Nurses are often portrayed as superheroes. However, this is often a disservice.
Nurses are human.
They get tired. They are susceptible to stress. They are affected by patient loss.
Therefore, it should come as no surprise that nurses struggle with addiction as much as the general population does—and in some settings and specialties even more.
However, the profession's demands—high stress, exposure to trauma, long hours, and access to controlled substances—create a unique and significant risk for substance use disorder (SUD).
For a nurse struggling with addiction, the fear of losing their license, damaging their reputation, or facing judgment can be overwhelming. This stigma often forces them into silence, preventing them from seeking the help they need and deserve.
This guide is here to break that silence.
Recovery is not only possible; it is common, and there are confidential, effective, and supportive pathways designed specifically for healthcare professionals. We will provide a compassionate and practical overview of the warning signs, confidential treatment options, how to navigate peer assistance programs, and the structured process for safely returning to practice.
You are not alone, and seeking help is a sign of strength that protects both you and your patients.
Note: This guide is informational and not medical or legal advice. If you’re in immediate danger or considering self-harm, call 911 or 988 (Suicide & Crisis Lifeline). For treatment referrals, call the SAMHSA National Helpline at 1-800-662-HELP (4357) or visit findtreatment.gov.
Understanding the unique risks for nurses
Nurses face a unique combination of professional risks, including high stress, exposure to trauma, demanding shift work, and access to controlled medications.
Compounding this, a culture of stigma and a deep fear of losing their license often prevent nurses from seeking help. This guide emphasizes that early, confidential support is not only effective but is the key to protecting your career, your well-being, and patient safety.
Prevalence and high-risk environments
How common is addiction among nurses?
While studies show that the overall prevalence of SUD in nursing is comparable to the general population, this data doesn't tell the whole story.
The risk is not distributed equally. It can be significantly higher in high-stress environments like critical care, emergency departments, and anesthesia-adjacent roles. Furthermore, factors like burnout, moral injury, chronic sleep disruption, and PTSD are all directly linked to an increased risk of substance misuse.
The professional risk factors: Access, stress, and stigma
The profession's unique demands create a high-risk environment. These risks are generally grouped into three main categories:
- Easy access to opioids and other controlled substances; diversion pressure
- Rotating/night shifts; circadian disruption
- Chronic stress, trauma exposure, grief, moral injury
- Cultural stigma and fear of reporting; limited recovery-friendly policies
Recognizing the warning signs (at home and at work)
Early recognition is critical.
Signs of SUD can be subtle and may appear in a nurse's personal life long before they become visible at work.
It's crucial to distinguish these signs from burnout, which can look similar (fatigue, irritability). However, when medication discrepancies or patient safety are involved, it's vital to follow your facility's policy for reasonable suspicion and reporting.
Personal signs
- Escalating use, cravings, withdrawal symptoms, or using to “cope/sleep”
- Secretive behavior, mood swings, isolation, memory lapses
- Declining self-care, missing appointments, financial strain
Workplace signs
- Medication discrepancies, excessive waste/voided doses, frequent narc pulls
- Charting errors, unusually helpful with narcotic administration
- Absences, tardiness, leaving the unit frequently, patient complaints
Confidential support: Get help while protecting your career
The single greatest fear for many nurses is the professional consequence of asking for help. The following resources are specifically designed to be confidential, often non-punitive pathways to assessment and referral:
- Employee Assistance Program (EAP): EAPs provide confidential assessment, short-term counseling, and referrals.
- State nurse peer assistance/alternative-to-discipline (ATD) programs: These programs offer confidential recovery pathways that can protect your license if you engage early.
- Private evaluation: Seek a private evaluation with an addiction-medicine specialist or therapist experienced with healthcare professionals.
- SAMHSA National Helpline: Call 1-800-662-HELP for 24/7 confidential referrals.
How peer assistance (ATD) programs work
Often run by or in partnership with the state Board of Nursing, these programs (sometimes called alternative-to-discipline or ATD) are designed for rehabilitation, not punishment. While specifics vary by state, their core functions generally include:
- Offering a pathway for voluntary entry (pre- or early-reporting) that can prevent formal discipline in many states.
- They provide a comprehensive assessment and individualized treatment plan (detox, residential, partial hospitalization, IOP).
- They establish a monitoring agreement (drug testing, therapy, support groups, work-site reports).
- They create a return-to-practice structure with restrictions (e.g., no narcotic handling initially).
- Their focus is on rehabilitation, patient safety, and license preservation.
