I personally knew somebody that was abusing alcohol when I went to school. I believe this person drank a lot. She didn't show up for most class days. Only ones that were required. She still did well on tests and was pretty good at clinicals. She had confided in me that she wanted treatment, but she was scared it might affect her career. I do not believe she was using other drugs, but our school did not do any drug testing, even for clinicals. I even asked for advice on what she should do on these forums. I always advised her to get treatment. As far as I am aware she never did. She also finished school (with honors!) and received her license. I never informed any instructor or any higher up official. I have never been drug tested for school or any nursing job I have had. So this person that OP is referring to may never be stopped by drug tests and they may finish school. That being said, this person personally told me that she had this problem. As far as I was aware she was never under the influence at school or clinicals. If she had been or if I knew she was abusing illegal drugs, I would have reported her. If I was OP, I would not report this person.