Substance Use in Healthcare Students: A Conversation We Need to Have
Substance use doesn’t wait for a diploma. It begins quietly, sometimes in the shadows of stress, perfectionism, and isolation—and it often starts during school. For pharmacy, nursing, and medical students, the pressure to succeed, meet high expectations, and maintain a professional image can create the perfect storm for problematic substance use. And yet, this is a conversation we rarely have.
The Hidden Risk Behind the White Coat
According to the American Association of Colleges of Pharmacy, an estimated 8% to 12% of pharmacists will struggle with a substance use disorder (SUD) during their careers. Among medical students, the number may be as high as 15%, and nursing students report increasing use of alcohol, stimulants, and anxiety medications.¹ ² These numbers are likely underreported due to stigma and fear of professional consequences.
For healthcare students, substance use often begins as a way to manage the immense stress of training: stimulants for studying, benzodiazepines for sleep, or alcohol to decompress. But these "tools" can quickly become crutches, and what starts as coping can evolve into dependence—especially when the internal pressure to be perfect drowns out the need for help.
What to Look Out For
Contrary to common belief, struggling students are not always the ones falling behind. In fact, many students dealing with substance use are "super-achievers"—those at the top of their class, holding leadership roles, or excelling in clinicals. Their overachievement may serve as a shield, delaying concern from peers and faculty while they silently unravel inside.
Key signs to look out for include:
- A growing need to be "on" all the time, with no ability to rest or disconnect
- Irritability, anxiety, or mood swings masked by perfectionism
- Dramatic fluctuations in energy, concentration, or personality
- A pattern of avoidance, secrecy, or withdrawing emotionally
- Changes in physical appearance, sleep habits, or weight
- Missing class, rotations, or being frequently "out sick"
- Over-reliance on caffeine, stimulants, or other substances to maintain performance
How to Seek Help Without Losing Everything
If you’re struggling—or you’re worried about someone else—know this: help is available, and you don’t have to sacrifice your career to get it. Many schools offer confidential mental health and counseling services, and most state health boards have assistance programs tailored for healthcare professionals and students.
Start with:
- SAMHSA Helpline – 1-800-662-HELP (24/7, confidential)
- State Pharmacist or Nurse Recovery Programs
- Medical Student Wellness Services (offered through most institutions)
- Peer support networks at your school or professional association
Changing the Culture of Healthcare from Within
Recovery isn’t the end of a career—it can be the beginning of a deeper, more resilient one. If we value empathy in our professions, we must offer the same compassion inward. As future clinicians, we must break the silence surrounding addiction and build systems that support, rather than punish, those brave enough to ask for help.
It’s time we make it okay for the healers to need healing too.
References:
- Baldwin, J. N., et al. (2009). “Substance Use Among Pharmacy Students.” American Journal of Pharmaceutical Education
- Jackson, E. R., et al. (2016). “Prevalence of Burnout and Substance Use in US Medical Students.” Academic Medicine