Substance Use Disorder (SUD) is not unique to nurses, nor are they at a higher risk. It occurs in every occupation at about a rate of 1:10. But for the 10% of nurses with SUD, the risk is passed along to the patients in their care.The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms “substance abuse” and “substance dependence” as diagnoses. The DSM-5 now refers to “Substance Use Disorders,” which are then classified as mild, moderate, or severe. According to the Substance Abuse and Mental Health Services Administration, a SUD occurs when “the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. The diagnosis of SUD is based on evidence of impaired control, social impairment, risky use, and pharmacological criteria.”Every year, Gallup Poll surveys Americans to find out the most trusted and ethical professionals. Nurses continue to lead the poll, even before doctors, pharmacists, police officers and clergy. People feel safe and secure when cared for by nurses. A nurse with SUD, also called “an impaired nurse,” is unable to uphold the high standards expected by patients, the community, and the field of healthcare.No one sets out to acquire SUD. It’s a progressive, chronic disease. While Alcohol Use Disorder is common in the general population, nurses also have access to controlled substances in their everyday work environment. At first it can be difficult to spot an impaired nurse; the natural stress of the job can account for some erratic behaviors. Some signs of a nurse with SUD, from the National Council of State Boards of Nursing:• Unexplained absences from the unit• Extended time in the bathroom or frequent trips to the bathroom• Increasing number of mistakes, including medication errors• A new pattern of isolation from co-workers• Outbursts or inappropriate responses• Changes in appearance over time, both physical and groomingAccording to the American Nurses Association, the most common substances abused by nurses (as well as all healthcare professionals) include alcohol, Ritalin, marijuana, inhalants, Ultram, methamphetamines, hallucinogens and sterol, sleeping pills, antidepressants, morphine, Demerol, Percodan, Vicodin and codeine. Drugs may initially be obtained by prescription from a provider. As the SUD develops, a nurse may divert a drug from patients or falsify medication records. The nurse may alter verbal or phone drug orders, or suddenly start to offer to medicate co-workers’ patients during busy shifts. In fact, they may volunteer for busy shifts.Because SUD affects the entire profession, nurses are ethically and legally required to report observations and suspicions to a manager. Each institution has policies regarding investigation and reporting. Every nurse should know the state Nursing Practice Act, which includes regulations for reporting as well as consequences for not doing so. Remember, not only is a colleague in need of intervention and treatment, but patient safety is at stake.