Overview
In addition to providing prevention oriented activities and information, a comprehensive substance abuse program needs to reach those individuals already harmfully involved with drugs and/or alcohol.
To be successful in its undertaking the substance abuse program must be responsive to students needs in a timely manner while providing quality services. It must realize that student behavior is often episodic and that response time to requests for service must be quick. To be effective the screening process should be completed within 48 hours of a request for service.
To be supportive and facilitative to the education community the screening process needs to address the multiple issues of various services by multiple providers. An example of a centralized screening process would include substance abuse, mental health, physical and sexual abuse, and physical counterparts to behavior difficulties. With this method the system would (1) establish the significant presenting problem, (2) determine the priority of treatment, and (3) refer to the appropriate service.
This section provides lists of symptoms as well as assessment instruments to aid in identifying individuals with substance abuse problems.
A. Indicators of Substance Abuse
Symptoms of drug abuse vary, but there are certain universal "tip-offs." The odor of alcohol, smoke, marijuana, or "cover-up" scents on clothing, along with bloodshot eyes and dilated pupils are signs of which to be aware. The possession of paraphernalia or the substance itself along with large amounts of money, missing money, or a definite lack of money may indicate a problem. Other symptoms are disappearance of personal belongings, evasiveness, and hostility and defensiveness when discussing drugs.
Trouble at school where there was none may signal the beginning of a problem. This may include change in performance, assignments not completed, day dreaming, short attention span, and difficulty in concentrating. Many times there is a lack of concern regarding class or school in general that can progress to extreme dissatisfaction. This individual can be hard to motivate, will sit in the back of class, and will have increased absenteeism or tardiness, many times with a group.
"I'm fine, but the rest of the world has a problem." Many substance abusers who feel this way will "tune out" talking about alcohol and drugs. They will exhibit signs of rejection and attempt to avoid others. They will have unrealistic goals and will tend to blame others for their problems or will deny that problems exist. Chronic dishonesty, a defensive attitude about altered behavior and verbal abuse toward authority are other signs indicating chemical dependency.
Expressions that are used can indicate the use of drugs. Talk about parties where alcohol or other drugs are involved, slogans on clothing, magazines, and jokes that are preoccupied with the same may be warning signals to observant family and friends. Conversations that center on drug or alcohol related topics and an attitude of acceptance of another's drug use may indicate a growing problem. Many times they will "mirror" parental drug use but not usually with the same drug.
Instead of looking for drug signs, look for changes in the substance abuser. These could include weight loss, excessive physical complaints or injuries, or an unhealthy appearance and an indifference to grooming and hygiene.
I. General Signs of Abuse
Usage:
Inability to always control frequency and amount of intake. Usage continues
even though individual knows that negative consequences will result.
Increasing ability to consume more of the substance.
Usage normally resulting in major impairment. Denial of actual usage.
Use to stop withdrawal.
Physical:
Physically observed abnormalities of skin, eyes, coordination and speech
pattern.
Pattern of frequent physical illnesses or sleep disturbances.
Evidence of withdrawal.
Decreased concern about grooming and appearance.
Emotional:
Use of drugs to deal with emotions.
Guilt about actions during intoxication.
Reduced emotional control.
Dramatic mood swing.
Guilt about use.
Anxiety reactions.
Cognitive:
Decreased attention and concentration spans.
Increased forgetfulness.
Decreased problem solving skills.
Blackouts (total memory loss for a period of time).
Poor judgement and decisions.
Social:
Family and other relationship difficulties.
Financial problems.
Legal problems.
Friends are regular heavy users of drugs.
Decrease in leisure time activities and interests.
Poor work record and/or performance.
II. Characteristics of Alcohol Abuse
In short, a drinking problem exists if we need alcohol in order to function, or if we use alcohol in such a way that it impairs our functioning. A problem drinker is anyone who uses alcohol to an extent that it measurably impairs his health, social functioning or vocational-academic adjustment.
