Abstract
Certain medicinal products, like pain medications and stress-reducing drugs, with therapeutic benefits but psychoactive side effects, may be misused, especially among medical personnel. This study used a phenomenological study design. A semi-structured interview guide was used to collect data from respondents. The data gathered were transcribed verbatim, reviewed thoroughly by the researchers, and analyzed. The study presents evidence on healthcare workers’ drug misuse, including withdrawal challenges, life impacts, and coping strategies. It emphasizes professional help, diversional therapy, boundaries, and support. It highlights the challenges of seeking assistance and calls for comprehensive efforts, recommending policies in healthcare organizations to address this issue. Based on the study’s findings, a specialized training program to detect substance misuse, a dedicated hotline for reporting difficulties, as well as providing assistance and services for healthcare staff struggling with drug misuse are all recommended.
Plain language summary
Many medicinal products, including calming drugs and pain medications, that have significant therapeutic applications also have psychoactive side effects that make them susceptible to misuse. Misusing drugs is frequently seen as a strategy to deal with the mental and physical demands of jobs or to find happiness in drugs. However, drug misuse among medical personnel has recently been a prominent cause for concern due to its negative effects on work, personal relationships, and patients’ lives. This study used a phenomenological study design. A semi-structured interview guide was used to collect data from respondents. The data gathered were transcribed verbatim, reviewed thoroughly by the researchers, and analyzed. The study results provide evidence-based literature on the issue of drug misuse among healthcare workers, highlighting the struggles with withdrawals, the effects of drug misuse on all aspects of their lives, and the strategies deployed by respondents to overcome their misuse. The study emphasizes the importance of seeking professional help and support in overcoming drug misuse, along with diversional therapy, setting boundaries, and maintaining healthy relationships. The study also discusses the challenges healthcare workers face in seeking help and the need for a comprehensive and collaborative effort to prevent and address drug misuse by providing support and resources to help individuals commit to the treatment process. The study recommends that healthcare organizations should develop policies to address drug misuse among healthcare workers.
Background
Therapeutic use of drugs is helpful in the treatment of various ailments when they are properly utilized. However, they become destructive when they are misused or abused. The misuse of drugs is traversing the health system in a large sense across the globe (Solomon et al., 2018) with an estimated of 10% to 15% of all healthcare professionals misusing drugs. Another study in Canada revealed that over 50% of respondents to a survey of front-line healthcare workers and substance users reported that problems associated with the use of prescription drugs (depressants) represent a “grave” concern in the region (Katzman et al., 2014). The misuse of drug is therefore a major public health problem that have serious consequences on individuals, families, and communities as the prevalence rates for the misuse of prescription drugs has not been stabilized or declined in recent years (Chiappini et al., 2020).
There are many different drugs that are commonly misused, including alcohol, analgesics (Paracetamol, Diclofenac, Ibuprofen), stimulants, opioids (Pethidine, Morphine), sedatives (Diazepam, Amitriptyline), hallucinogens, and anabolic steroids (United Nation Office and Crime, 2021).
While drug misuse can provide needed relief for some, it can lead to devastating consequences. It is difficult to generalize about how drug misusers feel while they are misusing drugs. A person’s experience is unique and may be influenced by a variety of factors such as the specific drug being used, the frequency and amount of drug use, the individual’s mental and physical health, and their social and environmental circumstances (Pickard, 2021). However, the main effect majority of the drug misusers experience is euphoria or a sense of pleasure (Dhawan & Arora, 2020; Santos et al., 2019; Zaami et al., 2020). The feeling can be very appealing to people who are seeking to escape from negative feelings or stress leading them to continue using drugs despite the risks and negative consequences (Kim et al., 2017; Ogochukwu et al., 2022; Pickard, 2021). This habit brings about dependency and withdrawal symptoms when use is stopped (Noreen et al., 2022; Sankingobir et al., 2020).
