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Signs That Someone May Have A Drug Or Alcohol Problem

Mark Dombeck, Ph.D.

Diagnosis is important in general because it helps doctors to know how to treat a problem. The diagnosis of a substance use problem (abuse or dependence) is important because it helps justify getting an addicted person into treatment.

Getting an addict to the point where a substance abuse or dependence diagnosis can be made is often a difficult task. People with drug and alcohol problems are often secretive about their use, or blind to the idea that a problem exists. It is helpful then to have a list of behaviors that one can look for that, when present, may suggest that someone has a substance use problem.

Behaviors to look for include:

  • A repeating failure to meet social, occupational or familial duties:
    • Repeated lateness or absence
    • Poor work performance
    • Neglect of children, etc.
  • Bizarre or lame excuses for social, occupational or family failures
  • Borrowing (or stealing) money without good reasons.
  • Uncharacteristic mood or personality changes

Physical signs may include:

  • Puncture marks, or long thin lines along the arms or legs (IV drug use such as heroin)
  • Skin Infections
  • Nose and throat problems (snorted drugs such as cocaine)
    • Bloody nose
    • Nasal and/or sinus infections
    • Coughing
    • Loss of the sense of smell
  • Drowsiness, or loss of coordination (depressant drugs such as alcohol)
  • 'Pinned' (tiny, constricted) pupils in the eye (secondary to opioid abuse)
  • Eye movement disturbances:
    • Nystagmus: back and forth eye movements during an extreme lateral gaze (secondary to alcohol abuse)
  • Red or bloodshot eyes (secondary to smoking marijuana)
  • Drug-related smells on clothing (drugs that are smoked)
  • Drug-related paraphernalia (pipes, 'works', pill bottles, small plastic bags or vials, lighters, etc.)

Medical signs (only apparent upon formal testing) may include:

  • Positive findings of drug related metabolic (break-down) byproducts in the urine, blood or hair.
  • Hypertension (High Blood Pressure) (may point to alcoholism)
  • Elevated levels of the liver enzyme 'delta-glutamic transferase' (GGT) (may point to alcoholism)
  • Enlarged red blood cells (may point to alcoholism)