There are many indicators of someone with a drinking problem. They include the following. Someone who must drink in order to function or to cope with life. Anyone who by his or her own personal definition, or that of his family and friends, frequently drinks to a state of intoxication. Anyone who goes to work or school intoxicated. Anyone who is intoxicated while driving a car. Anyone who sustains a bodily injury which requires medical attention as a consequence of injury which requires medical attention as a consequence of any intoxicated state. Anyone who comes into conflict with the law as a consequence of an intoxicated state. Anyone who, under the influence of alcohol, does something he avows he would never have done without alcohol.
Behavioral Characteristics
Destruction of property, vandalism.
Violation of others' rights and privileges.
Physical harm to others.
Verbally abusing others.
Participation in drinking games.
Missing classes and appointments due to hangovers.
Spending large amounts of money for alcohol.
Participation in weekend drinking binges.
Drinking before classes.
Unaccustomed risk taking.
Drinking continuously.
Use of stronger types of alcohol over time.
"Shooting" beer.
"Chugging" beer.
Mixing drugs and alcohol.
Out every night drinking.
Drinking alone.
Not premeditated use, not realizing how much one drinks.
Emotional/Attitude Characteristics
Missing classes and appointments due to drinking.
Mood swings.
Impaired judgment.
Personal depression.
Poor self concept.
Preoccupation with next drinking experience.
Bragging about drinking experience.
Interpersonal Characteristics
Violation of others' rights and privileges.
Physical harm to others.
Verbally abusing others.
Arguments with others.
Disruptions in personal relationships.
Fighting with dating partner.
Taking advantage of others.
Needing a drink before entering into a group situation.
Bragging about drinking experiences.
Physical Characteristics
Hangover recovery.
Chronic illness.
Impaired judgment.
Harm to self.
Physical reactions such as convulsions, vomiting, passing out.
Constant headaches.
Dehydration.
Loss of appetite.
Tired, sleepy, chronic exhaustion.
Increased tolerance.
Use of alcohol as medicine, panacea.
Drug/Alcohol First Aid
This section is meant as a basic emergency care guide. It would be wise to have several people in the task force trained in emergency care and CPR to be prepared for such situations.
Whenever an emergency situation arises. it is important to remain calm, assess the situation, and be aware of any dangers. Four basic signs to watch for in any drug emergency are as follows:
1. Respiration: Should be at least 9 breaths a minute.
2. Pulse: Should be between 50 and 140 beats per minute.
3. Pupil dilation: Should be evenly responsive to light.
4. Pain response: Should respond to shoulder pinch.
If one of these signs is unacceptable, immediate medical attention is needed. Always have emergency phone numbers listed by the phone and easily visible. When you call, identify yourself, state your problem and what you feel you need, give your specific location and phone number. If at all possible, be there when help arrives and keep a sample of the drug if other than alcohol. Many street drugs are impure or sold under false pretenses.
I. Alcohol Intoxication
Assess the person for:
1. Responsiveness (sleeping or unconscious)
2. Breathing (do CPR if necessary)
3. Pulse (regular, rapid, or thready)
4. Condition and color of skin (normal, clammy, or cold) An intoxicated person can be violent and uncooperative, you may need to prevent harm to yourself or others. If the person is being destructive and uncontrollable, call campus security or your local police department. Remember alcohol affects judgment.
Guide for Immediate Care
1. Stay with the person.
2. Protect the person from injury.
3. Keep person from alcohol and other drugs, even aspirin.
4. Keep the person still and comfortable.
5. Stay with a drunk person who is vomiting.
6. If the person is in bed, make sure he/she is on his/her side; not back.
Make sure the airways stay open in case of vomiting. If possible prop
something behind the person to keep him/her on his/her side.
7. Check on the person as often as possible, every 15 to 30 minutes, until
responses are normal.
