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2000 Jordan Institute
for Families

Vol. 4, No. 4
September 1999

Recognizing Substance Abuse

The effects and dangers of different drugs vary so much that it would be impossible to describe here all the signs and symptoms of even the most common drugs.

Many drugs, such as marijuana and LSD, cause the user's pupils to dilate. Heroin, on the other hand, may cause the pupils to contract. Alcohol intoxication can be very obvious when the drinker is stumbling and slurring her speech, but less obvious when she simply seems tired. Longtime alcoholics may become very skilled at hiding their drinking, and even the keenest observer may miss it.

People who abuse prescription drugs may act more strangely when they are unable to obtain their drugs of choice then when they are intoxicated, and taking the drug may return them to an apparent state of "normalcy." They may swallow pills quite openly, saying they have a prescription and need the medicine to sleep, stay calm, or stop smoking. And all this may be true without changing the fact that they are substance-dependent.

Finally, because everyone knows that certain drugs are illegal, users of narcotics and other "street drugs" are likely to go to great lengths to keep their addiction secret (Weil & Rosen, 1993).

What all this means is that substance abuse is easy to miss. It is also easily confused with other phenomena, including brain injury and stroke, the effects of crying or insomnia or too much sleep, mental illnesses, or simply having an unusual personality (DSM-IV, 1994).

Sometimes substance abuse may seem quite obvious. Yet delirium, total irrationality, extremely red eyes that can barely stay open, constant dozing off, unpredictable outbursts and extreme agitation, confused speech, and other strange behaviors can all be signs of many things, not just substance abuse. But when one or more of these behaviors shows up in someone who has previously not exhibited them, drugs are likely involved.

However, it is impossible to know that drugs are being used unless you observe them being ingested, smoked, injected and so forth, which is unlikely, or a person admits to using, or you receive reliable reports--as opposed to gossip and rumors--that a person uses.

But in the end, for a child protective worker, it is okay to be uncertain. While it is helpful to have as much information as possible, the fact that a caretaker uses drugs is not, in itself, of fundamental significance. What matters is the caretaker's ability to care for his children (Mason, 1996).

This is not to say that there is an appropriate response to finding out that there is substance abuse going on in the family. You will want to ascertain whether children are being put at risk, whether they are being exposed to dangerous activities, and whether they themselves are using. Finding the answers to these questions is what matters (Mason, 1996).


Diagnostic and Statistical Manual of Mental Disorders IV. (1994). Washington, D.C.: American Psychiatric Association.

Mason, J. (1996). Reporting child abuse and neglect in North Carolina. Chapel Hll: Institute of Government of the University of North Carolina at Chapel Hill.

Weil, A. & Rosen, W. (1993). Chocolate to morphine. New York: Houghton Mifflin Company.

1999 Jordan Institute for Families