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Open Journal of Nursing, 2017, 7, 435-448
http://www.scirp.org/journal/ojn
ISSN Online: 2162-5344
ISSN Print: 2162-5336
DOI: 10.4236/ojn.2017.73034 March 31, 2017
Is It Workplace Stress a Trigger for
Alcohol and Drug Abuse?
Maria Neyrian de Fatima Fernandes1,2, Edilaine Cristina da Silva Gherardi-Donato2
1Federal University of Maranhão (UFMA), Imperatriz, MA, Brazil
2Ribeirão Preto School of Nursing, São Paulo University (USP), Ribeirão Preto, SP, Brazil
Abstract
Those workers most vulnerable to pressure tend to suffer from scarce social
and personal resources with which to respond adaptively to stress. In this case,
the effects of psychoactive substances may exceed the stressed worker’s pos
i-
tive expectations. Thus, the aim is to analyze the scientific evidence on the r
e-
lationship between drug abuse and workplace stress, based on an integrative
review of the literature. Data were collected in February 2016 from the dat
a-
bases of the Virtual Health Library and PubMed. The final sample of 16 a
r-
ticles was divided into two categories: alcohol and drugs abuse in professions
with high degree of psychosocial hazards and risks, and alcohol and drugs
abuse for workplace stress in other professions. A relationship between prec
a-
rious conditions, the nature of the work and its influence on drug abuse could
be seen. However, other variables may strengthen psychoactive drug use as a
coping strategy for stress.
Keywords
Work, Psychological Stress, Workplace, Alcoholism, Substance Use
Related Disorders, Psychological Adaptation
1. Introduction
The human being cannot avoid work. Everything achieved and constructed by
humans from pre-history to the present day is the result of labor by diverse indi-
viduals. Thus, work can be viewed as one of the pillars of civilization which has
been built.
Although work is the basis of the wealth of nations and the source of the indi-
vidual’s financial support, it has also been the source of mental and physical ill-
ness. This is due to the characteristics of society that imposes daily situations of
How to cite this paper:
de Fatima Fer-
nandes
, M.N. and da Silva Gherardi-Do-
nato
, E.C. (2017)
Is It Workplace Stress a
Trigger for
Alcohol and Drug Abuse?
Open
Journal of Nursing
,
7
, 435-448.
https://doi.org/10.4236/ojn.2017.73034
Received:
January 31, 2017
Accepted:
March 28, 2017
Published:
March 31, 2017
Copyright © 201
7 by authors and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
436
stress and anxiety on the individual. Anyone who works complains of increased
demand and pressure in the workplace, where workers are constantly expected
to produce more in less time [1].
Workers, then, see the environment as wearing them down, exhausting their
physical and psychological resources and threatening their wellbeing. In this
context, stress appears as the individual’s reaction to these threats, impelling
them to seek to adjust or respond to these conditions that provoke anxiety or
fear. This response may be physical, mental or emotional and aims to stabilize
internal biological processes and preserve self-esteem [2] [3].
However, a point may be reached at which the organism can no longer bear or
support the stressful situation and attempts begin to decrease, manage, control
or tolerate the harmful effects of stress. These are known as coping strategies [4]
[5].
Coping mechanisms consist of cognitive and problems solving behavior that
the individual uses to deal with stress. Coping may be adaptive, through physical
activities or socializing with friends and family or non-adaptive, escape strate-
gies, unhealthy behavior such as drug abuse. In general, non-adaptive coping is
strongly linked to drug abuse [6] [7].
Studies [8] [9] have shown that there is a close relationship between stress and
alcohol and drug abuse. The more stressful events followed by inefficient coping
strategies, the greater the vulnerability to drug addiction and abuse. The more
negative situations, the greater the risk of using alcohol or drugs as a coping
strategy to improve one’s mood or distract oneself from disagreeable sensations.
Those individuals most vulnerable to pressure tend to suffer from scarce so-
cial and personal resources with which to respond adaptively to stressful situa-
tions in the workplace. In these cases, the stressed worker begins to feel positive
expectations regarding the effects of psychoactive substances, making them feel
more relaxed after use, escaping from the negative emotions of stress. Alcohol
possesses a double mechanism, on the one hand, it reduces anxiety and, on the
other hand, it acts as a stressor, activating the hypothalamic-pituitary-adrenal
axis [8] [10].
