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self-destructive, behaviors. In 2013, the American Psychiatric Association (APA) replaced the definitions of substance abuse and substance dependence in the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnostic manual used by clinicians that contains descriptions and symptoms of all mental disorders classified by the APA, with substance use disorder (SUD). Substance use disorder is associated with the following symptom categories: • Impaired control • Social impairment • Risky use • Pharmacological criteria (tolerance and withdrawal) (National Institute on Drug Abuse (NIDA), 2016) Risk Factors The risk factors for workplace impairment indicate some common themes. Work Place Risk Factors Human Risk Factors • High stress environment • Low job satisfaction • Long hours • Irregular shifts • Over time • Fatigue • Drug accessibility • Periods of inactivity or boredom • Irregular supervision • Lack of education regarding substance use disorders • Lack of pharmaceutical controls in the workplace • Enabling by peers and managers • Genetics • Post-traumatic stress disorder • Depression • Acute or chronic pain • Low self esteem • Addictive personality traits • History of substance abuse • Risk-seeking behaviors • Maladaptive coping strategies • Dysfunctional personal life • History of bullying Table developed from DrugRehab.com (2015) & National Council State Boards of Nursing (2011). Did You Know? Family history, personality characteristics, underlying comorbid conditions such as depression or anxiety, and inadequate coping skills may pose the greatest risk for impairment in nurses (Cares, Pace, Denious, & Crane, 2015). Material Protected by Copyright Workplace Impairment The DSM-5 manual indicates that a person may have a problematic pattern of substance misuse leading to significant impairment or distress if two of the following have occurred in a 12-month period: 1. The substance is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance. 3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects. 4. Craving, or a strong desire or urge to use the substance. 5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use. 7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance. 8. Recurrent use of the substance in situations in which it is physically hazardous. 9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. 10.Tolerance, as defined by either of the following: a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of the substance. 11.Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance). b. The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms. (NIDA, 2016) The Intervention Project for Nurses (IPN) (2015) also known as the Impaired Practitioners Program of Florida, has a mission to ensure public health and safety by providing education, monitoring, and support to nurses in the State of Florida. According to the IPN, a nurse is impaired when he or she is unable to provide safe patient care due to using a mood or mind-altering substance, or having a physical condition, or a distorted thought process from a psychological condition. Test Your Knowledge A colleague may have a substance use disorder if which of these actions have occurred in a 12- month period: A. The person has used the substance for the intended purpose and in the intended time frame B. The person has a craving or urge to use the substance C. The person has