Substance Misuse and Chemical Dependency

Formerly Position Statement Number 1.7

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Substance misuse refers to patterns of substance use not consistent with legal or medical guidelines and is associated with the amount of and context and pattern in which the substance is used leading to the potential for harm.1  According to the American Psychiatric Association DSM-IV-TR, the term substance use disorder "encompasses both dependence on and abuse of drugs usually taken voluntarily for the purpose of their effect on the central nervous system (usually referred to as intoxication or "high") or to prevent or reduce withdrawal symptoms. These mental disorders form a subcategory of the substance-related disorders."The American Association of Nurse Anesthetists (AANA) recognizes that substance misuse may lead to impairment and chemical dependency.  Chemical dependency is a disease characterized by a chronic, progressive process that may result in the devastation of the person professionally as well as negatively impact the person’s relationships with their family and professional colleagues.

The life time prevalence substance misuse rate of anesthesia professionals is approximately 9.8%3-16.8%4.  Two demographic risk factors attributed to increased risk for substance misuse among CRNAs are being a Caucasian male with possibly 6-10 years of work experience.3,5  More importantly, familial history of chemical dependency is a significant risk factor, suggesting a pre-disposition to substance use disorder.4-6  Anesthesia professionals in treatment programs have been found to misuse operating room drugs such as fentanyl, propofol, benzodiazepines, and anesthetic gases, suggesting that ready access to these substances may play a role in substance misuse and chemical dependency.3,6-12

The AANA, which is dedicated to fostering and supporting lifelong health and wellness for its members, is aware of the potential risk for substance misuse by and development of chemical dependency in anesthesia practitioners, as well as the professional implications of substance misuse. Most importantly the AANA acknowledges that an impaired anesthesia professional may have detrimental effects on patient safety. 

The AANA promotes education and awareness regarding the disease of chemical dependency and the effects of substance misuse on provider impairment in practice.  In acknowledging the occupational risk that direct access to anesthetics and analgesics may play in substance misuse and chemical dependency, the AANA encourages the use of controlled substance diversion monitoring coupled with a comprehensive for-cause drug screening policy consistent with state and federal law and national guidelines.  In the interest of patient safety and practitioner well-being, the AANA supports the concept of a comprehensive substance abuse policy consisting of education about substance misuse and abuse, methods to monitor controlled substance diversion, and a comprehensive for-cause drug testing program.  The AANA strongly recommends that a comprehensive substance abuse policy be a written and communicated policy accompanied by both supervisor and employee education and instituted in a non-discriminatory manner, applicable to all at-risk healthcare providers.  The AANA further supports organizational customization of such policies provided adherence to evidence-based national guidelines is maintained. 


  1. Ministry of Health Promotion.  Prevention of substance misuse guidance document.  The Prevention of Substance Misuse Working Group: Ministry of Health Promotion, Ontario, Canada.  Published May 2010.  Accessed September 27, 2011.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC:  Published 2000.  Accessed September 27, 2011.
  3. Bell DM, McDonough JP, Ellison JS, Fitzhugh EC. Controlled drug misuse by Certified Registered Nurse Anesthetists. AANA J. Apr 1999;67(2):133-140.
  4. Lutsky I, Hopwood M, Abram SE, Cerletty JM, Hoffman RG, Kampine JP. Use of psychoactive substances in three medical specialties: anaesthesia, medicine and surgery. Can J Anaesth. Jul 1994;41(7):561-567.
  5. Lutsky I, Hopwood M, Abram SE, Jacobson GR, Haddox JD, Kampine JP. Psychoactive substance use among American anesthesiologists: a 30-year retrospective study. Can J Anaesth. Oct 1993;40(10):915-921.
  6. Zacny JP, Galinkin JL. Psychotropic drugs used in anesthesia practice: abuse liability and epidemiology of abuse. Anesthesiology. Jan 1999;90(1):269-288.
  7. Booth JV, Grossman D, Moore J, et al. Substance abuse among physicians: a survey of academic anesthesiology programs. Anesth Analg. Oct 2002;95(4):1024-1030, table of contents.
  8. Bryson EO, Hamza H. The drug seeking anesthesia care provider. Int Anesthesiol Clin. Winter 2011;49(1):157-171.
  9. McAuliffe PF, Gold MS, Bajpai L, et al. Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons. Med Hypotheses. 2006;66(5):874-882.
  10. Talbott GD, Gallegos KV, Wilson PO, Porter TL. The Medical Association of Georgia's Impaired Physicians Program. Review of the first 1000 physicians: analysis of specialty. JAMA. Jun 5 1987;257(21):2927-2930.
  11. Wilson JE, Kiselanova N, Stevens Q, et al. A survey of inhalational anaesthetic abuse in anaesthesia training programmes. Anaesthesia. Jun 2008;63(6):616-620.
  12. Wischmeyer PE, Johnson BR, Wilson JE, et al. A survey of propofol abuse in academic anesthesia programs. Anesth Analg. Oct 2007;105(4):1066-1071, table of contents. 

Adopted by the AANA Board of Directors November 1984.
Revised by the AANA Board of Directors 1998, June 2007 and November 2011.