Next ASWB exam content item to explore: The indicators of addiction and substance abuse. Let's look at general indictors, then how substance abuse is assessed by social workers in session, followed by some substance-by-substance specifics, and, finally, how this material may look on the social work licensing exam.

General Indicators

Signs and symptoms of addiction and substance abuse vary depending on the substance being abused and the individual's physiological and psychological makeup. However, some common indicators include:

  • Loss of Control: The inability to stop using the substance despite repeated attempts to quit or cut down.

  • Preoccupation with Use: Spending a significant amount of time obtaining, using, or recovering from the effects of the substance.

  • Tolerance: Needing increasing amounts of the substance to achieve the desired effect, or experiencing reduced effects with continued use of the same amount.

  • Withdrawal Symptoms: Experiencing physical or psychological symptoms when attempting to cut down or stop using the substance.

  • Neglect of Responsibilities: Prioritizing substance use over responsibilities such as work, school, or family obligations.

  • Continued Use Despite Negative Consequences: Persisting in substance use despite experiencing negative consequences such as health issues, relationship problems, legal troubles, or financial difficulties.

  • Loss of Interest: A decline in interest or participation in activities that were once important or enjoyable, as substance use becomes the primary focus.

  • Changes in Behavior: Erratic or unpredictable behavior, mood swings, secrecy, or lying about substance use.

  • Physical Changes: Changes in appearance such as weight loss or gain, bloodshot eyes, or neglecting personal hygiene.

  • Social Isolation: Withdrawing from social activities or relationships in favor of spending time alone or with others who also use the substance.

  • Engaging in Risky Behaviors: Taking risks while under the influence, such as driving under the influence or engaging in unprotected sexual activity.

  • Cravings: Intense urges or cravings to use the substance.

It's important to note that experiencing one or more of these signs does not necessarily indicate addiction, but if several of these indicators are present, it may be a cause for concern.

Recognizing the Signs

Social workers play a crucial role in recognizing indicators of addiction and substance abuse in clients. Some ways they may identify these issues:

  • Client Disclosure: Clients may voluntarily disclose their substance use or express concerns about their own or a loved one's substance use during therapy sessions. Therapists can listen for cues related to frequency, quantity, and consequences of substance use.

  • Observation of Behavior: Therapists observe their clients' behaviors, such as physical signs of intoxication or withdrawal, changes in mood or energy levels, and patterns of attendance and engagement in therapy sessions. They may also notice signs of cognitive impairment or difficulty concentrating.

  • History Taking: Gathering information about the client's personal and family history, including any past experiences with substance use or addiction, can provide valuable insights. Therapists may inquire about substance use patterns, past treatment experiences, and any co-occurring mental health issues.

  • Assessment Tools: Therapists may use standardized assessment tools to screen for substance use disorders and assess the severity of addiction. These tools may include questionnaires or interviews designed to measure substance use patterns, consequences, and readiness for change.

  • Collaboration with Other Professionals: Therapists may collaborate with other professionals, such as addiction specialists, psychiatrists, or primary care providers, to obtain additional information and coordinate comprehensive treatment planning.

Substance Specifics

Some specific indicators of substance use and abuse for commonly abused substances:

  • Alcohol:

    • Drinking alone or in secrecy.
    • Drinking to cope with stress or emotions.
    • Increased tolerance, needing more alcohol to feel its effects.
    • Blacking out or experiencing memory lapses.
    • Neglecting responsibilities due to drinking.
    • Continued drinking despite negative consequences such as health issues or relationship problems.
  • Opioids (e.g., heroin, prescription painkillers):

    • Withdrawal symptoms such as nausea, vomiting, sweating, and muscle aches when not using the drug.
    • Doctor shopping or forging prescriptions to obtain opioids.
    • Needle marks or track marks on arms or other body parts.
    • Social withdrawal and isolation.
    • Financial problems due to spending money on drugs.
    • Respiratory depression or shallow breathing while under the influence.
  • Cocaine:

    • Rapid speech and increased energy levels.
    • Dilated pupils and heightened sensitivity to light and sound.
    • Paranoia or anxiety, especially during withdrawal.
    • Financial difficulties due to spending money on cocaine.
    • Nosebleeds or runny nose (if snorting cocaine).
    • Mood swings and irritability.
  • Marijuana:

    • Red eyes and dry mouth.
    • Increased appetite (the "munchies") and weight gain.
    • Impaired coordination and slowed reaction time.
    • Memory and cognitive impairments, particularly in heavy users.
    • Lack of motivation or interest in activities.
    • Using marijuana as a coping mechanism for stress or emotional issues.
  • Stimulants (e.g., methamphetamine, cocaine):

    • Increased energy levels and decreased appetite.
    • Agitation, paranoia, and hallucinations.
    • Skin sores or acne (common in methamphetamine users).
    • Teeth grinding and dental problems (methamphetamine use).
    • Risky behaviors such as unprotected sex or driving recklessly.
    • Rapid heartbeat and elevated blood pressure.
  • Benzodiazepines (e.g., Xanax, Valium):

    • Drowsiness and sedation.
    • Slurred speech and impaired coordination.
    • Memory impairment and confusion.
    • Using benzodiazepines for non-medical purposes or in larger doses than prescribed.
    • Withdrawal symptoms such as anxiety, tremors, and seizures when not using the drug.
    • Mixing benzodiazepines with alcohol or other drugs.

These are just some examples. Each person may exhibit a unique combination of signs and symptoms. 

On the Exam

Questions on the ASWB exam covering this topic may look something like this:

  • A social worker is conducting therapy with a client who has a history of substance abuse. The social worker notices that the client frequently avoids discussing their substance use and becomes defensive when the topic is raised. Which of the following strategies would be most appropriate for the social worker to use in this situation?
  • A social worker conducting an intake assessment with a client suspects substance abuse based on the client's history and behaviors. Which assessment tool would be most appropriate for screening for substance use disorders?
  • A social worker is working with a client who acknowledges struggling with substance abuse but expresses uncertainty about making changes. Which of the following statements by the social worker demonstrates an understanding of motivational interviewing principles?

Hint on the last one: it's likely the answer that surfaces ambivalence and/or explores the pros and cons of using and not using.

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April 22, 2024
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