Signs and Symptoms of Substance Abuse-Overdose Assistance

Please keep in mind your purpose for trying to find out if someone is doing alcohol and/or drugs- To Identify and Help rather than Catch and Punish.

General: General and specific guides to detection of alcohol and drug use, and definition of addiction.

Contents:I. General Guide to Detection

II. Definition of Addiction

III. Pupil Dilation

IV. Signs and Symptoms

V. Paraphernalia a) S/S Chart Version

VI. Drug Facts

VII. Articles and Other Resources

VIII. Drug Pictures/Resources

IX. Topics

X. Additional Articles (Alcoholism, Drugs, Teenage Addiction, Interventions)

XI. Overdose and Emergency Intervention Techniques

I. Specific: General Guide to Detection

Abrupt changes in work or school attendance, quality of work, work output, grades, discipline.

Unusual flare-ups or outbreaks of temper. Withdrawal from responsibility. General changes in overall attitude. Deterioration of physical appearance and grooming.

Wearing of sunglasses at inappropriate times. Continual wearing of long-sleeved garments particularly in hot weather or reluctance to wear short sleeved attire when appropriate. Association with known substance abusers. Unusual borrowing of money from friends, co-workers or parents. Stealing small items from employer, home or school. Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion such as frequent trips to storage rooms, restroom, basement, etc.

II. Specific: DSM-IV Definition of Addiction

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) Tolerance, as defined by either of the following:

a. A need for markedly increased amounts of the substance to achieve intoxication or desired effect.

b. Markedly diminished effect with continued use of the same amount of the substance.

(2) Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for the substance

b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms. (

3) The substance is often taken in larger amounts or over a longer period than was intended (loss of control).

(4) There is a persistent desire or unsuccessful efforts to cut down or control substance use (loss of control). (

5) A great deal of time is spent on activities necessary to obtain the substance, use the substance, or recover from its effects (preoccupation).

(6) Important social, occupational, or recreational activities are given up or reduced because of substance use (continuation despite adverse consequences).

(7) The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (adverse consequences).

III. Specific: Pupil Dilation

Before you do anything, consider this. There are two trains of thought prior to detection and intervention. One thought is to catch and punish, and the other is to identify and help- remember why you are doing this, and the intervention will turn out much better.

Note: A 6mm, 7mm, or 8mm pupil size could indicate that a person is under the influence of cocaine, crack, and meth, hallucinogens, crystal, ecstasy, or other stimulant. A 1mm or 2mm pupil size could indicate a person under the influence of heroin, opiates, or other depressant. A pupil close to pinpoint could indicate use. A pupil completely dilated could indicate use. Blown out wide pupils are indicative of crack, methamphetamine, cocaine, and stimulant use. Pinpoint pupils are indicative of heroin, opiate, depressant use.

Other causes of pupil dilation

IV. Specific: Signs and Symptoms

Alcohol: Odor on the breath. Intoxication. Difficulty focusing: glazed appearance of the eyes. Uncharacteristically passive behavior; or combative and argumentative behavior. Gradual (or sudden in adolescents) deterioration in personal appearance and hygiene. Gradual development of dysfunction, especially in job performance or schoolwork. Absenteeism (particularly on Monday). Unexplained bruises and accidents. Irritability. Flushed skin. Loss of memory (blackouts). Availability and consumption of alcohol becomes the focus of social or professional activities. Changes in peer-group associations and friendships. Impaired interpersonal relationships (troubled marriage, unexplainable termination of deep relationships, alienation from close family members).

Marijuana/Pot: Rapid, loud talking and bursts of laughter linearly stages of intoxication. Sleepy or stupor in the later stages. Forgetfulness in conversation. Inflammation in whites of eyes; pupils unlikely to be dilated. Odor similar to burnt rope on clothing or breath. Tendency to drive slowly – below speed limit. Distorted sense of time passage – tendency to overestimate time intervals. Use or possession of paraphernalia including roach clip, packs of rolling papers, pipes or bongs. Marijuana users are difficult to recognize unless they are under the influence of the drug at the time of observation. Casual users may show none of the general symptoms. Marijuana does have a distinct odor and may be the same color or a bit greener than tobacco.

Cocaine/Crack/Methamphetamines/Stimulants: Extremely dilated pupils. Dry mouth and nose, bad breath, frequent lip licking. Excessive activity, difficulty sitting still, lack of interest in food or sleep. Irritable, argumentative, nervous. Talkative, but conversation often lacks continuity; changes subjects rapidly. Runny nose, cold or chronic sinus/nasal problems, nose bleeds. Use or possession of paraphernalia including small spoons, razor blades, mirror, little bottles of white powder and plastic, glass or metal straws.