The negative consequences of drug misuse include confusion, disorientation, hallucinations or delusions, decreased work productivity, absenteeism, and financial or legal problems (Bjornestad et al., 2019; Lemonick & Park, 2018; Pickard, 2021; Santos et al., 2019; Velez et al., 2017). Healthcare workers who misuse drugs are at increased risk of engaging in indiscriminate behavior with the potential of self-harm, poor healthcare delivery, cognitive and psychomotor impairment, harmful interactions with alcohol or other drugs, and risk for accidents and overdose (Guise et al., 2017; Kim et al., 2017; Ryan & Rosa, 2020). Overdose in some instances has led to the death of some health workers as revealed by Zamorano et al. (2016). These are therefore indications that healthcare workers are in becoming junkies and the lives of patients in their care are being jeopardized. This study is to explore the challenges healthcare workers who misuse drugs face and their overcoming strategies. The findings will help develop policies to assist misusers of drugs and to restore the dignity of the healthcare profession.
Study Design and Setting
The study adopted a qualitative research approach with a phenomenological study design. This design enabled the researcher to describe healthcare workers’ drug misuse and its effects on the healthcare delivery (Alhazmi & Kaufmann, 2022). The study took place in Ho Municipality in the Volta Region of Ghana involving two hospitals namely Ho Teaching Hospital and Ho Municipal Hospital.
Study Population, Sampling, and Size Determination
The study population was healthcare providers in the Ho Municipality. The Purposive sampling method was used to select specific individuals to participate in the study based on their relevance to the research questions (Dartey et al., 2021; Polit & Beck, 2021). In addition to using purposive sampling, the study also used snowball sampling to recruit respondents. The sample size was determined based on saturation, where no new information was gathered after interviewing the 30th respondent.
Data Collection Method and Instrument
A semi-structured interview guide was used for the data collection. Respondents were assured of confidentiality and anonymity by assigning codes to their responses and storing the data under password protection which is only accessible to the research team. The principles of informed consent and voluntarism were strictly adhered to. The interviews were conducted in suitable locations that were convenient for the respondents. The interview was conducted in English which is commonly spoken by healthcare workers. Audio tapes were recorded and field notes were also kept throughout the process of data collection. The duration of the interviews ranged from 30 to 35 min.
Data Handling and Analysis
Data collected were treated with the needed confidentiality. All audio was transcribed verbatim by the researchers after they were read severally to confirm respondents’ responses in the audio. Content analysis was performed through the process of coding in phases to create recognized and meaningful patterns (Braun et al., 2023).
Ethical Consideration
Ethical approval for the study was obtained from a university. Letters were sent to the two hospitals’ management to seek their approval for the study. Written consent was sought from all respondents as well. The reasons for the study were explained to the respondents, which were treated as confidential. The respondents were not subjected to any physical or psychological harm. Respondents were made known that participation in this study was voluntary and they have the right to withdraw from the study anytime they wish.
Results
Presentation of Findings
The study recruited 30 respondents who were between the age range of 21 to 49 years, in which the age group of 41 to 49 years had the highest population in the study 8 (26.6%) (Table 1). The majority of respondents, 10 (33.3%) were married and Christians 22 (73.0%). The commonly spoken language by most of the respondents was Ewe accounting for 14 (46.7%) of the population. The majority of respondents 13 (43.3%) were nurses, followed by 8 midwives (26.7%), 5 doctors (16.7%), and 4 pharmacists (13.3%) (Table 1).
Socio-Demographic Data of Respondents.
Note. Compiled by authors from participants data (Field Work, 2023).
Theme One: Drug Withdrawal Difficulties
Assessing the challenges healthcare workers face during their recovery period from drug misuse, we realized it is difficult for the majority of them due to various reasons. The following were mentioned: fear of withdrawal symptoms, relapse, scarcity of support groups, and chronic medical condition. The aforementioned are the obstacles that prevent most healthcare workers from terminating misusing drugs despite their willingness to stop (Table 2).
Emerged Themes.
Note. Compiled by the authors based on thematic content analysis of participant interviews (Field Work, 2023).
Fear of Withdrawal Symptoms
The symptoms experienced by people withdrawing from drug misuse can be scary and life-threatening. As a result of these possible experiences, some healthcare workers are unable to stop misusing drugs even though they want to: I really want to stop using drugs because I know where it is leading me to. I am also aware of the withdrawal symptoms I will experience. It scarce me a lot, and this has been the main reason why I haven’t been able to stop. I seek for help and began it but a few days into it, I realized that I began feeling irritable, my mood began changing like unpredictable weather, and depression and anxiety set in. I also started hallucinating, and vomiting. It was at this point that I gave up and started using the drug again, I am afraid I can’t do it.
