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How do you identify chemical abuse and dependence earlier rather than later?

Early identification and early intervention are key, before the consequences are irreversible. This involves everyone in the community, family, friends, physicians, psychologists, employers and officials. Brief assessment is an important part of medical visits and psychological assessments. Self report by interview is usually the most accurate, especially with a trained interviewer, using assessment tools.

Earlier consequences include: psychological, family, friends, biomedical, work, legal and financial. Later consequences include cirrhosis, cardiomyopathy, AIDS, chronic pancreatitis, coronary artery disease, cancer, severe neuropsychiatric disorders, family dissolution, social isolation, unemployment, homelessness, incarceration, oral cancers and tooth loss. So, we’d rather look at the earlier consequences and intervene then.

Psychological consequences are the earliest to manifest, with dysphoria, depression, anxiety, irritability, mood swings, hostility, paranoia, and psychosis requiring a question of how this might be related to intoxication, overdose or withdrawal. Marital and family dysfunction, children’s behavior and school problems, with various mental health and somatic symptoms appearing in family members may occur. Alienation from old friends and acquisition of new heavily using friends occurs. As a clinical psychologist, I know the challenges that any of these bring for diagnosis and treatment.

Early biomedical consequences include many gastric symptoms, abdominal pain, diarrhea, hypertension, weight gain (for alcohol), weight loss (for cocaine and amphetamines), sleep and sexual dysfunction, unplanned pregnancies, unwanted sexual advances, sexually transmitted diseases, and periodontal disease. Injuries that occur as early consequences include domestic assault and other interpersonal violence, motor vehicle crashes or MVA/pedestrian incidents, falls, fires, swimming and boating accidents, suicide attempts, and repeated injuries in the home.

Work and school early consequences include frequent tardiness or absence, requests for excused absences, decline in performance, job changes and work site injuries. For many highly motivated people, such as professionals, the work performance is well preserved until much later. Legal consequences start to occur with domestic or violence issues, disturbing the peace, DWI/DUI’s, arrests for possession or dealing, shoplifting, burglary and robbery. Financial consequences such as spending more than what one can afford on obtaining alcohol or drugs, indebtedness, selling of possessions and perpetual financial strain. If some pattern of these are present, be thinking about alcohol or drug dependence. Treating just the resulting symptom, and not the underlying problem, isn’t going to fix it. It would be like trying to get rid of smoke without putting out the fire. Treatment works. Educate yourself further by watching some of the WYNK educational flash videos, perhaps the longer ones on alcohol or drug(s) of choice. Knowledge is power.

by: Lois Cochrane Schlutter, Ph.D. L.P.

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