from the American Council for Drug
Behavioral Signs of Substance Use and Abuse
A combination of the following signs should alert you to the
possibility that a person is using illicit
substances and to the importance of exploring that possibility through
an interview and/or laboratory testing:
1. 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.
2. Cigarette smoking.
3. Marked shift in the child’s peer
reference group, especially association with known or suspected drug
4. Serious erosion of parental trust
in the child.
5. Support by the child for the idea
of legalizing marijuana.
6. 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
7. Withdrawal from extracurricular
activities that were previously important to the child, such as
athletics, religious or youth programs, band, etc.
8. Cutting classes, tardiness or
truancy from school.
9. Deterioration in appearance and
10. Increased secretiveness
unexplained phone calls, heightened hostility to inquiry, sudden onset
11. 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.
12. Unexplained disappearance of
family funds, or family and personal possessions (this may be related
to a need for money to purchase drugs.)
13. Aggressive behavior such as
recurrent fighting, violent hostility, or other evidence of social
14. 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
15. 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
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