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 childs 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 drugs 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.