University of Applied Sciences and lead author of the study.
Healthcare workers closely link their own substance use to the quality of their work. Even practitioners with low levels of illegal drug use believe it negatively affects their patient care.
Spotlight on the working environment
Emma Brulin , a researcher in occupational and environmental medicine at the Karolinska Institutet, refers to previous research showing that other factors, such as burnout, also lead to employees feeling less capable of performing their work.
"Substance use is a problem where the working environment and working conditions in the healthcare system need to be improved," said Brulin, who is also in charge of the health personnel survey LOHHCS (the Swedish Longitudinal Study of Work Environment and Health in Healthcare), from which the study's data were obtained.
Fear, shame and stigma
Professor Siw Tone Innstrand at the Department of Psychology at the Norwegian University of Science and Technology (NTNU) is an expert in occupational health psychology. She says substance abuse and drinking habits can reduce attention, memory and our ability to make decisions. They can also inhibit 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 abuse problems only being discovered after mistakes have been identified and reported.
More self-critical a year later
This is a so-called longitudinal observation study, investigating development and change in a specific group over time. Of the 3280 participants, just over 75 per cent are women. More than half of the participants have more than 15 years' experience of working in the healthcare services. In 2022, they were asked about their own alcohol consumption and any problematic aspects of it. They were also asked about their use of illegal drugs such as amphetamines, cocaine, ecstasy, LSD and heroin, as well as cannabis. In addition, they were asked to assess the quality of their own patient care.
Of the respondents, 3.8 per cent reported a problematic relationship with alcohol and 1.3 per cent reported that they used 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:
- The healthcare workers with the least amount of work experience have a higher use of illegal drugs
- Employees who have been in their job the longest have more problematic alcohol consumption
- Male healthcare workers, most often doctors, and employees with the most work experience are less likely to see their own substance use as having a detrimental effect on patient care
- Doctors report more illegal drug use than nurses (1.8 per cent compared to 0.9 per cent)
- More nurses than doctors report 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 in the two occupational groups. However, according to Brulin, no differences are observed when adjustments are made for this.
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, i.e. non-prescription medications. It is 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.
"Overall, this suggests that the extent of substance use in the healthcare services may be greater than reported here," according to the study, which was conducted after the COVID-19 pandemic.
Substance use can serve as a maladaptive coping mechanism for doctors and nurses to manage high workloads.
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. Substance use can serve as a maladaptive coping mechanism for doctors and nurses to manage high workloads. It is therefore important that we address this," said NTNU professor Innstrand.
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 purposefully on the working environment, prevention, early detection of problems, and providing support to those who are struggling.
"Healthcare workers are often under huge amounts of pressure involving high workloads, unfavourable working hours and emotional strain," explained 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 work situation that is manageable and 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'," Innstrand said.
Reference:
Josefina Peláez Zuberbuhler, Amr Aroub, Emelie Thern, Siw Tone Innstrand, Bodil J. Landstad, Malin Sjöström, Emma Brulin: 'Associations between healthcare workers' substance use and quality of care: Findings from a one-year Swedish follow-up study' International Journal of Nursing Studies. DOI: 10.1016/j.ijnurstu.2025.105276