8. Speak in a clear, firm, reassuring voice.
9. If person is unresponsive get immediate emergency care.
II. Other Depressant Drugs
Depressant drugs such as barbiturates, narcotics, and sedatives depress bodily functions. General signs of an overdose include the following:
1. Irregular, slow, shallow breathing to the point of respiratory failure.
2. Lethargy and increasing reduction of activity and awareness.
3. Sleep that can lead to unconsciousness.
4. Profuse sweating.
5. Dramatic fall in body temperature.
6. Muscle relaxation.
7. Pinpoint pupils.
Immediate Care
1. Arouse the victim if possible.
2. Maintain open airway and be prepared to give CPR.
3. Reassure the person and get medical help immediately.
III. Hallucinogens
The most common hallucinogens are LSD, mescaline, psilocybin, morning glory seeds, and a number of synthetics called "angle dust." Disturbances of sensation, judgment, thought, emotion, and self awareness occur. A "bad trip" may occur at any time and help will be needed. Symptoms include increased activity (rapid shaking, seizures), heart rate and body temperature; dilated pupils; loss of emotional control or bizarre ideas, fearful behavior or hallucinations (I can fly); withdrawn depressed behavior, tension, or increased anxiety.
Immediate Care
1. Reassure the person and place the person in a quite, protected
environment.
2. Call for immediate medical help.
3. Talk the person down from the experience in a quiet calm fashion.
4. If possible two people should stay with the victim; they often have
super-human strength.
IV. Stimulants
Most common forms of stimulants are benzidrine, dexedrine, and methadrine. High doses induce confusion, disorientation, compulsive repetition of small meaningless acts, irritability, and delusions. The person may become paranoid, aggressive, and antisocial.
Immediate Care
1. Protect victim from injury to self or others.
2. Maintain body temperature.
3. Obtain medical help (physical or psychiatric).
V. Cocaine, Crack
Cocaine is a powerful stimulant; crack is a highly purified form of cocaine. Both affect the central nervous system quickly and strongly. In cases of possible overdose check breathing rate, responsiveness, and pulse.
Immediate Care
1. Start CPR if necessary.
2. Immediately call for medical help.
VI. Depression and Suicidal Thoughts
Often individuals become severely depressed and suicidal when drinking and drugging. When this occurs, do the following:
1. Have someone stay with the person at all times.
2. Talk directly with the person about his or her self-destructive
thoughts. Find out how, when, and where he or she plans to kill him or
herself.
3. If you think the person is serious, attempt to convince the individual
that he or she should go to a medical or counseling facility for help
NOW and that you will go with him or her.
4. If the person is depressed but not suicidal, talk to him or her the next
day when the person is sober and discuss the possibility of counseling
for his or her problems.
VII. Bleeding
1. Apply direct pressure to the wound.
2. If injured area is an extremity, elevate.
3. If sever bleeding is involved, call for medical help.
Nosebleeds
1. Position: sitting leaning forward, or lying down with head and shoulders
raised.
2. Keep person quiet.
3. Apply pressure by pressing bleeding nostril toward mid-line
4. Apply cold compresses to nose and face.
5. If bleeding continues. obtain medical assistance.
Source: College Substance Abuse Program Development Manual, Washington State Substance Abuse Coalition, Washington Traffic Safety Commission, January, 1989.
Signs of Cocaine Use
Cocaine is available, easy to conceal, fast acting and hard to diagnose. Cocaine abusers constantly send out signals. Signs to look for include the following:
Erratic or unusual behavior.
Failure to meet schedules.
Missed classes, appointments.
Increasing lateness and unexplained, lengthy disappearances in the course
of the day.
Irritability, negativism, and constant arguments.
Sharp mood swings.
Decreased energy and vitality.
Decreased confidence.
Showing less concern about their personal appearance.
Constant mentioning of physical problems, frequent visits to the doctor.
Loss of competitive spirit, seeming not to care anymore about promotions.
May even ask for a demotion so they can work in a more isolated area (to
avoid observation).