Depressants: Symptoms of alcohol intoxication with no alcohol odor on breath (remember that depressants are frequently used with alcohol). Lack of facial expression or animation. Flat affect. Flaccid appearance. Slurred speech. Note: There are few readily apparent symptoms. Abuse may be indicated by activities such as frequent visits to different physicians for prescriptions to treat” nervousness”, “anxiety”,” stress”, etc.

Narcotics/Prescription Drugs/Opium/Heroin/Codeine/Oxycontin: Lethargy, drowsiness. Constricted pupils fail to respond to light. Redness and raw nostrils from inhaling heroin in power form. Scars (tracks) on inner arms or other parts of body, from needle injections. Use or possession of paraphernalia, including syringes, bent spoons, bottle caps, eyedroppers, rubber tubing, cotton and needles. Slurred speech. While there may be no readily apparent symptoms of analgesic abuse, it may be indicated by frequent visits to different physicians or dentists for prescriptions to treat pain of non-specific origin. In cases where patient has chronic pain and abuse of medication is suspected, it may be indicated by amounts and frequency taken.

Inhalants: Substance odor on breath and clothes. Runny nose. Watering eyes. Drowsiness or unconsciousness. Poor muscle control. Prefers group activity to being alone. Presence of bags or rags containing dry plastic cement or other solvent at home, in locker at school or at work. Discarded whipped cream, spray paint or similar chargers (users of nitrous oxide). Small bottles labeled” incense” (users of butyl nitrite).

Solvents, Aerosols, Glue, Petrol: Nitrous Oxide – laughing gas, whippits, nitrous. Amyl Nitrate – snappers, poppers, pearlers, rushamie, .Butyl Nitrate – locker room, bolt, bullet, rush, climax, red gold. Slurred speech, impaired coordination, nausea, vomiting, slowed breathing. Brain damage, pains in the chest, muscles, joints, heart trouble, severe depression, fatigue, loss of appetite, bronchial spasm, sores on nose or mouth, nosebleeds, diarrhea, bizarre or reckless behavior, sudden death, suffocation.

LSD/Hallucinogens: Extremely dilated pupils, (see note below). Warm skin, excessive perspiration and body odor. Distorted sense of sight, hearing, touches; distorted image of self and time perception. Mood and behavior changes, the extent depending on emotional state of the user and environmental conditions Unpredictable flashback episodes even long after withdrawal (although these are rare). Hallucinogenic drugs, which occur both naturally and in synthetic form, distort or disturb sensory input, sometimes to a great degree. Hallucinogens occur naturally in primarily two forms, (peyote) cactus and psilocybin mushrooms.

Several chemical varieties have been synthesized, most notably, MDA , STP, and PCP. Hallucinogen usage reached a peaking the United States in the late 1960’s, but declined shortly thereafter due to a broader awareness of the detrimental effects of usage. However, a disturbing trend indicating resurgence in hallucinogen usage by high school and college age persons nationwide has been acknowledged by law enforcement. With the exception of PCP, all hallucinogens seem to share common effects of use. Any portion of sensory perceptions may be altered to varying degrees. Synesthesia, or the “seeing” of sounds, and the “hearing” of colors, is a common side effect of hallucinogen use. Depersonalization, acute anxiety, and acute depression resulting in suicide have also been noted as a result of hallucinogen use. Note: there are some forms of hallucinogens that are considered downers and constrict pupil diameters.

PCP: Unpredictable behavior; mood may swing from passiveness to violence for no apparent reason. Symptoms of intoxication. Disorientation; agitation and violence if exposed to excessive sensory stimulation. Fear, terror. Rigid muscles. Strange gait. Deadened sensory perception (may experience severe injuries while appearing not to notice). Pupils may appear dilated. Mask like facial appearance. Floating pupils, appear to follow a moving object. Comatose (unresponsive) if large amount consumed. Eyes may be open or closed.

Ecstasy: Confusion, depression, headaches, dizziness (from hangover/after effects), muscle tension, panic attacks, paranoia, possession of pacifiers (used to stop jaw clenching), lollipops, candy necklaces, mentholated vapor rub, severe anxiety, sore jaw (from clenching teeth after effects), vomiting or nausea (from hangover/after effects)

Signs that your teen could be high on Ecstasy: Blurred vision, rapid eye movement, pupil dilation, chills or sweating, high body temperature, sweating profusely, dehydrated, confusion, faintness, paranoia or severe anxiety, trance-like state, transfixed on sites and sounds, unconscious clenching of the jaw, grinding teeth, very affectionate.

