Key takeaway
You can spot a substance use disorder in a patient and still be afraid to ask for care yourself. Get an evaluation from a clinician who is not your supervisor. Ask what an internal assistance program reports before you use it. Do not stop a benzodiazepine or heavy drinking to finish a shift.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You know how to spot this in a patient. You are hoping you can finish the shift before anyone spots it in you. Get an evaluation from a clinician who is not your supervisor. Ask what an internal assistance program reports to management, and to a licensing board, before you use it.
If you are seizing, collapsing, or having trouble breathing, call 911. For a mental health crisis, call or text 988. Do not try to finish the shift first.
The building you work in can be the reason you stay quiet
NIDA says people with substance use disorders meet negative bias in health care, and that those experiences can keep them from asking for help. Some clinicians hold that bias and may fail to offer evidence-based care because of it. You may have learned the same reflex in training.
Words matter inside that reflex. In one study, clinicians rated a person described as a "substance abuser" as more worthy of blame and punishment than a person described as "having a substance use disorder." Changing the label does not protect a license. It can change whether a colleague is willing to say they need an assessment.
Knowing the medicine does not replace an assessment of your own. NIDAMED is a set of tools for screening and treating patients. Use it for that. It is not a substitute for a clinician who is not your coworker and not your supervisor. The FDA also tells health professionals who suspect a substance use disorder to evaluate the patient and to start or refer for treatment. That sentence was written about the people you treat. It is also the right move when the patient is you.
Ask who receives the information
People delay care because they think a board, a partner, or a charge nurse will automatically see the file. Sometimes a job or a license requires a disclosure. Sometimes it does not. Ask the program, in specific words, who will receive this information and whether that disclosure is required. If a board complaint is the fear, ask a lawyer who handles professional licensing.
HHS says the federal confidentiality rule exists because discrimination and fear of prosecution keep people out of treatment. It protects records of identity, diagnosis, prognosis, or treatment kept by a substance use program that is conducted, regulated, or assisted by the federal government. Those records are not to be used to investigate or prosecute the patient without written consent or a court order. Read who can see treatment records before you sign a broad release.
A limit on the treatment record is not a promise about every file that names you. A fitness-for-duty exam, a credentialing file, a prescription-drug monitoring query, and a licensing investigation can sit outside the chart you think you are protecting.
Do not detox between cases
Some hospitals offer an employee assistance program and call it confidential. The EEOC says the Americans with Disabilities Act does not require an employer to have that program, or to offer rehabilitation instead of discipline. An employer may discipline, may suggest a program, or may do both. Ask what an internal line reports before you call it.
Time away from work, when the law applies, is summarized in workplace leave. Coverage depends on the employer and on hours worked. First responders face a related set of fears, covered in first responders and addiction treatment. How to start a search outside your own hospital is in finding treatment.
Do not stop a medicine to look fit for a shift. Physical dependence on benzodiazepines can occur even at prescribed doses, and an abrupt stop can cause seizures that can be life-threatening. Read benzodiazepine withdrawal before you cut a dose between shifts. A sudden stop after chronic heavy drinking can be life-threatening. The warning signs are in alcohol withdrawal. If opioids are the concern, read methadone, buprenorphine, and naltrexone before you write your own induction because you know the pharmacology.
Search FindTreatment.gov for a program outside your own building. Call or text (800) 653-9376 if you want help asking what a program will disclose.
Additional Resources
Sources cited on this page:
- NIDA: Stigma and Discrimination
- NIDA news release: Doctors reluctant to treat addiction most commonly report lack of institutional support (July 2024)
- NIDAMED clinical resources
- HHS fact sheet: 42 CFR Part 2 final rule (SAMHSA and OCR, updated January 30, 2026)
- EEOC: Applying performance and conduct standards to employees with disabilities
- FDA: Boxed warning to improve safe use of benzodiazepines
- NIAAA Core Resource: Alcohol Use Disorder, From Risk to Diagnosis to Recovery
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Can a nurse, physician, or pharmacist have a substance use disorder?
Yes. NIDA describes substance use disorders as chronic, treatable conditions that can affect people in any job. In a July 2024 news release, NIDA said nearly 49 million people in the United States had at least one substance use disorder in 2022. That figure is a national count. It is not a rate for physicians, nurses, or pharmacists. Needing care is not a verdict about skill. Only a clinician who is assessing you can make a diagnosis.
Will treatment automatically go to my licensing board or my employer?
Not as a blanket rule. HHS says records from a federally assisted substance use program are not to be used to investigate or prosecute the patient without written consent or a court order. A fitness-for-duty exam, a credentialing file, a prescription-monitoring query, and a licensing investigation can follow other rules. Ask the program who receives the information. A licensing lawyer is the person to ask about a board complaint.
What if I am the one who treats other people's addiction?
NIDAMED publishes science-based tools so health professionals can screen and treat addiction in patients. It is not a substitute for your own assessment. A 2024 NIDA review found that doctors most often cited lack of institutional support as the reason they were reluctant to treat patients' addiction, in 81 percent of the studies. Insufficient skill was next, at 74 percent. Those findings are about caring for patients. They are not a count of clinicians who need care.
Should I stop a benzodiazepine or alcohol before anyone at work notices?
No. The FDA says stopping a benzodiazepine abruptly, or cutting the dose too quickly, can cause seizures and can be life-threatening. Dependence can occur even at prescribed doses. NIAAA says a sudden stop after chronic heavy drinking can be life-threatening. Tell a clinician who is not your supervisor. Call 911 for a seizure, collapse, or trouble breathing.
Does my hospital have to offer a confidential assistance program?
The EEOC says the Americans with Disabilities Act does not require an employer to have an employee assistance program, or to offer rehabilitation instead of discipline. Some workplaces have one. Ask what it reports to management and to a licensing board before you use it. Time away from work, when the law applies, is summarized in the workplace-leave guide.