Co-Occurring Disorders in Nurses

Higher risk and specialized treatment

The Substance Abuse and Mental Health Services Administration estimates that of the individuals diagnosed with substance use disorders, 39.1 percent also have some type of mental health disorder.1 However, some studies suggest that the incidence of co-occurring disorders among nurses is significantly higher.

Health professionals in the United States, including nurses, have higher rates of hospital admission from mental health disorders and elevated admission rates to mental health centers when compared to the general population.2 The Robert Wood Johnson Foundation concluded that nurses suffer depression at twice the rate of the national population, due in part to workplace stress, emotional and physical exhaustion, and feelings of lack of control.

Treating co-occurring disorders

Effective treatment for co-occurring disorders depends on accurate assessment and diagnosis, which require understanding and considering the following:

Mental health disorders that commonly co-occur with substance misuse

Mental health issues that commonly occur with substance use disorders include depressive disorders and anxiety disorders with symptoms ranging from mild to severe.3 These mental illnesses can be triggered by high-stress situations and physical exhaustion, which are common in nursing.
  • Depressive disorders. Depression is common among alcoholics and addicts seeking substance use disorder treatment. As many as 80 percent of alcoholics experience depressive symptoms at some time in their lives, and 30 percent meet diagnostic criteria for major depression.
  • PTSD. There is a strong correlation between substance use disorders and post-traumatic stress disorder, with as many as one-third of patients meeting criteria for PTSD when they enter treatment for alcohol or other substance use issues.
  • Anxiety disorders. Rates of other anxiety disorders, such as agoraphobia, panic disorder, social anxiety disorder, and generalized anxiety disorder, are high in treatment populations, ranging from 10 to 60 percent.
  • Eating disorders. Most studies find that between 15 and 32 percent of women (the majority of nurses are women) with alcohol or other substance use disorders meet diagnostic criteria for an eating disorder at some time in their lives.

The reasons mental health and substance use disorders frequently co-occur

While there aren’t conclusive answers about co-occurrence, there are many theories. The Dartmouth Psychiatric Research Center puts forth the following theories:
  • Self-medication. People use alcohol or other drugs to "self-medicate" against disturbing symptoms of mental illness.
  • Early onset. Certain drugs may precipitate an early onset of mental illness in vulnerable individuals.
  • Genetic and environmental. Genetic predisposition or environmental factors (social isolation, stressful work, lack of structure, financial pressures) may lead to substance use problems and mental illness.
  • Susceptibility. People with mental illnesses may be more susceptible to the harmful effects of alcohol and drugs.

The complexities of diagnosing co-occurring disorders

Psychiatry is a complex field with regard to diagnostic assessment. Most often a blood test or lab procedure does not provide conclusive diagnoses for psychiatric illness. Co-occurring disorders can be especially problematic to diagnose because the presence of one disorder can interfere with diagnosis of the other. For example, a person with alcohol or other substance use disorder is likely to manifest symptoms of depression or anxiety. Likewise, a person seeking medical care for depression or anxiety may downplay or deny his or her alcohol use. Conducting a comprehensive evaluation is of paramount importance because effective treatment of co-occurring disorders is diagnosis driven.

Best practices for treating co-occurring disorders

A treatment plan that doesn't address both the substance use disorder and the mental health condition will compromise the desired outcome. An integrated treatment approach, with a focus on stabilizing symptoms of the mental health disorder while providing a foundation for recovery from addiction, provides the comprehensive care and support needed to position the patient for long-term recovery.

The treatment of mental health disorders lags behind progress made with other major diseases such as heart disease and cancer. The biomarkers of mental illness are still being discovered, making it difficult for early diagnosis. Even when behaviors warrant investigation, stigma is still attached to mental health issues, often resulting in avoidance or delay of treatment until the disease is advanced and the patient has relied on harmful choices (such as substance use) to mask the pain.

Addiction and recovery programs for medical professionalsHazelden Betty Ford Foundation's Nurse Professionals Program
Now there is hope and support for nurses struggling with mental health and substance use disorders to ensure they get the help they deserve. The Hazelden Betty Ford Foundation's Nurse Professionals Program offers specialized care for nurses, including return-to-work support. For more information, go to or call 1-866-831-5700. We offer a free, confidential consultation and phone-based assessment.
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