The question, then, is: What is the relationship between drug abuse and work-
place stress? To assist in elucidating this issue, the following objective was out-
lined: to analyze the scientific evidence on the relationship between drug abuse
and workplace stress.
2. Materials and Methods
This is an integrative review of the literature, a broad approach that enables di-
verse published studies on the topic in question to be integrated. This means that
experimental and non-experimental studies can be included to give a complete
understanding of the phenomenon in question. The results obtained can create a
consistent and comprehensive view of the relevant concepts, theories or prob-
lems [11].
The following six steps for the integrative review were followed. The first was
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
437
to identify the topic and select the hypothesis or research question. Next, inclu-
sion and exclusion criteria were defined for the studies/samples or searches in
the literature. The third stage was defining the data to be extracted from the se-
lected studies. The fourth evaluated the studies included. Next, the results were
interpreted and, finally, at the sixth stage, the review/synthesis of knowledge was
presented [11].
The following question was drawn up to guide the research: What is the rela-
tionship between drug abuse and coping strategies for workplace stress? Data
were collected in February 2016 from the databases included in the Virtual
Health Library (VHL) and PubMed through the link “search by DeCs/MeSh de-
scriptors”.
The descriptors used were “work”, “psychological stress”, “alcoholism” and
“substance-related disorders” combined through the Boolean operator “AND”.
Inclusion criteria were: publications between 2010 and 2015, so as to analyze the
most up to date publications available in the literature; studies dealing with the
topic of stress in workers and drug abuse; workers being study participants; qua-
litative or quantitative methodological design; and published in Portuguese, Eng-
lish or Spanish. Those studies were excluded which were reviews or discussions;
not published in the form of an article (theses or dissertations) and duplicated
articles.
The combination of the descriptors “psychological stress”, “work” and “alco-
holism” produced 94 articles in VHL and 10 in PubMed, the combination of
“psychological stress”, “work” and “substance-related disorders” produced 115
articles in VHL and 12 in PubMed. Figure 1 synthesizes the search process. The
initial sample totaled 231 articles. Of the studies listed, 45 met the inclusion cri-
teria. After applying the exclusion criteria and reading the articles in full, the
corpus
of this study was composed of 16 articles. Next, the pertinent data were
selected for the review and grouped.
Classification of the articles was based on the scientific evidence currently
available in the literature, including the levels of the evidence and grades of re-
commendation to obtain the best results. Level of evidence was classified by the
type of study according to the Oxford Centre for Evidence-based Medicine [12].
In reading the articles for the corpus of this study, those with evidence levels up
to three were considered.
At level 1, the evidence is from randomized, controlled clinical trials with na-
rrow confidence intervals, or from systematic reviews or meta-analyses of all re-
levant randomized, controlled clinical trials, or from clinical directives based on
systematic reviews of randomized, controlled clinical trials; level 2, evidence de-
rived from historical cohort studies or with segments of compromised cases (at
least one well designed randomized controlled clinical trial, but of lower quality)
and ecological study; level 3, evidence obtained from well-designed, non-ran-
domized clinical trials (case-control studies), systematic reviews of case control
studies [12].
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
438
Figure 1. Flow chart of search procedures.
Among the articles making up the final sample, however, there were no ran-
domized clinical trials. Thus, the strength of the evidence of 16 articles was classed
as level 2, as the studies were observations of clinical developments or treatment
results and two articles as level 3, as they were non-randomized. Thus, the rec-
ommendation grade was B, denoting a moderate grade of evidence, being studies
that presented important evidence in the outcome.
In order to analyze and interpret the data, they were organized using a previous-
ly-prepared data form [13], containing data on the study such as year of publica-
tion, authors, type of study, location and population studied; when completed for
each article from the sample, the data could be catalogued. Thus, it was easy to
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
439
get an overview of the articles and compare the studies. The articles were divided
into two categories of analysis: alcohol and drugs abuse in professions with high
degree of psychosocial hazards and risks (8) and alcohol and drugs abuse for
workplace stress in other professions (8).
3. Results
The articles making up the corpus of this study were written in English, of which
two were bilingual (English-Portuguese) and none of them were Spanish. The
professionals studied in the 16 articles were separated into two categories. Table
1: professions with high degree of psychosocial hazards and risks and other pro-
fessions.
Table 2 and Table 3 synthesize the general data on the selected articles. The
majority (88%) were of quantitative design. As for origin, seven (41%) were con-
ducted in the United States (USA) and the rest in a variety of other countries.