Relapse
Stopping drug misuse is a major accomplishment, but it is just the beginning of the recovery process and each person’s journey is unique. Maintaining long-term sobriety can be challenging, and many people experience relapse.
Yes, I have tried to stop on my own before and I must say, it was quite successful, but I found it difficult to maintain my sobriety for long without professional help and support. Yes, I have successfully stopped using drugs on my own before, but I eventually relapsed and now I know that I need more structured and sustained support to maintain my recovery.
Scarcity of Support Groups
It is impossible to discuss the fight against drug misuse and other addictions and its success without recognizing the role that support groups and anonymous communities have played. The study’s respondents were clear that they sincerely want to stop using drugs, but the paucity of these support groups in their area and throughout the nation makes it harder for them.
The following confessed the willingness to cut back on their drug misuse but due to the scarceness of support groups, their attempts have been unsuccessful.
I have tried to cut down on my drug misuse by myself, but it hasn’t been very successful. I think I need more structured support to help me overcome my misuse. But I do not have access to that help I’ve tried to put a limit on my drug misuse on my own, but it hasn’t been successful in the long term. I realize now that I need help, a support group should be created so we can address the root causes of our misuse and develop healthier coping strategies.
While the above respondents had challenges in cutting down their drug misuse, others faced challenges in stopping totally.
Yes, I have tried to stop on my own before, but I found it very difficult to do so without professional help and support.
Chronic Discomfort Associated With Diseases
Many chronic conditions, especially chronic pain require continuous use of analgesics for their management. Instead of opting for medical treatment, some healthcare workers prescribe their drugs at a rate and dose that seems fit to them. This is to say, as long as the condition exists, they will keep on with their prescription.
I had a back injury due to my work. The pain never stops and I can’t be living in pain every day. To deal with this non-stop pain, I have to keep taking drugs to alleviate the pain.
A doctor stated I try to be mindful of the potential side effects of drugs, but it can be difficult when you’re dealing with chronic pain or other conditions. It’s a constant balance between managing symptoms and avoiding harm.
Theme Two: Effects of Drug Misuse
Respondents were asked to narrate how they really felt after taking the various drugs they misused. This was to assess the effect of such drugs on their health, relationships, finances, and work. Their confessions were grouped into the following sub-themes (Table 2).
Inability to Focus
Respondents informed that after taking the drug, their alertness was distorted and they mostly lose focus of whatever thing they are to do.
As a doctor, I need to pay attention when attending to my patients because assessment is very important and the type of treatment depends on it. However, the drug I misuse has affected my ability to focus on my work and provide effective care to my patients.
A pharmacist stated: Drug misuse has made it difficult to maintain focus and perform well at work. Sometimes the pharmacy gets busy with lots of patients to be served and lots of mixtures to be done. I began using the drugs to keep me focused, but in the long term, I can’t concentrate even when I take the drug. This made me dispense the wrong medication to patients on some occasions.
Absenteeism and Presenteeism
It was also revealed that absenting oneself from work was a common effect since they would not want to go to work in a state that would make them liable to identification as drug users. They come up with excuses to stay away from work.
Misusing drugs has led me to absenteeism at work which has affected my career. At the end of the year, when my appraisal is done, the issue of poor job performance comes up. It has also caused me to miss work days, which has affected my job security. I am just lucky in this country we are not paid according to the number of hours or days we work in a month. Otherwise, I will never get enough money to support myself at the end of the month.
Some other respondents revealed that they still come to the workplace, present themselves at work yet do nothing for the whole of their shift.
You know, I try as much as possible to be present at work but most of the time, I don’t do much at work. Sometimes, when colleagues require my assistance, I am unable to help because I don’t feel like doing anything. (
Poor Decision
Decision is a key component when rendering care to patients. These decisions are to be taken in line with ethical codes of practice. Respondents revealed how drug misuse has affected their ability to make informed decisions in the following quotes. The poor decisions made has led to medication errors and poor health outcome for patients.
