Substance Use Disorder (SUD)

Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

Those with substance use disorder (SUD) often try to hide their symptoms and downplay their problem. If you’re worried that a friend or family member may be misusing drugs, look for the following warning signs:

Stethoscope on a background X-ray images

Physical Warning Signs

Bloodshot eyes, pupils larger or smaller than usual
Changes in appetite or sleep patterns
Deterioration of physical appearance, personal grooming habits
Runny nose or sniffling
Sudden weight loss or weight gain
Tremors, slurred speech, or impaired coordination
Unusual odors on breath, body, or clothing

Psychological Warning Signs

Appearing fearful, anxious, or paranoid, with no apparent reason
Lack of motivation; appearing tired or “spaced out”
Periods of unusually increased energy, nervousness, or instability
Sudden mood swings, increased irritability, or angry outbursts
Unexplained change in personality or attitude

Behavioral Warning Signs

SUD causes difficulties in one’s relationships
Engaging in secretive or suspicious behaviors
Frequently getting into legal trouble, including fights, accidents, illegal activities, and driving under the influence
Neglecting responsibilities at work, school, or home, including neglecting one’s children
Sudden change in friends, favorite hangouts, and hobbies
Unexplained need for money or financial problems. May borrow or steal money.
Using drugs under dangerous conditions (driving while using drugs, using dirty needles, having unprotected sex)
Increased drug tolerance (the need to use more of the drug to experience the same effects one used to achieve with smaller amounts)
Misusing drugs to avoid or relieve withdrawal symptoms (nausea, restlessness, insomnia, depression, sweating, shaking, anxiety)
Loss of control over drug misuse (using more than intended, unable to stop)
Life revolves around drug use (always thinking of using, figuring how to get more, or recovering from use)
Abandoning enjoyable activities (hobbies, sports, and socializing) to use drugs
Continuing to use regardless of negative consequences (blackouts, infections, mood swings, depression, paranoia)

Alcohol Warning Signs

Underage drinking and/or binge drinking.
Needing greater quantities of alcohol to achieve the desired effects or to function “normally.”
Drinking more alcohol to get rid of or ease alcohol withdrawal symptoms.
Attempts to stop or limit drinking are unsuccessful.
An extensive amount of time is needed to recover from the effects of alcohol.
Spending a great deal of time thinking about the next drink.
Drinking alone or trying to hide one’s drinking patterns.
Discontinuing use causes withdrawal symptoms such as nausea, mood swings, irritability, tremors, inability to sleep, and overall sickness.
Displaying anger when questioned about one’s drinking patterns.
Acting as if drinking is more important than one’s friends and family; isolating from one’s social support system.
Becoming anxious or stressed if a social gathering does not include alcohol.
Continuing to drink regardless of the negative physical or psychological difficulties.
Drinking frequently or in excess, which may include blackouts when drinking.
Making excuses to continue to drink and/or drinking at unacceptable times or places.

What to do?

SUD

Recognizing that you have a problem is the first step in recovery. Facing your SUD takes courage and strength and can feel scary and overwhelming, but recovery is possible. If you’re ready to make a change and willing to get help, you can overcome your SUD and build a satisfying, drug-free life.

For information and treatment referral, call 1-800-662-HELP in the U.S. to reach the National Hotline from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Don’t try to go it alone; it’s too easy to get discouraged and rationalize “just one more” hit or pill. Whether you choose to go to detox, rely on self-help programs, or go to inpatient/outpatient treatment, support is essential. Recovering from SUD and working toward long-term recovery is much easier when you have people you can lean on for encouragement, comfort, and guidance. Support can come from:

family members
close friends
therapists or counselors
others recovering from substance use disorders
healthcare providers
people from your faith community

Reasonable Suspicion of Impairment at Work

Any observed or possible impairment must be assessed for reasonable suspicion.
- Notify leadership (Program Director, DIO, Supervisor) and HR Business Partner immediately. In HR’s absence (i.e. after hours), contact the house supervisor.
- Write down what you saw, smelled, and witnessed with as much detail as possible. You will be asked for this data during the process.
- Once HR has been notified, they will guide the policy/process.

Screening

Tobacco, Alcohol, Prescription Medication, and other Substance use Tool – nida.nih.gov

Resources

SAMHSA – samhsa.gov

Guide for processing reasonable suspicion – Click to view

Reasonable suspicion observation checklist – Click to view