Evidence-based treatment for healthcare professionals
Effective recovery for healthcare professionals is not a one-size-fits-all solution. It involves a comprehensive, multi-faceted treatment plan that addresses the physical, psychological, and social aspects of addiction. A strong plan typically includes:
- Detox (when indicated) followed by residential or outpatient levels (PHP/IOP)
- Evidence-based therapies (CBT, DBT, motivational interviewing, relapse-prevention)
- Medication for addiction treatment (MAT), including buprenorphine, methadone, naltrexone for opioid use disorder and naltrexone/acamprosate/disulfiram for alcohol use disorder
- Dual-diagnosis care for co-occurring depression, anxiety, PTSD
- Family involvement and aftercare planning (relapse warning sign monitoring, sponsor/mentor)
Protecting your license: Legal and BON considerations
Navigating the professional and legal landscape is a primary source of fear. Here’s a breakdown of the key components:
- Board of Nursing (BON): The BON is the state's licensing authority. However, many states offer ATD programs that are separate from the disciplinary track, especially if you self-refer early and remain compliant with the program.
- Reporting requirements: Employers are typically mandated to report issues like diversion or impaired practice to the BON. This is why self-reporting first to the peer assistance program can be a protective action that demonstrates your commitment to recovery.
- Legal exposure: Be aware that diversion, falsification, or working while impaired can carry separate criminal and licensing consequences. If you believe an investigation is likely, you should consult a professional license defense attorney immediately.
- Documentation: From day one, keep organized copies of all your treatment records and compliance documents. Never sign a consent order or monitoring agreement until you fully understand all of its terms.
The pathway back: Returning to work safely
Returning to practice after treatment is a structured, gradual process designed to protect both you and your patients. This pathway is managed in coordination with the ATD program and your employer, and typically involves the following steps:
- Fitness-for-duty evaluation and employer coordination
- Gradual reentry with role restrictions (no access to controlled substances initially, added supervision)
- Random toxicology testing, therapy, and support group attendance
- Relapse-prevention plan, stress and sleep management, mentor or peer coach
Long-term wellness: Preventing burnout and protecting recovery
Recovery is an ongoing journey, not a one-time event. Protecting your sobriety long-term is deeply connected to managing professional stress and preventing burnout. Key strategies for long-term wellness fall into four main areas.
1. Address systemic burnout drivers
- Advocating for safe staffing levels
- Setting firm professional and personal boundaries
- Making necessary schedule adjustments to protect rest
- Participating in debriefing sessions after traumatic events
2. Commit to self-care basics
- Maintaining a regular sleep schedule
- Focusing on nutrition and physical movement
- Continuing with individual therapy or peer support groups
3. Adopt practical workplace strategies
- Using efficiency techniques like task-batching
- Taking scheduled microbreaks during your shift
- Limiting or eliminating overtime
- Rotating away from high-trigger roles or units when possible
4. Strengthen your recovery support system
- Maintaining regular contact with a sponsor or mentor
- Seeking out recovery-friendly employers and work environments
- Continuing with ongoing counseling or aftercare programs
Finding community: Support groups for nurses
Connecting with other professionals who understand the unique pressures of nursing can be one of the most powerful components of recovery. This peer support reduces isolation and provides a shared language of understanding. Common groups include:
- Caduceus meetings (healthcare professionals)
- AA, NA, SMART Recovery, Refuge Recovery
- Al-Anon/Alateen for families
- Online communities and nurse-specific peer groups (verify moderation/privacy)
How to support a colleague (and ensure patient safety)
This is one of the most difficult situations a nurse can face. Your primary responsibility is always patient safety.
- Report up, not out: Your first step is to alert your charge nurse or supervisor and follow your facility's policy for reasonable suspicion. This is a professional and non-confrontational action.
- Document objectively: Do not confront the person alone or try to diagnose them. Instead, document objective, factual concerns (e.g., "Observed X at Y time," "Medication discrepancy of Z").
- Avoid enabling: Do not cover up errors, ignore discrepancies, or take on your colleague's workload. This may feel kind, but it endangers patients and delays your colleague from getting the help they need.
- Encourage confidential help: If an appropriate moment arises, you can privately and compassionately suggest they contact the EAP or the state peer assistance program, emphasizing that these resources are confidential and designed to help.
State-specific nurse peer assistance programs (examples, USA)
Every state offers a program for nurses, though the name and administrative body can vary. The best way to find your state's resource is to search online for "[Your State] nurse peer assistance program" or to check your Board of Nursing's official website. Here are some examples:
- Alabama: Voluntary Disciplinary Alternative Program (VDAP)
- Arizona: Alternative to Discipline Program (AZBON)
- California: Board of Registered Nursing Intervention Program (administered by Maximus)
- Colorado: Colorado Nurse/Peer Health Assistance Program (Peer Assistance Services, Inc.)
