Healthcare Workers Report That Their Own Drug and Alcohol Use Degrades Patient Care

The question is uncomfortable but clinical: does substance use by healthcare workers affect the care they deliver? Surveys of public confidence in healthcare systems assume the answer is yes. Regulatory frameworks assume the answer is yes. But direct evidence - from the workers themselves, assessed prospectively over time - has been thin.

A study published in the International Journal of Nursing Studies provides some of that evidence, drawing on responses from nearly 3,300 Swedish doctors and nurses over a one-year period. The findings confirm the concern and quantify it in specific terms.

The Study Design

The data come from LOHHCS, the Swedish Longitudinal Study of Work Environment and Health in Healthcare, coordinated by Emma Brulin, a researcher in occupational and environmental medicine at Karolinska Institutet. In 2022, researchers asked participants about their alcohol consumption - assessing for problematic patterns using established criteria - and their use of illegal drugs including amphetamines, cocaine, ecstasy, LSD, heroin, and cannabis. Participants also rated the quality of their own patient care. One year later, those assessments were repeated.

The sample included 3,280 participants; just over 75 percent were women. More than half had more than 15 years of experience in healthcare. Among all respondents, 3.8 percent reported a problematic relationship with alcohol and 1.3 percent reported using illegal drugs.

The longitudinal design - asking the same people the same questions a year apart - allows researchers to track change over time rather than simply measuring a snapshot. It also allows them to examine whether baseline substance use predicts future self-rated care quality, rather than just correlating two measures taken at the same moment.

The Correlation Is Clear

Overall, 15.9 percent of all participants reported providing low-quality care. Among those who reported providing low-quality care, the rates of substance use were notably elevated: nearly one in three (28.9 percent) reported using illegal drugs, and one in four (25 percent) reported a problematic relationship with alcohol.

Workers who reported problematic substance use at baseline in 2022 were approximately twice as likely as other respondents to rate their patient care as poor one year later. The relationship was present even at low levels of illegal drug use - workers with minimal reported drug use still believed it was affecting their care negatively.

Lead author Josefina Pelaez Zuberbuhler, associate professor at Kristiania University of Applied Sciences, framed the finding in terms of patient safety. "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."

Structural Factors Behind the Problem

The study was conducted in the aftermath of the COVID-19 pandemic, a period that placed extreme and sustained pressure on healthcare systems. Siw Tone Innstrand, professor of occupational health psychology at the Norwegian University of Science and Technology and a co-author, noted that substance use among health professionals increased during the pandemic and that the structural pressures driving that increase have not resolved.

"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," Innstrand said. Burnout, extended shifts, emotional labor, and limited institutional support all contribute to conditions where self-medication becomes tempting.

The study also identified occupational and demographic patterns in how substance use distributes. Healthcare workers with less experience had higher rates of illegal drug use; those with longer careers showed more problematic alcohol patterns. Doctors reported more illegal drug use than nurses (1.8 percent versus 0.9 percent), while more nurses than doctors reported problematic alcohol use (4.4 percent versus 3.3 percent). Male healthcare workers - more commonly doctors in the sample - were less likely to believe their substance use was affecting their patient care, even when it was.

Stigma and the Undercount

The researchers note their data almost certainly undercount the actual prevalence of substance use in the sample. The study relied on self-report, and fear of professional consequences, stigma, and shame are known barriers to honest disclosure in healthcare settings. Some doctors also prescribe controlled substances to themselves, a category of use not captured by the survey's focus on illegal drugs specifically.

The data are also cross-sectional in a specific sense: they rely on self-rated care quality rather than objective measures of clinical errors or patient outcomes. Whether the self-ratings accurately reflect actual care quality degradation - or whether workers with substance use problems are simply more self-critical - cannot be fully determined from the current study design. The findings are a starting point for more targeted institutional and regulatory responses, not a final answer on the scale of harm to patients.