Signs of Drug or Alcohol Abuse

I have unfortunately learned that people will routinely lie to their pastor or counselor. Being able to determine whether or not a parishioner or counselee is abusing drugs and/or alcohol even when they hide it is critical to getting them the help they need. The following are some signs and symptoms that can help you make that determination.

Physical signs

• Fatigue
• Sleep problems
• Repeated health complaints
• Red and glazed eyes
• A lasting cough
• Needle track marks
• Skin abscesses, cigarette burns, or nicotine stains
• Tremors (shaking and twitching of hands and eyelids)
• Unclear speech: slurred, incoherent, or too rapid
• Unsteady gait: staggering, off balance
• Dilated (enlarged) or constricted (pinpoint) pupils
• Scratching
• Swollen hands or feet
• Smell of alcohol or marijuana on breath
• Drug paraphernalia such as pipes, paper, needles, or roach clips
• "Nodding out" (dozing or falling asleep)
• Agitation
• Inability to focus
• Burns on the inside of the lips (from freebasing cocaine)

Emotional signs

• Personality change
• Sudden mood changes
• Irritability
• Irresponsible behavior
• Low self-esteem
• Poor judgment
• Depression
• Withdrawal
• A general lack of interest in life

Social signs

• Starting arguments
• Breaking rules/laws
• Withdrawal
• Decreased interest in relationships
• Negative attitude
• Drop in performance
• Absences (from school or work)
• General discipline problems
• Friends are involved in substance abuse
• Dramatic change in dress or appearance

General signs and symptoms of drug addiction may include the following characteristics:

• Feeling that they need the drug on a regular basis to have fun, relax or deal with life.
• Giving up familiar activities such as sports, homework or hobbies.
• Sudden changes in work or school attendance and quality of work or grades.
• Doing things they normally wouldn’t do to obtain drugs, such as frequently borrowing money or stealing.
• Taking uncharacteristic risks, such as driving under the influence or sexually risky behavior.
• Anger outbursts, acting irresponsibly or an overall drastic attitude change.
• Deterioration of physical appearance and grooming.
• Wearing sunglasses and/or long sleeve shirts frequently or at inappropriate times.
• No longer spending time with friends who don’t use drugs and/or associating with known users.
• Engaging in secretive or suspicious behaviors such as frequent trips to storage rooms, restrooms, basement, etc.
• Needing to use more of the drug of choice to achieve the same effects
• Talking about drugs all the time and pressuring others to use as well.
• Feeling exhausted, depressed, hopeless or suicidal.

The following are signs and symptoms of specific drugs:

Marijuana

• Rapid, loud talking and bursts of laughter in early stages of intoxication
• Sleepy or stuporous in the later stages
• Forgetfulness in conversation
• Inflammation in whites of eyes; pupils unlikely to be dilated
• Odor similar to burnt rope on clothing or breath
• Tendency to drive slowly—below speed limit
• Distorted sense of time passage—tendency to overestimate time intervals
• Use or possession of paraphernalia including roach clip, packs of rolling papers, pipes or bongs

Stimulants (cocaine, amphetamines, methamphetamines)

• Dilated pupils (when large amounts are taken)
• Dry mouth and nose, bad breath, frequent lip licking
• Excessive activity, difficulty sitting still, lack of interest in food or sleep
• Irritable, argumentative, nervous
• Talkative, but conversation often lacks continuity; changes subjects rapidly
• Runny nose, cold or chronic sinus/nasal problems, nose bleeds
• Use or possession of paraphernalia including small spoons, razor blades, mirror, little bottles of white powder and plastic, glass or metal straws

Depressants (barbiturates, benzodiazapines)

• Symptoms of alcohol intoxication with no alcohol odor on breath (remember that depressants are frequently used with alcohol)
• Lack of facial expression or animation
• Flat affect
• Flaccid appearance
• Slurred speech

Note: There are few readily apparent symptoms. Abuse may be indicated by activities such as frequent visits to different physicians for prescriptions to treat "nervousness", "anxiety"," stress", etc.

Narcotics (heroin, codeine, morphine, Vicodin)

• Lethargy, drowsiness
• Constricted pupils fail to respond to light
• Redness and raw nostrils from inhaling heroin in power form
• Scars (tracks) on inner arms or other parts of body, from needle injections
• Use or possession of paraphernalia, including syringes, bent spoons, bottle caps, eye droppers, rubber tubing, cotton and needles
• Slurred speech

Hallucinogens (LSD, mescaline)

• Extremely dilated pupils
• Warm skin, excessive perspiration and body odor
• Distorted sense of sight, hearing, touch; distorted image of self and time perception
• Mood and behavior changes, the extent depending on emotional state of the user and environmental conditions
• Unpredictable flashback episodes even long after withdrawal (although these are rare)

Dissociative Anesthetics (PCP)

• Unpredictable behavior; mood may swing from passiveness to violence for no apparent reason
• Symptoms of intoxication
• Disorientation; agitation and violence if exposed to excessive sensory stimulation
• Fear, terror
• Rigid muscles
• Strange gait
• Deadened sensory perception (may experience severe injuries while appearing not to notice)
• Pupils may appear dilated
• Mask like facial appearance
• Floating pupils, appear to follow a moving object
• Comatose (unresponsive) if large amount consumed; eyes may be open or closed

Inhalants (glue, vapor producing solvents, propellants )

• Substance odor on breath and clothes
• Runny nose
• Watering eyes
• Drowsiness or unconsciousness
• Poor muscle control
• Prefers group activity to being alone
• Presence of bags or rags containing dry plastic cement or other solvent at home, in locker at school or at work
• Discarded whipped cream, spray paint or similar chargers (users of nitrous oxide)
• Small bottles labeled "incense" (users of butyl nitrite)