Behavioral Signs of Substance Use and Abuse
 A
combination of the following signs should alert you to the possibility that a
patient is using illicit substances and to the importance of exploring that possibility
through an interview and/or laboratory testing:
- Sudden decline in school achievement. Since alcohol and other types of
drug intoxication interfere with learning, it is not surprising that rapidly deteriorating
school performance frequently results. Poor functioning in school that contrasts sharply
with earlier adequate functioning, especially in the absence of a school change or other
obvious explanation, should arouse suspicion.
- Cigarette smoking.
- Marked shift in the child’s peer reference group, especially
association with known or suspected drug users.
- Serious erosion of parental trust in the child.
- Support by the child for the idea of legalizing marijuana.
- Marked personality changes. Although childhood and especially
adolescence are often marked by mood swings and some instability, evidence of social
withdrawal, a new guardedness in communication with other family members, inexplicable
depression or other evidence of psychological disruption such as changes in sleeping
patterns, are all possible indicators of drug involvement.
- Withdrawal from extracurricular activities that were previously
important to the child, such as athletics, religious or youth programs, band, etc.
- Cutting classes, tardiness or truancy from school.
- Deterioration in appearance and personal hygiene.
- Increased secretiveness unexplained phone calls, heightened hostility
to inquiry, sudden onset of hypersensitivity.
- Going out every night. Youth who are intensely involved with weekday
social activity consisting primarily of "hanging around" (as opposed to
scheduled youth activities or activities on weekends) may be drug involved.
- Unexplained disappearance of family funds, or family and personal
possessions (this may be related to a need for money to purchase drugs.)
- Aggressive behavior such as recurrent fighting, violent hostility, or
other evidence of social alienation.
- Heavy use of over-the-counter preparations to reduce eye reddening
(e.g., injected conjuctiva produced by acute marijuana intoxication), nasal irritation
(resulting from "snorting" cocaine), or tell-tale bad breath (produced by
alcohol or cigarettes).
 Physical Symptoms of Alcohol and Other Drug Use
Behavioral manifestations, not physical appearance, are the red flags of alcohol and
other drug use. Generally, physical symptoms or sequelae of substance abuse will
not be obvious. For example, smoking marijuana or crack cocaine may not usually
cause coughing, wheezing, or other obvious irritation of the upper respiratory system.
While a reddening of the eyes of occurs, eye irritation can have a variety of other
causes, so this symptom is hardly pathognomonic. Even acute intoxication with marijuana
may not be apparent. Many experienced marijuana users are able to hide the outward signs
of the drug’s intoxicating effects, thereby disguising their use and fooling even the
most astute physicians.
Although some clinicians have noted a quality of listlessness, unhealthy pallor and
complaints of tiredness in their young, drug-using patients, these symptoms may not always
be apparent even in advanced stages of use. While weight loss and other evidence of
malnutrition may occur following continued use of cocaine or other stimulant drugs, these
signs are unlikely to result from recently initiated or occasional use.
Evidence of I.V. Drug Use
Given the risks of such secondary infections as hepatitis and AIDS, and of anaphylactic
reaction to the injected material, any evidence or admission of I.V. drug use
should be regarded as indicating a need for assessment by an experienced drug
treatment professional. |