A nurse stated: Drug misuse has affected my ability to provide quality patient care. It has led to some minor errors in medication administration and other aspects of my patient care. ( My capacity to deliver quality patient care has been hampered by my drug usage. It has resulted in a few minor mistakes which led to poor patient outcomes. In fact, I don’t want to expose myself by saying all the details.
In as much as these decisions affect patients, respondents acknowledged the effects on their personal health as well.
It has also affected my mental and physical health, causing anxiety, depression, and physical health problems.
The poor decisions made have also led them to exhibit unprofessional behaviors in the line of their work.
It has also caused me to make poor decisions and exhibit unprofessional behaviour at work. Like how I talk to patients and relatives sometimes, it is not professional. You will make some decisions, and later on, when you are back to yourself, you will feel bad because the decisions and actions you took are far below the standards.
Impaired Relationships
Drug misuse can result in behavioral changes and create tension and conflict within relationships. Drug misusers distance themselves from friends and family who disapprove of their behavior. These behaviors make it difficult for them to maintain relationships with friends and family.
A nurse stated: My personal life has been significantly impacted by drug misuse. It has caused issues with my relationships, including strained friendships and difficulties in my romantic relationships. Drug misuse has strained my relationships with my family and friends. I am even ashamed to demand for my rights in any relationship whether family or friends. Drug misuse has caused me to become isolated and withdrawn from loved ones, leading to further strains on relationships.
Financial Consequences
The cost of drug misuse goes beyond the price of the substances themselves and has impacted various aspects of their financial life. The most apparent and immediate financial impact of drug misuse is the money spent on purchasing the drugs. Substance misuse can become an expensive habit, especially if the user develops tolerance, leading to increased consumption.
A midwife said: It has also led to financial problems, as drugs can be expensive and take a toll on my finances. It has been a challenge to balance my personal life with my drug misuse. I have observed a drastic change in my expenditure since I began buying these drugs to feel good. My monthly estimated budget increases causing financial difficulties. Drugs are becoming very expensive and I need higher doses these days too.
Legal Complications
Drug misuse can have significant legal consequences on the user, as many countries have strict laws and regulations surrounding it. The legal consequences can vary depending on factors such as the type and quantity of the drug, the user’s prior criminal record, and the specific laws of the jurisdiction. Respondents informed in the following quotes the actual and potential consequences they are liable to.
A pharmacist stated: I have experienced legal consequences as a result of drug misuse which has had long-term effects on my life. Medication errors can be caused by my drug misuse. Patients and families who are literate and understand their legal rights may sue you for misconduct. It occurred to a co-worker of mine before, so I’m being extra cautious.
Apart from the legal consequences they face, some verbalized concerns about losing their job. One respondent said: As a doctor in this facility, I’m constantly worried about being caught or losing my job. I pray it doesn’t get worse because even my license to practice elsewhere is also at risk once I get caught and sacked from this hospital. This thought adds to my stress and anxiety levels.
Theme Three: Strategies in Overcoming Drug Misuse
Coping with drug misuse can be an uphill battle, and it requires a great deal of effort and support from various sources. The study found from the respondents the following approaches that helped them overcome this challenge. Professional and support networks provide a safe and uplifting environment while helping one another overcome the difficulties of recovery, important information is also provided on de-stigmatization, relaxation techniques, addiction, and addiction therapy.
Seeking Help From Professional and Support Networks
Many respondents in this study revealed how seeking help from professional and support networks has greatly aided them in coping with drug misuse. Some respondents said the following: Personally, I find that drug misuse has a negative impact on all aspects of my life (personal and professional). In fact, my work output was reduced and patient care became difficult because some of the decisions and actions that I took. Some of my awkward decisions were frowned upon by most of my colleagues. Coping with drugs can be challenging, and it often requires a combination of strategies. For me, seeking professional help has been essential in managing my drug misuse and maintaining a healthy work-life balance. As a healthcare worker, I recognize the importance of seeking professional help and support for drug misuse. In addition to seeking help from a healthcare provider, I also prioritize self-care, including getting enough sleep, eating well, and staying physically active. I also try to avoid triggers that can lead to drug misuse and focus on maintaining healthy relationships with colleagues, friends, and family. Drug misuse can be a challenging issue to cope with, but it’s important to seek help and support when needed. In my experience, reaching out to healthcare professionals and attending support group meetings have been helpful in managing drug misuse. I also make sure to communicate openly with my loved ones and colleagues about my struggles and work together to find solutions. I cope with drug misuse by talking to a therapist and joining a support network. It’s important to me to have people in my life who understand what I’m going through and can offer encouragement and advice.