Increased taking of sick leave, and when confronted with poor performance,
may ascribe it to poor health.
Signs of Marijuana Use
+ Bloodshot eyes (rarely seen because of use of eye drops).
+ Cough.
+ Chest pain.
+ Irregular menstruation and/or amenorrhea.
+ Poor grooming.
+ Mental changes: irritability and/or memory loss.
+ Personality changes: paranoid thinking, mood shifts (passivity to
aggressiveness).
+ Fatigue.
+ Difficulty with speech.
+ Changes in eating habits.
+ Deteriorating school performance (possibly due to impaired intellectual
function).
+ Absentmindedness, forgetting thoughts in mid-sentence.
+ Stereo addiction (preoccupation with sensory input).
+ Secretiveness.
+ Alienation and withdrawal.
+ Circumstantial evidence, such as drug paraphernalia, friendships with known
drug-users, unexplained losses of money in the home.
Effects of Selected Other Drugs
Drugs can be classified by a variety of systems. They can be separated in different broad categories using legal, medical, drug action, and some social systems. The most widely accepted classification system is by drug action on the nervous system. There are five (and sometimes six) categories: stimulants, depressants, hallucinogens, narcotics, tranquilizers, and volatile inhalants.
1. Stimulants increase functional activity. They include amphetamines,
amphetamine-like drugs, or equivalents, as well as the so-called minor
stimulants, such as the socially accepted drugs nicotine and caffeine.
Cocaine, a drug which is both a stimulant and an analgesic, is generally
considered as a stimulant drug. Another stimulant, ritalin, when
administered to hyperactive children, produces a paradoxical result; it
slows down activity like a depressant. Often stimulant drugs are used for
weight control, because they decrease one's appetite.
2. Depressants decrease or slow down functional activity. Sometimes referred
to as sedatives or sedative hypnotics, depressants include alcohol,
barbiturates, and inhalants (volatile inhalants). They act on the nervous
system to reduce anxiety and muscle tension. If taken in large volumes,
they can produce sleep. Sedative hypnotics are the most prescribed drugs
in the U.S.
3. Hallucinogens cause some degrees of distortion of reality by altering
one's perception. Some professionals refer to this category as
psychedelics. Included are LSD, mescaline, psyilocybin, STP, DMT, and
numerous others. Hallucinogens intensify emotional reactivity (with rapid
swings and great lability) create a relative sense of timelessness
bordering on eternity, and can shift thinking to a deep, symbolic
integrative level resembling dream states. Marijuana falls into this
category according to the pharmacological properties, although it is
listed as a narcotic by law.
4. Narcotics are usually products of the opium poppy that sedate and suppress
pain as well as reduce activity. Examples are heroin, morphine, and
codeine. Some synthetic narcotics are meperidine (Demeral), oxydodone
(Percodan), and methadone.
5. Tranquilizers are psychotherapeutic agents used in psychiatric medicine.
Basically, they are muscular relaxants which relieve anxiety and
excitability. Tranquilizers are further divided into two categories, major
and minor tranquilizers. Major tranquilizers act upon the human brain to
control psychic thinking. Examples are meprobarnate (Milltown, Equanil),
chlordiazepoxide (Librium), and diazepam (Valium).
6. Volatile inhalants are substances which are ingested by breathing or
smelling. Most act quickly upon the tissues as a depressant, slowing down
respiration and other bodily functions. A few substances, such as Nitrous
Oxide and Amylk Nitrite have medical uses while most others involve
recreational use. Other examples of inhalants are nail polish removers,
model airplane glue, spot removers, gasoline products, and aerosol sprays.
Different drugs affect people in different ways: physically, mentally, emotionally, and behaviorally. It is important for people to know the adverse as well as the desirable affects of a drug. The following is a selection of some of the more common drugs and the effects on human functioning.