Professionals who worked directly in caring for others were analyzed in eight
(53%) of the articles.
3.1. Alcohol and Drugs Abuse in Professions with High
Degree of Psychosocial Hazards and Risks
All the studies explored the job characteristics and workplace conditions. Both
exposure to drugs and difficult working conditions can create psychological dis-
tress and cause secondary problems such as drug abuse [14].
Among the prison warders and the police officers studied, their own percep-
tion of difficult working conditions and stressful, traumatic day-to-day expe-
riences constituted a risk factor for increased smoking and alcoholism [14] [15].
Such stressful situations can trigger illegal drug use due to constant contact with
drugs and drug dealing [15].
Similar working conditions are also found among urban police officers in the
USA [16]. In this category, alcohol consumption in the sample (747) studied was
considerable; a third of the men and women studied reported consuming large
quantities of alcohol on single occasions (bingeing) during the preceding month,
a higher proportion than in the general population.
Table 1. (a) Categories of studies according to the professionals’ categories.
Categories of studies
Professionals studied
Professions with high degree of psychosocial hazards and risks
Doctors
Prison warders
Police officers
Bartenders
Fire fighters
Other professions
Truck drivers
Latino immigrant workers
Journalists
Construction workers
Civil servants
General workers
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
440
Table 2. Panorama of the articles by author, title, year of publication, type of study, country of origin and population of the study.
Authors Title Year Objective Type Country Population
Biron M.
Work-Related Risk Factors
and Employee Substance Use:
Insights from a Sample of
Israeli Blue-Collar Workers
2011
To identify work-related
risk factors and
employee substance use
Quantitative Israel
569
construction
workers
Austin-Ketch
T. L.
et al
.
Addictions and the Criminal
Justice System, What
Happens on
the Other Side?
Post-Traumatic
Stress Symptoms and
Cortisol Measures in a
Police Cohort
2012
To evaluate physiologic and
stress measures in a high-risk
occupation where occupational
exposure to difficult criminal
situations can lead to
physiologic and psychological
health consequences
Quantitative United
States
100 police
officers
Cheng
W. J.
Alcohol Dependence,
Consumption of Alcoholic
Energy Drinks and Associated
Work Characteristics in the
Taiwan Working Population
2012
To examine the association
between work and characteristics
and the risk of alcohol dependence
across different employment
types and occupations
Quantitative Taiwan,
China
22,085
general
workers
Unrath M.
Identification of Possible Risk
Factors for Alcohol Use Disorders
among General Practitioners in
Rhineland-Palatinate, Germany
2012
To identify possible risk factors
for alcohol use disorders among
general practitioners (GP) working
in the outpatient sector
Quantitative Germany 2092
doctors
Oreskovich R.
M.
et al
.
Prevalence of Alcohol Use
Disorders among
American Surgeons
2012
To determine the point prevalence
of alcohol abuse and dependence
among practicing surgeons
Quantitative United
States
7197
Surgeons
Tutenges S.
Drunken Environments:
a Survey of Bartenders Working
in Pubs, Bars and Nightclubs.
International Journal of
Environmental Research
and Public Health
2013 To asses risk factors in the working
environment of bartenders Quantitative Denmark 424
bartenders
Barros
V. V.
et al
.
Mental Health Conditions,
Individual and Job
Characteristics and
Sleep Disturbances
among Firefighters
2013
To assess the associations between
mental conditions, individual and
job characteristics and sleep
disturbance among firefighters
Quantitative Brazil 303 fire
fighters
Fjeldheim
C. B.
et al
.
Trauma Exposure,
Posttraumatic Stress
Disorder and the Effect
of Explanatory Variables
in Paramedic Trainees
2014
To investigate the type, frequency,
and severity of direct trauma
exposure, posttraumatic stress
symptoms and other
psychopathology amongst
paramedic trainees
Quantitative South Africa
131
paramedics
Collel
E.
et al
.
Work-Related Stress
Factors Associated with
Problem Drinking: A Study
of the Spanish Working
Population
2014
To examine the association between
work-related stress and alcohol
use in a representative sample of the
Spanish working population
Quantitative Spain
13,005
general work-
ers
Gavin R. S.
Association between
Depression, Stress, Anxiety
and Alcohol Use among
Civil Servants
2015
To identify depressive symptoms
association with sociodemographic
variables, exposure and dimensions
of occupational stress
Quantitative Brazil 1239 civil
servants
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
441
Table 3. Panorama of the articles by author, title, year of publication, type of study, country of origin and population of the study.
