Alcohol Abuse

Signs and Symptoms

Alcohol use is negatively affecting your family, friends, school, or work.

Risky or dangerous behaviors. You are drinking in risky situations, where it is physically dangerous, or your drinking is putting you at risk of harm.

Blackouts. After drinking, you cannot remember what happened while you were drinking.

Legal issues or negative consequences. You have legal problems because of your drinking or have experienced negative consequences as a result of your drinking.

Harm/Health Problems. You keep drinking even though you have health problems that are caused or made worse by drinking.

Continued drinking despite it causing problems or consequences. You continue drinking even though your alcohol use is causing problems in your relationships, or your friends or family members are worried about your drinking.

This also includes missing class/study hall/meetings/weight-lifting because of being too tired or hung over; coming to weight lifting smelling of alcohol; and/or continuing to use alcohol despite being told of medical or psychiatric reasons that alcohol should not be consumed (i.e. depression; recent fractures or surgery; sleep problems; recovering from a concussion).

Drinking to relieve stress or relax. You drink as a means to cope, de-stress, or relax.

You lose control over how much you drink. You often drink more alcohol than you wanted, for longer than you intended, or despite telling yourself you wouldn’t.

You want to quit, but can’t. You have a desire to quit or cut down on your drinking, but your efforts have been unsuccessful.

Time and focus. You spend a lot of time drinking, thinking about drinking, planning your next time to drink, and recovering. Or you spend time worrying about getting enough alcohol.

Activities. You have given up important activities so you can drink. You are spending less time on activities that used to be important to you because of your alcohol use.

Morning use. You drink in the morning.

Drinking alone or for long periods of time. You drink by yourself or for longer than intended.

You feel guilty after drinking. You feel guilty about your drinking, your behavior while under the influence, or are ashamed about your drinking or behavior.

You drink to get drunk. You intend to and drink until intoxicated.

Excuse or hide it. You make excuses for your drinking or do things to hide your drinking.

Withdrawal

Alcohol withdrawal is a life threatening condition. Although it is not typical in a young adult, it is entirely possible.

Symptoms of withdrawal include: anxiety, tremors (both internally and externally. Internal "tremors" are when a patient "feels" shaky inside but there is no evidence externally of tremors. The best way to measure external tremors are to put the arms straight out in front and bend the hands upwards to a 90% angle. It is very hard to control tremors at that angle, whereas just having the hands straight ahead uses other muscles and may be controlled); nausea/vomiting; sweats; elevated blood pressure and pulse; tactile disturbances; auditory disturbances; visual disturbances; anxiety; head fullness; agitation; orientation and clouding of sensorium; ultimately can lead to cardiovascular collapse and seizures. A person on a beta blocker (like propranolol) for blood pressure; anxiety; or headache prophylaxis; will have these symptoms blunted and slide into DT's without the usual symptoms.

Note that people abusing benzodiazepines (Xanax, Ativan, Clonazepam all widely abused) have the same type of withdrawal - can be life threatening - and abrupt discontinuation can lead to seizures.

Drug Use/Abuse

Signs and Symptoms of Drug Use

• Neglecting responsibilities at school, athletically, or home
• Using drugs under dangerous conditions or taking risks while high
• Legal consequences
• Causing problems in your relationships
• Sudden change in behavior
• Mood swings; irritable and grumpy and then suddenly happy and easy-going
• Withdrawal from family members, friends, and teammates
• Careless about personal grooming
• Loss of interest in hobbies, sports, and other favorite activities
• Changed sleeping patterns; up at night and sleeps during the day
• Red or glassy eyes
• Sniffle or runny nose
• Unable to quit
• Excessive time and focus (especially marijuana) in using or obtaining the drug
• Cravings or urges to use.

Signs and Symptoms of Drug Dependency

Built up a tolerance – a need to use more of the drug to experience the same effects used to attain with smaller amounts.

Take drugs to avoid or relieve withdrawal symptoms – use to relieve withdrawal symptoms including nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.

Lost control over drug use – spend a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.

Abandoned activities use to enjoy – such as hobbies, sports, activities, and socializing because of drug use.

Continue to use drugs, despite knowing it’s hurting you – It’s causing major problems in your life – blackouts, infections, mood swings, depression, and paranoia – but you continue to sue anyway.

Side Effects related to Specific Drugs

Cocaine/Stimulants Effects: Impaired thinking, confused, anxious, depressed, short-tempered, panic attacks, suspiciousness, dilated pupils, sleeplessness, loss of appetite, decreased sexual drive, restlessness, irritability, very talkative, scratching, hallucinations, paranoia. UNDER the influence of stimulants (cocaine, meth, Adderall), which can cause malignant hyperthermia; seizures; heart attack; stroke.); PCP/Hallucinogens/synthetic marijuana (violent behavior).

Depressants: Decreased inhibition, slowed motor coordination, lethargy, relaxed muscles, staggering gait, poor judgment, slow uncertain reflexes, disorientation, and slurred speech.

Designer drugs: Depends on the drug but refers to drugs that are made synthetically to mimic certain natural drugs like stimulants/hallucinogens. Substances like Ecstasy/Molly have stimulant and hallucinogenic effects. Often behavior is erratic/violent/bizarre - due to altered perceptions of reality.

Heroin Effects: Chemically enforced euphoria. “Nodding”, which is a dreamlike state, near asleep, drifting off for minutes or hours. For long-time abusers, heroin may act like a stimulant and they can do a normal day routine; however, for others it leaves them completely powerless to do anything. Heroin/opioids (accidental overdose).

Inhalant Effects: Short-lasting euphoria, giggling, silliness, dizziness. Then come headaches and full-blown “fainting’s” or going unconscious. Long-term use: short-term memory loss, emotional instability, impairment of reasoning, slurred speech, clumsy staggering gait, eye flutter, tremors, hearing loss, loss of sense of smell, and escalating stages of brain atrophy.

LSD (Acid) Effects: Dilated pupils, skin discoloration, loss of coordination, false sense of power, euphoria, distortion of time and space, hallucinations, confusion, paranoia, nausea, vomiting, loss of control, anxiety, panic, helplessness, and self-destructive behavior.

Marijuana Effects: Compulsive eating/”munchies”, bloodshot red eyes that are squinty, dry mouth, excessive and uncontrollable laughter, forgetfulness, short-term memory loss, extreme lethargy, delayed motor skills, occasional paranoia, hallucinations, laziness, lack of motivation, sickly sweet smell on body, hair, and clothes, and strong mood changes and behaviors when the person is “high”.

Methamphetamine Effects: “Wired” – sleeplessness for days and weeks at a tie, total loss of appetite, extreme weight loss, dilated pupils, excited, talkative, deluded sense of power, paranoia, depression, loss of control, nervousness, unusual sweating, shaking, anxiety, hallucinations, aggression, violence, dizziness, mood changes, blurred vision, mental confusion, agitation.

PCP/Hallucinogens/synthetic marijuana (violent behavior).

References

• Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA – Ar)
• MayoClinic, “Alcohol Use Disorder – Signs, Symptoms, and Help for Drinking Problems, www.mayoclinic.org.
• Rosecrance Center, Rockford, IL.
• Segal, Jeanne, Ph.D., Smith, Melinda, M.A., and Robinson, Lawrence, “Trusted guide to mental, emotional & social health: Alcoholism and Alcohol Abuse, June 2016.