Others admitted that despite the nation’s dearth of support networks, they had been able to get assistance from these networks in the struggle against drug misuse. Friends, classmates, and professionals who comprehended the difficulties of misuse and provided emotional support, encouragement, and direction made up support networks.
Coping with drug misuse has been a difficult journey, but I’ve found that staying connected with others who are going through similar struggles has been helpful. I attend support group meetings and try to be a source of support for others as well.
Nevertheless, some individuals were in denial about the severity of their misuse. They believed that their drug misuse was not negatively affecting their lives and that seeking professional help was unnecessary. To this, a respondent said: I have not considered seeking professional help because I don’t believe I have a problem with drug misuse. I feel that I am in control of my drug misuse and it is not negatively affecting my life.
Diversional Therapy
Apart from seeking professional help, some respondents confessed that diversional therapy has been very useful in times of craving for drugs to distract themselves. This helps them put their minds on other things aside from the urge to take drugs: I wasn’t feeling well when I decided to stop misusing drugs. The want to feel better keeps growing, yet when the urge strikes, I indulge in physical activity. I used to take long walks around the neighbourhood to distract myself.
Family Support
In the quest to overcome drug misuse, most families have not abandoned these respondents to their fate. Some respondents have acknowledged the support of their families in the following ways: The urge to go back to the misuse of drugs is always there. But luckily for me, I’ve opened up to my family. They were ready to support me, so whenever the cravings go high, I leave my personal space and visit my siblings. Spending quality time with family has been my way of not thinking about drugs. I cope with drug misuse by being honest with my loved ones, especially my immediate family members, and seeking their support. I also take time off work and to be away from the drugs when necessary to focus on my recovery.
Setting Boundaries
Boundary setting has been another tool used by some respondents to overcome their addiction. Setting boundaries can include avoiding people or situations that may encourage drug misuse, being honest with loved ones about the need for space and time to focus on recovery, and communicating clearly about the behaviors and situations that are off-limits.
I cope with drug misuse by staying organized and disciplined. I keep track of my medications and appointments, and I avoid situations that might trigger cravings or relapse. My coping with drug misuse is by keeping my misuse separate from my work and personal life, so I set boundaries and prioritize my recovery. Drug misuse has had a significant impact on my life, and I’ve had to make tough choices to protect my health and relationships. I cope by staying committed to my recovery and focusing on rebuilding the areas of my life that have been affected.
Discussion
Drug misuse is the use of a substance for a purpose that is not permitted by law or recommended by a clinician (Mark & Parish, 2019). Leaving with such a condition comes with its own burdens. The study revealed that overcoming drug misuse is a complex and challenging process. Healthcare workers face individual challenges such as fears of withdrawal symptoms, relapse, persistent discomfort associated with chronic diseases, and scarcity of support groups. The findings were similar to a study by Lader and Kyriacou (2016) uncovered that the process of attempting to stop drug misuse is often accompanied by intense withdrawal symptoms that can make recovery difficult. (Farhoudian et al., 2022; Sarkar et al., 2021; Scott & Marshall, 2023) also found out that the scarcity of support groups has been a challenge for many drug misusers to overcome their addiction. While Kampman and Jarvis (2015), documented the perceived withdrawal symptoms as the discouraging factor in quitting drug misuse. This study reported that the majority reported experiencing withdrawal symptoms such as nausea, vomiting, and muscle aches as common symptoms during withdrawal which are in line with the finding of Horowitz and Taylor (2022), Pergolizzi et al. (2020). Brown and Capili (2020) described in their theory the negative physical and/or psychological side effects of drug withdrawal to be intolerant, hence users will continue to use the drugs despite the immense negative consequences. McLellan (2017) ascertained the level at which chronic medical conditions can lead to drug misuse. The longer the existence of the condition, the more drugs will be used to gain relief which eventually in most cases leads to dependence on the drug.