Authors Title Year Objective Type Country Population
Bierie D. M. The Impact of Prison
Conditions on Staff Well-Being 2010
To examine the impact of
prison conditions on staff
well-being (substance use...)
Quantitative United States 1738 prison
warders
Shattell
M.
et al
.
Occupational Stressors and
the Mental Health of Truckers 2010
To report findings on the
occupational stressors and
the mental health of truckers
Quantitative/
Qualitative United States 60 truck
drivers
Negi J. N.
Identifying Psychosocial
Stressors of Well-Being and
Factors Related to Substance
Use among Latino Day Laborers
2011
To identify psychosocial stressors
of well-being and factors
related to substance use
among Latino Day laborers
Qualitative United States
150 Latino
immigrant
workers
Ballenger
J. F.
Patterns and Predictors of
Alcohol Use in Male and
Female Urban Police Officers
2011
To examine the drinking
patterns of a large sample of
urban police officer and to identify
specific predictors of alcohol use
Quantitative United States 747 police
officers
Buchanan M.
Coping with Traumatic
Stress in Journalism:
A Critical Ethnographic Study
2011
To identify the coping strategies
used to buffer the effects of being
exposed to trauma and disaster
events and work-related stress
Qualitative Canada 31
journalists
Mezuk B.
Job Strain, Depressive Symptoms,
and Drinking Behavior among
Older Adults: Results from the
Health and Retirement Study
2011
To examine the relationship
between job strain and two
indicators of mental health,
depression and alcohol misuse,
among currently
employed older adults
Quantitative United States
2902
working
adults
It is noteworthy that in this study, the female police officers showed low levels
of workplace stress, but high levels of alcohol consumption. This characteristic is
attributed to the need to identify oneself with an organization culture for self-affir-
mation in a male-dominated environment [16].
Even given such results, it is thought that substance abuse among police offic-
ers is underreported, as this category perceive alcohol as part of a social event,
commonplace and innocent, such as having some beers after work. This type of
habit can develop into a coping strategy to deal with the day-to-day tragedies and
stress of the profession [15].
Alcohol may also be an element present in the workplace itself, as is the case
with bartenders
,
professionals who make and serve alcoholic drinks to diverse
clients. They also live under constant stress because of the risks of verbal aggres-
sion and threats. Thus, this work environment presents a risk of developing dis-
orders related to abuse of alcohol and other drugs. One study interviewed 489
bartenders in Denmark; 68.3% stated they had drunk alcohol while on shift,
40.15% reported a binge drinking episode during a least one shift within the last
month, 17.57% has drunk 10 or more doses during the last month and 41% ad-
mitted using illegal drugs [17].
The violence at work these professionals experience has been associated with
the high levels of stress found, although not with drug use. However, continuous
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
442
exposure to stressors that are out of our control, as in the case of bartenders, can,
over time, negatively affect the ability to cope with stress [17].
The case of bartenders reinforces that the norms surrounding alcohol use and
that of other drugs and their easy availability in the workplace are basic factors
influencing the abuse if these substances [15].
Likewise, high levels of alcohol and greater vulnerability to developing alco-
hol-related disorders affect health care professionals; 24% of the 131 emergency
services paramedics studied in South Africa abused alcohol, 23% of the 2092
doctors analyzed in Germany reported drinking alcohol every day and it was
found that 18.9% had suffered from alcohol-related disorders, with females more
affected compared to the population in general. In this case, it is believed that
the female doctors are exposed to greater stressful factors than other women, to
which are allied the challenges of bringing up their own children and the lack of
free time [18] [19].
The female surgeons of the 7197 interviewed in the USA also showed greater
vulnerability to alcohol abuse or addiction compared with their male colleagues.
Another important factor found in this study was the close relationship between
alcohol abuse and addiction and the existence of symptoms of depression and
burnout syndrome, such as emotional exhaustion, de-personalization and insen-
sitivity [20].
In this study, an association was found between resilience and daily consump-
tion of alcohol which can be considered a coping strategy for at least some of the
doctors interviewed [21].
Certain individuals do not possess coping mechanisms sufficient to face day-
to-day stressful situations. Thus, they internalize conflicts and emotions, causing
a state of agitation and psychological activation, culminating in sleep distur-
bance. This was the situation found in 51% of the 303 Brazilian firefighters’ stu-
dies, with sleep disturbances associated with alcohol abuse and addiction asso-
ciated with increases in suicidal thoughts [21]. Constant exposure to risk may
lead professionals such as prison warders, police officers, fire fighters and doc-
tors, among others, to develop post-traumatic stress.