V. DRUG SIGNS & SYMPTOMS

Stimulants (Cocaine, Ecstasy, Meth., Crystal)

Depressants (Heroin, Marijuana, Downers)

Hallucinogens (LSD)

Narcotics (Rx. Medications)

Inhalants (Paint, Gasoline, White Out)

PCP

Alcohol

Note: Paraphernalia- Keep in mind, that you may not find drugs, if you are searching for them, but you can usually find the paraphernalia associated with use.

VI. Specific: Drug Facts

Includes identifiers, definitions, language of users and dealers. Drug Terms Slang and Street Terms

VII. Specific: Articles and Other Resources

This the additional information for brain chemistry and the drug user)

VIII. Specific: Drug Pictures/Resources from the DEA

CHEMICAL CONTROL

INTRODUCTION TO DRUG CLASSES

NARCOTICS Narcotics of Natural Origin

Opium, Morphine, Codeine, Thebaine

Semi-Synthetic Narcotics

Heroin Hydromorphone Oxycodone Hydrododone

Synthetic Narcotics

Meperidine

Narcotics Treatment Drugs

Methadone Dextroproxyphene Fentanyl Pentazocine Butorphanol

DEPRESSANTS Barbiturates

Controlled Substances Uses and Effects (Chart) Benzodiazepines Gamma

Hydroxybutric AcidParaldehyde, Chloral HydrateGlutethimide 7

MethaqualoneMeprobamate

Newly Marketed Drugs

STIMULANTS Cocaine Amphetamines

Methcathinone, Methylphenidate

ANORECTIC DRUGS hat

CANNABIS Marijuana Hashish Hashish Oil

HALLUCINOGENS LSD Psilocybin & Psiocyn and Other Tryptamines Peyote & Mescaline MDMA (Ecstasy) & Other Phenethylamines Phencyclidine (PCP) & Related Drugs Ketamine

STEROIDS

INHALANTS

IX. Specific: NICD Topics

Do you have questions relating to addiction /addictions / substance abuse? Contact us…Health Info and Videos Medical issues updated weekly. Family Resources for the family, intervention information, support, and counseling. Medical information, doctor and specialists directory, terminology and dictionary of terms. Treatment.

The Villa at Scottsdale- Providing a full continuum of care for the treatment of alcoholism and drug addiction.

Alcohol and Drug Addiction Survival Kit

General: A series, for the individual, family, friends, employers, educators, professionals, etc. on prevention, intervention, treatment, recovery, relapse prevention, support, and other issues relating to alcoholism and drug addiction.

1. Prevention- Includes tips on how to talk to your kids about alcohol, tobacco, and drugs.

2. Detection of Signs and Symptoms- A guide to detection of alcohol and various drug usage.

3. Definition of Addiction- A DSM-IV definition of exactly what constitutes alcoholism and drug addiction.

4. Intervention- Interventions can and do work. We will show you how to do it effectively.

5. Treatment & Housing- A treatment center and halfway house locator.

6. Support- Some guides to how to support someone while they are in treatment.

7. After Care- What to do prior to and after release from treatment.

8. Recovery / Relapse Prevention- Addiction can surface again, in the form of relapse.

9. Other Issues- Issues to think about regarding those affected by substance abuse, as well as those around them.

10. References- A list of those who contributed to this series of articles.

Articles Medical Today Dr. William Gallagher takes us through his use of DNFT with his patients. Psychotherapy Today Psychologist Jim Maclaine keeps us up to date with his articles of insight, therapy, and healing. Counseling Today Therapist Thom Rutledge gives a creative approach to dealing with life on life’s terms via his unique counseling sessions. Big Book Bytes Author Shelly Marshall shares via the Big Book on issues of concern to those in recovery. All pages are set-up to copy, for use by counselors, professionals, sponsors, and others.

Recovery Today Interviews of people in recovery, about alcoholism, drug abuse, addictions, recovery, sobriety, spirituality, wisdom, experience, strength, and hope. Tune in monthly for new articles!

A.A. History Author Dick B. will take you back to a time when the recovery rates were as high as 93%.

Journaling Today A series of informative articles by Author Doreene Clementon how, why, and what to write about.

Spirituality Today Author Carol Tuttle takes us to new heights on our spiritual journey.

Articles of God and Faith Features 100’s of topics relating to God, faith, spirituality, and more.

Life Today Everyday life experiences from people all over the world. Life, Addictions, Recovery, Hope, Inspiration, Wisdom, Advice, and so much more. Tune in on a regular basis to see what others have and are going through. Find hope from the experiences of others.

Steps Today Recovery Peer and Advisory Board Member Dean G. gives creative approach to dealing with life on life’s terms via his unique recovery sessions.