The misuse of drugs mostly comes with some enjoyable short-term actions; however, the long-term effects are disastrous. The euphoric and pleasurable feelings are usually followed by negative effects, such as impaired cognitive and physical abilities, poor decision-making, decreased productivity, and increased risk of accidents or injuries. These were found to be consistent with the following studies (Martini et al., 2022; Olmstead et al., 2019). The negative effects of drug misuse on the lives of patients have also been documented by Krill et al. (2016). However, the above was contradicted in a study by Dolan et al. (2015) which revealed that healthcare workers who use drugs do not necessarily have worse patient outcomes or provide lower-quality care.
The effects of misusing drugs on respondents as emerged from the analysis were lack of focus, absenteeism and presenteeism, poor decisions, legal complications, financial consequences, and impaired relationships. These findings are in line with Toney-Butler and Siela (2023) which stated that most healthcare professionals who abuse drugs are unable to provide competent and safe patients due to its effects on their mental health. Financial constraints have been reported by Carpenter et al. (2017), Hollingsworth et al. (2017) who said that drug misuse is a state that takes control of one’s life, and as one’s physical dependency on the substance develops, the mind may be stuck in a never-ending loop, thinking about the next fix which ultimately makes it difficult for an addict to prioritize their finances and stay away from drugs. (Toney-Butler & Siela, 2023) revealed legal issues including fining and permanent loss of a medical license as the consequences of medical errors resulting from drug misuse by healthcare workers. Individuals misusing drugs whose moods are altered, preoccupied with getting high, or spending significant amounts of time recovering from the effects of substances, may miss the opportunities to foster healthy attachment as reported by Lander et al. (2013).
The study also revealed that seeking professional help and support can increase the chances of successful recovery and reduce the risk of relapse. Individuals who sought treatment for drug misuse were more likely to achieve long-term recovery than those who did not seek treatment (Patel et al., 2016; Rodríguez-Espinosa et al., 2021). However, a study with inconsistent findings conducted by Gilbert et al. (2019) found that harm reduction and self-care approaches may be more effective than traditional approaches such as medication and other therapies. Nevertheless, Degenhardt et al. (2016), Orwat et al. (n.d.) pointed out that some individuals may be hesitant to seek professional help for drug misuse due to concerns about stigma. Self-care and stress management, meditation, exercise, and healthy eating are also important for maintaining physical and mental health. Setting boundaries and avoiding triggers is also important for preventing drug misuse. The above were consistent with a study conducted by Strang et al. (2020) in which similar coping mechanisms were associated with improved mental health and reduced drug misuse in individuals recovering from addiction.
Conclusion
The challenges healthcare workers face in managing drug misuse were highlighted. Seeking professional help and support, diversional therapy, setting boundaries, and maintaining healthy relationships were revealed to be the coping strategies used by most respondents. The study’s findings provide insight into the factors that hinder or promote the willingness to stop drug misuse, emphasizing the need to offer support and resources to help individuals struggling with drug misuse overcome their ambivalence and commit to the treatment process.
Implications of Study
The early identification of healthcare professionals at risk of substance misuse is crucial for safeguarding patients, staff, and the integrity of the healthcare organization.
Recommendation
The creation and implementation of a focused training program on the symptoms and warning indicators of possible substance addiction and substance impairment is recommended. This program will facilitate early identification of substance misusers in order to protect patients, personnel, and the organization from disastrous outcomes. A dedicated hotline to report irrational drug usage should be made available. The study suggests that healthcare organizations should provide drug-misusing healthcare personnel with access to support networks and other resources.
Footnotes
Acknowledgements
The authors wish to thank our hardworking research assistant Mr. Francis Mawougnon Sagbo for his relentless effort in supporting this work.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Availability of Data
Data on this study is readily available and can be retrieved with permission from the university’s Research Ethics Committee where clearance was obtained.