If a friend is drunk and belligerent, it is best not to be verbally confrontational or aggressive in any way. Joking, kidding, bargaining and enlisting the help of friends are the best way to deal with a belligerent person. It is important to speak clearly and calmly and to try to coax the person to a quiet place where he/she can calm down and hopefully fall asleep. If repeated attempts to calm the person down are unsuccessful, it is best to take the necessary measures to enlist outside intervention.
REMEMBER: An intoxicated person is not rational and cannot be reasoned with. He/she can be violent and uncooperative. You may need to prevent harm to yourself or others. If the person is being destructive and uncontrollable, call for assistance or your local police department. Remember alcohol affects judgment.
If a person is very intoxicated and staggering, vomiting or passing/passed out, try to get the individual in bed and follow the guidelines listed below.
Guidelines for Immediate Care
1. Stay with the person, comfort them and reassure them.
2. Protect the person from injury.
3. Keep person from alcohol and other drugs, even aspirin.
4. Keep the person still and comfortable.
5. Stay with a drunk person who is vomiting.
6. If the person is in bed, make sure he/she is on his/her side; not back.
Make sure the airways stay open in case of vomiting. If possible prop
something behind the person to keep him/her on his/her side.
7. Check on the person as often as possible, every 15 to 30 minutes, until
responses are normal.
8. Speak in a clear, firm, reassuring voice.
9. If person is unresponsive, get immediate emergency care.
Guidelines for Emergency Care
Four basic signs that indicate an emergency are changes in breathing patterns, pulse, pupil dilation and response to pain. Normal function should fall within the following range:
1. Respiration: Should be at least 9 breaths a minute.
2. Pulse: Should be between 50 and 140 beats per minute.
3. Pupil dilation: Should be evenly responsive to light.
4. Pain response: Should respond to shoulder pinch.
If one of these signs is unacceptable, immediate medical attention is needed.
Guidelines for Obtaining Medical Assistance
1. Call 911
2. Identify yourself to the 911 operator
3. State your problem and what you feel you need
4. Give the specific location of the incident and the phone number
5. If at all possible, stay there until help arrives
Dealing With Intoxicated Students in Class
A. If a student attends class drunk and belligerent it is best not to be verbally confrontational or aggressive in any way. Joking, kidding, bargaining and enlisting the help of friends are the best way lo deal with a belligerent person. It is important to speak clearly and calmly and to try to coax the person to a quiet place where he/she can calm down and hopefully fall asleep. If repeated attempts to calm the person down are unsuccessful it is best to take the necessary measures to enlist outside intervention. REMEMBER: An intoxicated person is not rational and cannot be reasoned with.
B. If a person is very intoxicated and staggering, vomiting or passing/passed out try to get the individual to lie down and then sit with them and observe their breathing pattern. Very intoxicated drinkers will have trouble maintaining their airway. If breathing is difficult, propping the person on his/her side helps. If vomiting occurs, protect the airway by rolling the person on his/her side. This prevents aspirations of stomach contents into the lungs. IMPORTANT: If you are ever in doubt about the person's health or personal safety call the rescue squad or take the person to the Emergency Room immediately!
Remember to verbally comfort and reassure the student and to try and keep them calm. This is not the moment to be judgmental.
Red Flags-Warning signs for a Drinking Problem
1. Blackouts on a fairly regular basis (Blackouts-Total lapse of memory that
cannot be recalled).
2. Concern expressed by friends or family.
3. Decrease in performance in school and other activities.
4. Change of friends to associate with a crowd that drinks or uses drugs on a
regular basis.
5. Drinking to get drunk.
6. Medical emergency or accident as a result of drinking.
7. Adamant denial when confronted.
Confronting Student Afterwards re: Possible Drinking Problem
Ask student if they remember what happened - they may have had a blackout. This can be a danger signal.
Recall the situation exactly to them. Describe the incident and the behavior in a non-emotionally charged manner.
