Many nurses who have used drugs or alcohol at work say they were too embarrassed to seek help, or they were concerned about losing their license, according to a new study.

The study included 302 nurses who had participated in a peer health assistance program. Almost half said they used drugs or alcohol at work. More than two thirds of respondents thought their problem could have been recognized earlier.

Researchers asked nurses about substance-related behaviors in the workplace; behavioral cues that may lead to earlier identification of substance use and mental illness; perceptions of barriers to asking for help; and strategies for preventing issues and overcoming barriers to seeking assistance, according to MedicalXpress.

They found 48 percent of respondents said they used drugs or alcohol at work. In addition, 40 percent felt their competency level was affected by drug or alcohol use. The study found 27 percent of respondents said patients were put at risk one or more times because of their substance use, and 25 percent said they obtained drugs in the workplace.

More than 50 percent of respondents said they were too scared or embarrassed to seek assistance, or they were concerned about confidentiality or thought they would lose their license. Respondents said they needed more education about how to seek support from friends, colleagues and family. They also said they needed more information about what steps to take to seek help confidentially, so their licenses would not be at risk.

“We hope that our findings can be used to help improve awareness and understanding of substance use and mental illness among nurses and their professional peers, inform education and training efforts in nursing schools, encourage further research to explore the prevention and early identification of co-occurring disorders in healthcare settings where nurses work, and ultimately enhance public safety,” the researchers wrote in the journal Substance Abuse.