Substance use is one of the most stigmatized health concerns—yet it’s one of the most prevalent. The United Nations Office on Drugs and Crime has reported a recent increase in drug use, with 60 million people across the world using opioids and 23 million using cocaine. They also discovered a jump in overdose deaths after the rise of synthetic opioids in use known as nitazenes, which may be more deadly than fentanyl.
For NPs working to provide holistic care, it’s crucial to know how to identify substance use among patients.
Early Signs and Symptoms
When identifying early signs of substance use, NPs must look out for multiple types of indicators: physical, behavioral, and psychological.
Physical Indicators
A physical sign that a patient may be engaging in substance use is a sudden change in their weight—either weight loss or weight gain. This abrupt change in weight signifies that something is drastically affecting either their appetite or their metabolism.
The state of a patient’s eyes can also indicate that they are using substances. Bloodshot eyes are one symptom, as certain drugs can affect the blood vessels in the eyes. Drug use also affects how one’s pupils appear, but the symptom also depends on the drug. For instance, substances such as cocaine, ecstasy, and hallucinogens can cause dilated pupils, meanwhile heroin, morphine, and fentanyl can cause pupils to constrict.
Behavioral Indicators
A patient’s behavior can also drastically change due to substances. A patient may become secretive by avoiding questions about their health and lifestyle, or they might even share conflicting explanations on their health. Aggression is another behavior to look for, as sudden outbursts and irritability can be symptoms. Patients who seem inattentive or disengaged with treatment plans, including inconsistent attendance, are other ways that signs can manifest.
Alone, these behaviors could be signs of more casual life occurrences. Putting them together with the various other symptoms of drug use could shed more light on the patient’s situation.
Psychological Indicators
Patients who use substances may exhibit rapid mood swings during their appointment, such as going from calm to aggressive. Or they might be showing anxious behavior and sometimes express irrational fear, which could stem from withdrawal.
Aside from emotions, patients who have been using substances might also affect a patient’s memory. Note if the patient can remember details well, or even follow the conversation.
Note that each of these symptoms could be the result of general life stressors. It’s important to look at the whole picture before coming to a conclusion.
Evidence-Based Screening Tools
If there is real suspicion of substance use after reviewing the different signs and symptoms, there are multiple evidence-based screening tools at an NP’s disposal to reach a conclusion and determine their next steps.
- CAGE Questionnaire: This questionnaire screens for alcohol use among adults, as it can cause many of the symptoms listed above. It focuses on four simple yes/no questions, allowing it to be performed quickly. These questions can also be adapted to include drug use (referred to as CAGE-AID).
- AUDIT (Alcohol Use Disorders Identification Test): This test also screens for harmful alcohol consumption among adults, but it can also work for adolescents. It is a 10-question list that can also be administered easily and within a patient’s routine appointment.
- DAST (Drug Abuse Screening Test): This test includes drug use such as prescription medications and illicit substances. It comes in the format of 10 yes or no questions that help determine if the patient is at risk of drug use.
- SBIRT (Screening, Brief Intervention, and Referral to Treatment): This is a comprehensive strategy for id identifying and addressing substance use. It’s a process that not only includes the previously mentioned tools but also helps provide evidence-backed interventions and links patients with sources, allowing it to work as a holistic approach to the screening process.
Empowering Early Intervention
Recognizing and addressing substance use is a critical component of holistic care for NPs. By staying vigilant for physical, behavioral, and psychological indicators and utilizing evidence-based screening tools NPs can identify substance use early and provide appropriate interventions.
