Sudden weight loss or weight gain can be a good sign of substance abuse. This may come as a result of a decreased or increased appetite when an individual is using drugs or alcohol. For example, cannabis and heroin often cause an increase in appetite, resulting in extra snacking or overeating. Conversely, stimulants and opiates can cause a substantial decrease in appetite, and one might forget to eat or find eating a chore. Weight change can also come as a result of drug or alcohol addiction consuming an individual’s life, neglecting previous hobbies and interests, and leaving little time to eat.
Irregular sleep patterns are a good sign that an individual is abusing drugs or alcohol. Lack of sleep, increased tiredness, extreme exhaustion, and more extended periods of sleep are usually common symptoms of stimulant abuse. An individual may sleep for much longer than usual and experience insomnia when not using stimulants. Conversely, those abusing opiates may sleep for an extended period and feel an increase in tiredness, yet not feel refreshed upon waking. Changes in sleep habits can be a big red flag for substance abuse.
Physical Signs of Substance Abuse
Developing a clinical impression or a diagnostic hypothesis requires gathering information about the client’s condition. The first part of the assessment, referred to as the pretreatment assessment, is typically designed to obtain fundamental information about the client and their problems to be addressed, setting the stage for an in-depth understanding of the problem. Pretreatment interviews include both formal and informal assessments.
At a minimum, the clinician seeks to ferret out the information necessary to diagnose the individual (including the definition of the problem’s severity) and decide on a course of action in conjunction with the client. Pretreatment interviews are typically characterized by warmth, empathy, and understanding; a rapport is established, and the clinician uses open-ended questions in a non hurried fashion to collect information. Pretreatment interviews often evolve from unstructured (gathering general information) to structured (obtaining specific diagnostic or treatment-planning information) tasks.
The information received can be helpful if the client is intoxicated during a pretreatment interview. Still, interviews should not assess the individual’s current level of impairment, and content should be checked out with the client at a subsequent time. This basic rule involves risks; a client may not return for more assessment, and the clinician may not remember to check the client’s intoxicated statements. Ideally, a more formal pretreatment assessment attempts to build a case for treatment where various pieces of client information and collateral information are collected and organized into a plan for the client—more of a decision-making process. Documentation of symptoms is an essential aspect of assessment.
Treatment outcome studies are typically based on groups of clients characterized by chief complaints and diagnostic labels, and matching clients with research groups is necessary. Further, clients’ specific problems and requirements are typically more complex than a simple diagnostic statement. The treatment for a general diagnostic category often varies depending on patients’ characteristics. Both matching client characteristics with a research group and treatment require diagnosis and treatment plans emerging from diagnostic formulations—working hypotheses concerning the client’s problem and an appropriate way to address it. Diagnosis, diagnostic formulation, and treatment planning require moving beyond a surface-level knowledge of signs and diagnoses to a specific and detailed understanding of criteria.
A treatment plan provides an overall description of what the clinician wants to accomplish with the client and the client’s goals. Adequate and appropriate diagnosis and treatment planning requires information about the client’s symptoms and context. Context includes the client’s biological vulnerabilities and physical health; social, cultural, and socioeconomic influences; psychological assets; and the catastrophic events, traumas, and current life events.
A diagnosis and decisions on treatment should be revisited repeatedly during a client’s course in treatment. Research on diagnostic reliability provides evidence that diagnoses, mainly when they are based on informal clinical diagnosis rather than standardized interviews, are often unstable, and a mismatch between treatment given and a diagnosis is a common cause of client dropout and iatrogenic change in the client. A comprehensive assessment also seeks to understand the client holistically beyond the immediate problem and will focus less on sifting information to make a treatment decision.
Behavioural Signs of Substance Abuse
In popular culture and everyday vocabulary, when thinking about a ‘typical’ alcoholic or addict, the image that comes to mind is often a person who is frequently drunk or high, probably unemployed, possibly homeless, and without family or friends. It is well recognized in the medical field, however, that individuals with substance abuse problems often come from higher socio-economic backgrounds and may be successful in their careers. This means that there is no single unifying behavioral profile for a person with substance abuse problems. Instead, different behaviors associated with intoxication or preoccupation with obtaining more of the substance and so on will be present at different times. Nevertheless, the APA lists several relatively typical types of behavior for a person with a severe substance abuse problem.
This section provides an overview of some of the general behaviors that may be exhibited by individuals who are abusing or are dependent on alcohol or other drugs. The purpose here is to present the kind of behaviors that will provide clues to different people, family, and friends that there may be a substance abuse problem with the person they are concerned about. The more of these clues that are present, the more likely it is that there is a severe substance abuse problem. This is a part of the diagnostic process to ascertain the severity of a patient’s substance abuse problem. It may be that you or a family member will recognize behavior typical of their recent actions. These kinds of descriptions from the American Psychiatric Association are often the most effective ways to convey crucial diagnostic information.
Psychological Signs of Substance Abuse
Many substance abusers suffer from depression, anxiety, and other stress-related syndromes. Several factors can lead to mental disorders, including personality, genetics, environment, and drug effects. All these problems can continue to get worse if the abuser experiences further drug-related issues and often can be improved once drug use ceases. Delirium is a potentially dangerous and life-threatening state of confusion and disorientation. Drug-induced delirium can come on at any time and is most often associated with periods of intoxication or withdrawal. Psychological symptoms can include vivid and frightening hallucinations and delusions, seeing and hearing things that aren’t there, and feeling paranoid, leading to aggressive or evasive behavior. This may lead to the abuser being medicated or hospitalized for a mental illness before discovering the drug problem.