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What are some signs of drug abuse?

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Answered 2012-08-07 21:46:04

Symptoms/signs of drug

abuseabuse and dependency by drug class:


Central Nervous System Stimulants (amphetamine, dextroamphetamine, methamphetamine, cocaine, methylphenidate)

  • Less need for sleep, staying awake for days at a time.
  • Aggression
  • Symptoms similar to hypomania or mania
  • Hyperactivity
  • Increased libido, promiscuous sex, unprotected sex.
  • Irritability, agitation, anxiety, and psychomotor agitation.
  • Repetitive and obsessive behaviors (taking apart and putting a computer back together, repetitive movements)
  • Delusions of grandeur.
  • More out going, less inhibited
  • Paranoia, psychos, hallucinations.
  • Dilated pupils (mydriasis)
  • Hypersomnia and somnolence after drug binges.
  • Depression, anhedonia (especially with prolong use).
  • Poor hygiene (the primary contributor to "meth mouth").
  • Weight loss, anorexia (a lack or loss of appetite for food as a medical condition or symptom).
  • Tachycardia.

Opioids (narcotics, opiates, morphine, heroin, methadone, hydrocodone, oxycodone)

  • High tolerance (marked increase in amount and marked decrease in effect)
  • Respiratory depression
  • Depression
  • Apathy
  • Sleepiness, falling asleep mid sentence, "nodding"
  • Track marks (from IV drug use)
  • Volatile mood
  • Tachycardia
  • Bradycardia
  • Chronic, often severe, constipation
  • Weight loss
  • Nausea/Vomiting
  • Abdominal pain
  • Use of other drugs (polysubstance abuse) especially benzodiazepines, hypnotics, barbiturates, and marijuana.
  • Pin point pupils (miosis)
  • Poor judgment
  • Lack of coordination
  • Physical dependency (also occurs in people using opioids long term for a legitamite medical need).
  • Withdrawal symptoms in people physically dependent include yawning, restlessness, agitation, depression, suicidal ideation, anxiety, diarrhea, hot and cold flashes, pain, insomnia, dilated pupils (mydriasis), and "flu-like" symptoms.

Alcohol and sedative/hypnotics including:

benzodiazepines, barbiturates, "Z" drugs, chloral hydrate, meprobamate, carisoprodol

  • High tolerance (marked increase in amount and marked decrease in effect)
  • Most people (70-90%) diagnosed with sedative/hypnotic abuse or dependence will have a comorbid substance dependence disorder, typically opioid, cocaine, or alcohol dependency.
  • Hostility
  • Poor judgment.
  • Mood swings
  • Lack of coordination
  • Inattention
  • Loss of focus
  • Emotional blunting
  • Disrupted sleep architecture (reduction/elimination of sleep stage N3, altered sleep latency for stage N1 and REM), this may continue for years after stopping the drug.
  • Blackouts
  • Anterograde amnesia
  • Stupor
  • Coma (rare with benzodiazepines, more likely with alcohol or barbiturate abuse)
  • Respiratory depression (most likely with barbiturates)
  • Violence
  • Self harm ("cutting,"suicidal ideation, or attempt)
  • Loss of inhibitions
  • Highly talkative (especially in more introverted people)
  • Psychomotor retardation (slow movements, difficulty doing simply tasks)
  • Barbiturate overdose has one of the highest mortality rates of all drugs.
  • Physical dependency (this also occurs in non abusing patients with a legitimate medical need)
  • Withdrawal, long term/high dose users can not stop without a gradual reduction in dosing. Users in withdrawal from chronic use often require immediate medical intervention including activation of emergency services and hospitalization.
  • Rapid withdrawal may lead to gran mal seizures, status epilepticus (can be lethal), psychosis, suicidal ideation, suicide attempt (can be lethal), homicidal ideation, catatonia (can be lethal), rage, and hallucination.
  • More common withdrawal includes rebound anxiety, panic attacks, agitation, hostility, dilated pupils (mydriasis), weight loss, insomnia, muscle aces, rebound REM, hypertension, hyperthermia (often above 38oC/100oF), cognitive and memory problems, tachycardia, paranoia, depression, myoclonic twitches, and tremor.

The medical diagnosis for substance dependence (addiction) is primarily based upon the consequences of drug use and is a way to determine if a person is addicted.

According to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (American Psychiatric Association, 2000), substance dependence is "a maladaptive pattern of substance use leading to clinically significant impairment or distress." Or, to put it another way, the repeated and maladaptive use of a substance, despite clinically significant impairment, distress, craving, due to continued use of the substance. A loss of control.

Substance dependence symptoms (for all substances) include

*1) Tolerance, characterized by either (a) A need for markedly increased amounts of the substance to achieve the desired effect (people may "chase" the high they got from their first use) or (b) Markedly diminished effect with continued use of the same amount of the substance (ie use of 180 mg of oxycodone is required to obtain the effect 10 mg once gave).

*2) Withdrawal, characterized by either (a) Withdrawal syndrome of the substance if it is abruptly stopped (b) The same (or closely related) substance is able to relieve withdrawal symptoms or (c) Use of an antagonist produces withdrawal syndrome (ie using flumazenil, a benzodiazepine antagonist, induces withdrawal).

3) The substance is taken in larger amounts or over a longer time than intended (ie continuing to get prescriptions for opioids even though pain has been resolved).

4) There are unsuccessful efforts to cut down or control substance use (ie putting a "limit" on how much alcohol may be consumed or setting a maximum dose of medication to be taken daily).

5) A great deal of time is spent on activities necessary to obtain the substance, use the substance, or recover from its effects (ie sleeping for days after an amphetamine binge, spending hours doctor shopping).

6) Social, occupational, or recreational activities are given up or reduced because of substance use (ie loss of friends, job, and hobbies).

7) The use of the substance continues despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (ie continued drinking despite liver steatosis, the first stage in alcoholic liver disease).

*Commonly occurs in people compliant with medication dosing instructions, who have a legitimate medical need for the drug, and do not inappropriately use the drug or escalate dosage without doctor approval. Alone these symptoms do not constitute abuse, misuse, addiction, or psychological dependency.

Written based on information from The American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

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