Tips for First Responders
Possible Alcohol and Substance Abuse Indicators

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The following indicators or warning signs are associated with alcohol and drug addiction, and other physical and mental disorders. Use this list in psychological fi rst aid situations. If several symptoms are present, refer the person for alcohol and drug assessment.This list is not to be used as a substitute for a screening or qualified clinical assessment.

Physical/Emotional Indicators

• Has smell of alcohol on breath or marijuana on clothing
• Has burned fingers, burns on lips, or needle track marks on arms
• Slurs speech or stutters, is incoherent
• Has difficulty maintaining eye contact
• Has dilated (enlarged) or constricted (pinpoint) pupils
• Has tremors (shaking or twitching of hands and eyelids)
• Is hyperactive and overly energetic Appears lethargic or falls asleep easily
• Exhibits impaired coordination or unsteady gait (e.g., staggering, off balance)
• Speaks very rapidly or very slowly
• Experiences wide mood swings (highs and lows)
• Appears fearful or anxious; experiences panic attacks
• Appears impatient, agitated, or irritable
• Is increasingly angry or defi ant

Personal Attitude/ Behavior Indicators

• Talks about getting high, uses vocabulary typical among drug users
• Behaves in an impulsive or inappropriate manner
• Denies, lies, or covers up
• Takes unnecessary risks or acts in a reckless manner
• Breaks or bends rules, cheats
• Misses interviews, appointments, or meetings or arrives intoxicated
• Fails to comply with program requirements without easily verifiable reasons (may be verbally uncooperative to disguise the problem or divert attention)

Cognitive/Mental Indicators

• Has difficulty concentrating, focusing, or attending to a task
• Appears distracted or disoriented
• Makes inappropriate or unreasonable choices
• Has difficulty making decisions
• Experiences short-term memory loss
• Experiences blackout
• Needs directions repeated frequently
• Has difficulty recalling known details
• Needs repeated assistance completing ordinary paperwork (e.g., application forms)