Step Work / Relapse Prevention This service is designed to assist with step work, with quotes and pages from the Big Book, with forms ready to copy and utilize. There is a section devoted to relapse prevention as well.

X. Specific: Additional Articles

Health and Medical News, videos, text from the world of medicine, health, and medical.

Ecstasy information.

How Do I Talk With My Kids About Alcohol?

How Do I talk to my kids about drugs?

How Do I talk with my teenager about drugs and alcohol?

What does a crack pipe look like?

Family assistance for substance abuse.

Addiction treatment for my teenager.

Overdose or OD Information

XI. Specific: Overdose & Emergency Intervention Techniques

Drug Overdose- Drug overdoses can be accidental or on purpose. The amount of a drug needed to cause an overdose varies with the type of drug and the person taking it. Overdoses from prescription or over-the-counter (OTC) medicines, “street” drugs, and/or alcohol can be life threatening. Know, too, that mixing certain medications or “street” drugs with alcohol can also kill.

Physical symptoms of a drug overdose vary with the type of drug(s) taken. They include: Abnormal breathing Slurred speech Lack of coordination Slow or rapid pulse Low or elevated body temperature Enlarged or small eye pupils Reddish face Heavy sweating Drowsiness Violent outbursts Delusions and/or hallucinations Unconsciousness which may lead to coma (Note: A diabetic who takes insulin may show some of the above symptoms if he or she is having an insulin reaction.)

Parents need to watch for signs of illegal drug and alcohol use in their children. Morning hangovers, the odor of alcohol, and red streaks in the whites of the eyes are obvious signs of alcohol use. Items such as pipes, rolling papers, eye droppers and butane lighters may be the first telling clues that someone is abusing drugs. Another clue is behavior changes such as: Lack of appetite Insomnia Hostility Mental confusion Depression Mood swings Secretive behavior Social isolation Deep sleep Hallucinations.

Prevention- Accidental prescription and over-the-counter medication overdoses may be prevented by asking your doctor or pharmacist: What is the medication and why is it being prescribed? How and when should the medication be taken and for how long? (Follow the instructions exactly as given.) Can the medication be taken with other medicines or alcohol or not? Are there any foods to avoid while taking this medication? What are the possible side effects? What are the symptoms of an overdose and what should be done if it occurs? Should any activities be avoided such as sitting in the sun, operating heavy machinery, driving? Should the medicine still be taken if there is a pre-existing medical condition?

To avoid medication overdoses: Never take a medicine prescribed for someone else. Never give or take medication in the dark. Before each dose, always read the label on the bottle to be certain it is the correct medication. Always tell the doctor of any previous side effects or adverse reactions to medication as well as new and unusual symptoms that occur after taking the medicine. Always store medications in bottles with childproof lids and place those bottles on high shelves, out of a child’s reach, or in locked cabinets. Take the prescribed dose, not more. Keep medications in their original containers to discourage illicit drug use among children: Set a good example for your children by not using drugs yourself. Teach your child to say “NO” to drugs and alcohol. Explain the dangers of drug use, including the risk of AIDS. Get to know your children’s friends and their parents. Know where your children are and whom they are with. Listen to your children and help them to express their feelings and fears. Encourage your children to engage in healthy activities such as sports, scouting, community-based youth programs and volunteer work. Learn to recognize the signs of drug and alcohol abuse.

Questions to Ask:

Is the person not breathing and has no pulse? FIRST AID Perform Cyprinids the person not breathing, but has a pulse? FIRST AID Perform Rescue Breathing AND is the person unconscious? FIRST AID lay the victim down on his or her left side and check airway, breathing and pulse often before emergency care. Do CPR or Rescue Breathing as needed. ANDdoes the person have any of these signs? Hallucinations Confusion Convulsions Breathing slow and shallow and/or slurring their words

Do you suspect the person has taken an overdose of drugs? FIRST AID Call Poison Control Center. Follow the Poison Control Center’s instructions. Approach the victim calmly and carefully. Walk the person around to keep him or her awake and to help the syrup of ipecac work faster, if you were told to give this to the victim. Also, see “Poisoning”. AND is the person’s personality suddenly hostile, violent and aggressive? FIRST AID Use caution. Protect yourself. Do not turn your back to the victim or move suddenly in front of him or her. If you can, see that the victim does not harm you, himself or herself. Remember, the victim is under the influence of a drug. Call the police to assist you if you cannot handle the situation. Leave and find a safe place to stay until the police arrive. AND Have you or someone else accidentally taken more than the prescribed dose of a prescription or over-the-counter medication? DO NOT perform any technique unless it is a matter of life and death! If you are unsure of what you are doing, please follow the instructions given by a 911 operator.

Note: If doctor is not available, call Poison Control Center. Follow instructions given.