3.2. Alcohol and Drugs Abuse for Workplace Stress in
Other Professions
In general, professions are exposed to different types of pressure that can cause
stress in susceptible individuals. Each person develops their own strategy for
coping with the prolonged effects of stress. However, coping strategies with neg-
ative results may cause behavior and mental problems, such as a distraction to
avoid thinking of the stressor, which can occur through alcohol or drug abuse,
daydreams and insufficient sleep [22].
Professionals in diverse categories, therefore, may view alcohol or drugs as the
most accessible and immediate strategy to deal with these demands. For exam-
ple, truck drivers interviewed in the USA stated that the constant pressure to de-
liver cargo on time, irrespective of weather or traffic conditions led them to
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
443
resort to drug abuse to stand the pressure and keep active. The preferred drug in
this category was crack as it helped deal with the constant loneliness and depres-
sion, keeping them alert so as to be able to remain on the road [23].
In contrast, the pressures of the world of work are dealt with better by older
professionals, those in their 60s or 70s. Research conducted in the USA with 2902
workers aged over 60 found no association between work pressure and alcohol-
ism. This discrepancy is believed to young workers [24].
In addition to constant pressures at work, flouting labor laws, discrimination,
social isolation, instability, undervaluing the professionals and hazardous envi-
ronments are also determinants of drug abuse, attempting to reduce the effects
of these psychosocial stressors. Such situations are faces by truck drivers, Latino
workers living illegally in the USA and working men in Taiwan [23] [25] [26]
[27].
Of workers in Taiwan, China, those that present the highest prevalence of al-
cohol addiction (16.8%) were those doing manual work, other categories at risk
included construction workers and miners (20.3%), chief executives and politi-
cians (20%), laborers (15.8%), journalists and artists (15.4%) [25]. This preva-
lence in certain categories may, in some cases, be the result of organizational cha-
racteristics such as the culture and behavioral norms in the workplace, as well as
easy access to alcohol.
Workers in Spain also showed propensities to drug abuse; of the 13,005 inter-
viewees, 5% of the males and 2.3% of the females were classed as heavy drinkers
and 19.5% of the men and 8% of the women reported bingeing. In the majority
of cases, alcohol abuse was associated with work stress factors. It was observed
that male heavy drinkers were exposed to hazardous work environments and a
lack of social support. Bingeing, in turn, was related to men working in preca-
rious situations [27].
To deal with post-traumatic stress experienced in the workplace routine, 31
Canadian journalists reported resorting to a variety of drugs to overcome the
psychological stress. The substances of choice were alcohol, marihuana, hashish,
cocaine, crack and heroin. The drugs were used to help “anesthetize” whatever
situation might appear in their daily work. The main objective of substance abuse
was to suppress or avoid feelings and memories of covering war, homicide or
other traumatic events [28].
Among civil servants in Brazil, it was found that anxiety and self-reported prob-
lems from alcohol abuse were risk factors for depression. Alcohol use in depres-
sive workers can be seen as a coping strategy [29].
In contrast, 91% of the 261 workers studies in Israel reported not having drunk
alcohol in the month preceding the interview, even when experiencing stress at
work. The group studied did not use alcohol or drugs to cope. Culturally, Israel
has low per capita alcohol consumption, and a high prevalence of abstinence. It
can thus be seen that the company norms and the cultural context also exert
considerable influence on the coping strategies chosen to face workplace stress
[30].
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
444
4. Discussion
Abuse of alcohol and drugs is more likely to be adopted as a coping strategy for
stress when the norms and social context accept alcohol. It represents a serious
problem for a significant percentage of the working population (5% - 20% of
workers) especially in some sectors and occupations [31]. This can be easily ob-
served in the interaction between controlling the quantity of alcohol consumed
in high-risk jobs and the quantity of drugs consumed at social events.
To understand the degree of alcohol use in the workplace it is adopted the
concept of standard drinks that means the alcoholic beverages in their contain-
ers, that is the same number of units of pure alcohol (approximately 12 g alco-
hol). A moderate user would be in an intake of 22 units or more of alcohol a
week for men, and 14 or more units a week for women [32]. It is important to
highlight that the International Labour Organization (ILO) stated that chronic
substance abuse and even moderate use of alcohol and drugs can performance
negative effects at the workplace [32].