A confrontation with someone using alcohol unsuccessfully should occur when the person is sober and preferably alone. This section contains some principles to keep in mind as you confront a person who has this problem. The sixteen (16) items represent a couple of different confrontation styles; one fairly low-key and a second more aggressive. You may be more comfortable with one approach than the other. While it is important that you keep these principles in mind; it is even more important that you fit them into your usual style of working with people.
A. Be simple and direct as you speak, but proceed openly and smoothly. Rushed encounters of any type are usually not conducive to increased awareness.
B. Know the basic facts regarding the behavior (in this case alcohol abuse) you are confronting, but don't try to come across as an expert.
C. Be specific and clear in your confrontation. You are confronting the person's drinking and resulting behaviors, not the person or his/her behavior in general.
D. Confront behaviors, not values. Pushing values (especially if you are not into alcohol) probably will not work. Specify what behaviors are causing others a problem; such as damage, rowdiness, messiness, etc., and specify what behaviors you observe that may be causing the person a problem-such as personal isolation, disciplinary problems, etc.
E. Care!!! At every available opportunity, communicate your interest in the person and ask him/her clarifying questions: How do you view your current behavior? Why are you acting this way?
F. Show your feelings about the confrontation. If you are angry, check to see that your anger is directed at the behavior; not the person. Communicate this distinction to the person. Identify feeling as feelings; facts as facts.
G. Focus on the person's strengths rather than his/her weaknesses.
H. Confront behavior in a positive and constructive manner. Show the individual that you are concerned with the positive elements of living together. (Collective responsibility is such an element.)
I. Attempt to make the confrontation objective in terms of specific observed behavior. However, be subjective about your interest in the person.
J. Maintain the offensive; don't let the individual put you on the defensive about your behavior and the fact that you may drink yourself. Remember, use of alcohol in itself is not a problem, abuse is a problem. However, use of alcohol when under the legal age or in places where alcohol is prohibited is a problem.
K Use constructive coercion if necessary. Give negative possible results, if behavior doesn't change (i.e., referral, letters of reprimand, etc.).
L. Stick to the issues. The problem is alcohol. Don't let the person bring in a lot of outside circumstances, and rationalities. For every excuse the person gives you for drinking excessively, you can probably name another person with the same problem who doesn't abuse alcohol because of it.
M. It is sometimes helpful to relate personal experiences; but be careful that the focus of the conversation doesn't switch to your experiences.
N. Always avoid "I told you so..." type of comments in confrontation.
O. Realize and convey that the confrontation need only be an initial contact, and that helpful referral service time and understanding can and will follow.
P. End the confrontation with an open invitation to talk.
Reactions to Expect
A. A lot of excuses. B. Promises of behavior change that will not be fulfilled. C. Attempts to challenge you and the fact that you drink yourself.
D. Attempts to change the conversation to other subjects. E. Attempts to pass the behavior off as "no big thing".
When you become aware of a potential problem it is time to make a referral. Do not expect your interaction with the student to turn their attitudes and behavior around. Realize that this is only an initial contact.
In making a referral, it is important to convey to the student that you care and would like to help him/her follow up with someone who knows more about substance use/abuse than you do. You can set up an appointment for them (see referral form) and offer to go with them. However, do not be surprised if they refuse to go or lie about going. You cannot force them to see someone. However you may still call and ask to talk to a counselor, a peer educator trained in substance to talk to a counselor, a peer educator trained in substance abuse, a parent, or other appropriate sources about the problem drinker.
Enabling
Those around the drinker/user who inadvertently encourage that person to continue their abusing habits by not constructively dealing with them are enablers. For example: laughing, ignoring, denying, down playing etc. is enabling behavior. Enabling is NOT helpful. It is destructive in that it keeps the problem substance abuser from seeking help.
HOW To Stop Enabling Everyone has been an enabler at sometime in their lives. It is difficult to deal head on with something that makes us uncomfortable. However most people don't realize how destructive enabling can be, and once they learn they think twice before they laugh at someone's drunken behavior. Have a presentation on Problem Drinking -and have a discussion about this aspect.