- Florida: Intervention Project for Nurses (IPN)
- Georgia: Peer Assistance Program for Nurses (PAPN)
- Indiana: Indiana State Nurses Assistance Program (ISNAP)
- Kentucky: KARE for Nurses (Kentucky Alternative Recovery Effort)
- Louisiana: Recovering Nurse Program (RNP)
- Massachusetts: Substance Abuse Rehabilitation Program (SARP)
- New Jersey: Recovery and Monitoring Program (RAMP)
- New York: Professional Assistance Program (PAP)
- North Carolina: Alternative Program (NCBON)
- Ohio: Alternative Program for Chemical Dependency (AP)
- Pennsylvania: Professional Health Monitoring Programs (PHMP), Voluntary Recovery Program (VRP)
- Texas: Texas Peer Assistance Program for Nurses (TPAPN)
- Washington: Washington Health Professional Services (WHPS)
Note: Program names and administration can change. Always verify current details directly with your state BON.
Your questions answered (FAQs)
What are the signs of addiction in nurses vs. burnout?
Addiction often involves medication discrepancies, concealment, and signs of intoxication or withdrawal, whereas burnout typically presents as exhaustion and cynicism without medication diversion or intoxication.
How common is nurse addiction?
Estimates vary, but research suggests that rates of addiction among nurses are broadly comparable to those in the general population, although the risk may be higher in some specialties.
Where can I get confidential help without losing my license?
You can get confidential help from your Employee Assistance Program (EAP) and your state’s alternative-to-discipline (ATD) or peer assistance program; early self-referral is the key to protecting your license.
What treatments work best?
The best treatments involve evidence-based care matched to the severity of the condition, which may include detox, residential/PHP/IOP, therapy, medication for addiction treatment (MAT) for OUD/AUD, plus aftercare and monitoring.
What is a peer assistance program?
A peer assistance program is a confidential, recovery-focused pathway that includes monitoring and return-to-practice support, which may help you avoid formal discipline when used early.
How do addiction and mental health interact for nurses?
Addiction and mental health issues have a high co-occurrence; treating co-occurring depression, anxiety, or PTSD improves recovery outcomes and lowers the risk of relapse.
How does this affect my license?
Licensure requirements vary by state, but compliant participation in an ATD program can often help preserve or restore your license.
What legal issues might I face?
You could face possible criminal or licensing action for medication diversion or impairment at work; it is important to consult a license defense attorney early if you face these issues.
Can I return to bedside nursing?
Yes, nurses can often return to bedside nursing after completing a fitness-for-duty evaluation and following a monitored reentry plan, although some may start with restricted roles.
Are there nurse-specific support groups?
Yes, nurse-specific support groups include Caduceus meetings, state program groups, and healthcare-professional meetings within AA/NA.
How are alcohol and opioid addiction treated differently?
Alcohol use disorder (AUD) is often treated with medications like naltrexone or acamprosate, while opioid use disorder (OUD) is treated with buprenorphine, methadone, or naltrexone; both disorders benefit from therapy and monitoring.
How long do monitoring agreements last?
Monitoring agreements commonly last between two and five years, but the duration varies by state and individual case.
What if I suspect a colleague?
If you suspect a colleague, you should follow your facility's policy, notify leadership, document objective facts, and encourage them to seek confidential help.
How do I talk to my employer?
If it is safe to do so, you can coordinate communication with your employer through your EAP or peer assistance program, bringing your treatment plan and monitoring requirements to the discussion.
Where can families get help?
Families can get help from Al-Anon/Alateen, family therapy, and educational resources provided through treatment programs and SAMHSA.
Your immediate next steps
If you or a colleague is struggling, taking the first step is the hardest part. Here are the most direct actions you can take right now:
- If you’re ready to talk: Contact your EAP or call the SAMHSA National Helpline at 1-800-662-HELP (24/7).
- If you want a nurse-specific path: Search for “[Your State] Board of Nursing peer assistance program.”
- If you may face an investigation: Consult a professional license defense attorney experienced with healthcare matters.
- If you’re a leader: Review your facility’s reasonable suspicion and safe return-to-practice policies; work to reduce stigma and encourage early help.
With early, compassionate intervention, nurses recover, protect their licenses, and rebuild meaningful careers—while keeping patients and themselves safe.