The results of this study show the relationship between precarious conditions,
the nature of the work and its influence on drug abuse, principally alcohol.
However, work is not the only risk factor, there are other variables that may also
increase alcohol and drug use as coping strategies adopted by workers. Thus, the
reasons behind the alcohol and drug abuse triggered by workplace stress are mul-
tifactorial.
From the results of this study, it can be seen that cultural factors, such as so-
cial acceptance, or lack thereof, of alcohol; social issues, such as the need for fe-
male self-affirmation in organizations dominated by male culture; loss of cultur-
al identity, the situation experienced by immigrants; lack of psychological sup-
port to deal with pressure and trauma experienced at work all influence the use
of psychoactive substances as coping strategies.
In the global context of the impact of psychoactive substance use and abuse
within the workplace, public health needs to develop a better understanding of
the potential impact. To obtain this better understanding, it is recommended that
studies are used that relate to the intervening variables, those that influence the fi-
nal result, so as to explain how negative experiences of work can lead to psychoac-
tive substance abuse. Moreover, the design of these intervening variables may ex-
plain with more consistency the relationship between negative work experiences
and alcohol and other drug use [33].
It should be highlighted that the difficulty of evaluating the direct relationship
between work stress and consuming psychoactive substances lies in the two-way
mechanism of this association. On the one hand, the work may consume alcohol
as a way of coping with workplace stress, on the other, alcohol tends to reduce
efficiency at work and cause increased workplace stress [34]. Following this line
of reasoning, a study involving 140,000 European workers revealed that those
who consume large amounts of alcohol and those who abstain are more affected
by workplace stress that moderate consumers [34].
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
445
Of the professionals studies in the articles included in this study, only the bar-
tenders and the journalists reported using illegal drugs, the other only reported
using alcohol. This may be because of organizational and cultural issues. This
finding shows how psychoactive drug use may be underreported and not reliably
reflect these workers’ quality of life.
For the prevention of drug abuse at the workplace it is necessary to focus on
the identification and rehabilitation of workers with severe alcohol and drug
abuse problems. According to the ILO, one of the most challenging issues in com-
bating drug and alcohol abuse in the workplace and in society lies in ignoring
the fact that alcohol and drug use is an accepted part of many social and cultural
sets. It is difficult to develop a distinction between social drinking of alcohol and
the real dangers to health and safety of abusive consumption. It is also proble-
matic in some wine and beer producing countries to discourage workers drink-
ing [35]. For example, in Portugal, in a sample of 100 interviewed, 25% of work-
ers in the construction and public works sector declared they had drunken alco-
hol during working hours and most of them stated that they drank it with a meal
[36].
Workers who seek treatment and rehabilitation should not be discriminated
and should enjoy normal job security and opportunities. Counseling, treatment
and rehabilitation programs should be adapted to individual needs. Prevention
is a positive approach because emphasize worker health, well-being and safety.
Self-assessments can be an important tool to help educate individuals on their own
level of substance consumption quantified on a daily or weekly basis [32]. Also, it
is imperative to identify individuals’ risks and implement protective factors, to
promote peer support and to create a healthy workplace environment.
5. Final Considerations
From the synthesis of these studies, the relationship between drug abuses as the
most used coping mechanism for workplace stress was confirmed. However, the
scientific evidence found showed the need to evaluate intervening variables that
influenced the use of psychoactive substances so as to minimize the harm of ne-
gative experiences at work.
It is still believed to be impossible to draw up a reliable profile of the types of
drugs used to cope with workplace stress as, for the majority, illegal drugs may
cause more damage to the professional’s image. Moreover, the studies did not
show a clear methodology for differentiating the nature of the stress identified in
their sample, in other words, the measurement of workplace stress cannot be iso-
lated from other sources of stress in the subjects’ lives. However, the complexity
of the relationship between workplace stress and psychoactive substance con-
sumption as compensatory and codependent mechanisms is evident.
Acknowledgements
Thanks to the National Department of Drug Policy/SENAD of the Institutional
Security Office/Brazil, to the Ribeirão Preto School of Nursing, Universidade de
M. N. de Fatima Fernandes, E. C. da Silva Gherardi-Donato
446
São Paulo and World Health Organization Collaborative Center for Developing
Nursing.
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VHL: Virtual Health Library
USA: United States of America
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