
Resource to help understand what Substance Abuse is:
https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
Substance use disorder is a cluster of physiological, behavioral, and cognitive symptoms associated with the continued use of substances despite substance-related problems, distress, and/or impairment, such as impaired control and risky use.
Addiction is a state of psychological and/or physical dependence on the use of drugs or other substances, such as
alcohol
The intoxicating agent in beverage alcohol, ethyl alcohol, or other low molecular weight alcohols including methyl and isopropyl alcohol.Alcohol
Adapted from the APA Dictionary of Psychology
Sub·stance a·buse
noun
- overindulgence in, or dependence on an addictive substance, especially alcohol or drugs.
Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.
Drugs most often associated with this term include alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, hallucinogens, methaqualone, and opioids. The exact cause of substance abuse is not clear, but there are two predominant theories: either a genetic predisposition or a habit learned from others, which, if addiction develops, manifests itself as a chronic debilitating disease.
If a person compulsively seeks and uses drugs even though they are experiences negative reactions and consequences, they are most likely addicted. Professionals that screen for drugs and alcohol problems use the CAGE questionnaire to help and detect a problem. We will not be or never should attempt to diagnose an individual’s substance abuse problem but this is provided to review so that you can understand the behaviors and factors around substance abuse.
CAGE Questionnaire
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a
hangover (Eye opener)?
- Scoring:
Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol
problems. A total score of 2 or greater is considered clinically significant. - Developed by Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies,
University of North Carolina at Cahpel Hill, CAGE is an internationally used assessment instrument for identifying alcoholics. It is particularly popular with primary care givers. CAGE has been translated into several languages. - The CAGE questions can be used in the clinical setting using informal phrasing. It has been
demonstrated that they are most effective when used as part of a general health history and should NOT be preceded by questions about how much or how frequently the patient drinks (see “Alcoholism: The Keys to the CAGE” by DL Steinweg and H Worth; American Journal of Medicine 94: 520-523, May 1993.
- Scoring:
Substance Abuse Broken Down
- For 1 in 10 people, abuse leads to addiction
- Primary Phase
- Crucial Phase
- Chronic Phase
Primary Phase

Crucial Phase

Chronic Phase

Effects of Substance Abuse
Here is where we will start to look at indicators that become part of your determination process. Knowing these indicators will help you quickly make decisions and take care of issues in the workplace that involve drugs or alcohol.
Emotional Effects
- Aggression
- Burnout
- Anxiety
- Depression
- Paranoia
- Denial
- Mood Swings
Behavioral Effects
- Slow reaction time
- Impaired coordination
- Slowed or slurred speech
- Irritability
- Excessive Talking
- Inability to sit still
- Limited attention span
- Poor motivation or lack of energy
Physical Effects
- Weight loss/gain
- Insomnia
- Fatigue
- High blood pressure
- Sweating/chills
- Memory loss
- Irregular heart rate
- Susceptible to disease
-
Accident
Accident
For the purposes of post-accident testing, the term “accident” is defined uniquely by each DOT Agency. An “accident” involving an airplane will be different from one in a ship, train, school bus, or pipeline. Links to the DOT Agency regulations are found under the definition of “DOT Agency” in this NDASA University Glossary. Adulterant – A substance added to a specimen for the purpose of interfering with the normal testing process or altering the test results.
Physical Indicators – Eyes
Click on the blue hot spots to learn more!

Involuntary jerking of the eye
Occurs naturally as the eyes gaze to the side when the eyes are rotated at high peripheral angles
When a person is impaired by alcohol, nystagmus is exaggerated and may occur to lesser angles
An alcohol-impaired person will also often have difficult smoothly tracking a moving object
Pupil Dilation – Dilated pupils can signal a range of causes, from natural bodily reactions and emotional states to the influence of certain drugs. Observing pupil dilation is an indicator in your reasonable suspicion process. Stimulants, antidepressants, and hallucinogens like LSD are known to cause this effect.
Why Do Pupils Dilate?
Pupil dilation, also known as mydriasis, occurs through the activation of the iris’s two muscle groups: the iris sphincter and the iris dilator. The parasympathetic nervous system, responsible for managing the body’s rest and digest functions, activates the iris sphincter. Conversely, the sympathetic nervous system, overseeing the fight-or-flight response, engages the iris dilator.
Psychotropic stimulants, among other drugs, significantly influence these systems, leading to pupil dilation. These substances can target either the parasympathetic or sympathetic nervous systems, or both, depending on the drug’s nature. This effect is due to the drug’s components interacting with brain neurotransmitters that partly regulate pupil size, resulting in dilation.
Commonly Abused Drugs and Their Effect on Pupils
Although we are not to diagnose or figure out which drug we think someone may be using, it is good to know and be familiar with what is out there.
Drugs That Dilate Pupils
Mescaline: A natural psychedelic that induces dilation of the pupils.
Amphetamines: These stimulants heighten alertness and energy, causing marked pupil dilation.
Bath Salts: Synthetic compounds that stimulate the central nervous system, leading to pupil enlargement.
Benzodiazepines: Although mainly sedatives, some types can induce pupil dilation.
Cocaine (including crack cocaine): Prevents dopamine reabsorption, resulting in dilated pupils.
Crystal Methamphetamine: A potent stimulant that significantly enlarges pupils.
Ecstasy: Triggers dilation by affecting serotonin levels.
Ketamine: A dissociative substance, also known for causing pupil dilation.
LSD: A hallucinogen that usually leads to significant pupil enlargement.
MDMA: Similar to Ecstasy, influences serotonin levels, causing pupils to dilate.
Pupil constriction – Drugs That Constrict Pupils
Substances frequently misused that result in pupil constriction, a condition medically known as miosis, include a variety of opioids. These powerful drugs not only significantly affect mood and perception of pain but also cause noticeable physical changes, including the narrowing of the pupils.
Among these substances are:
• Oxycodone: A prescription opioid commonly used to treat moderate to severe pain. Despite its legitimate medical uses, oxycodone has a high potential for abuse and addiction.
• Fentanyl: An extremely potent synthetic opioid, fentanyl is used in medical settings to manage severe pain, especially after surgery or for pain associated with cancer. However, due to its potency, even small amounts can be deadly, and it has become a significant contributor to opioid-related overdoses when misused.
• Heroin: An illegal opioid synthesized from morphine, heroin is known for its euphoric effects. Its use not only constricts pupils but also significantly increases the risk of addiction, overdose, and various health complications.
The misuse of these drugs can lead to a myriad of health issues, including but not limited to addiction, respiratory depression, and even fatal overdose. The presence of constricted pupils in someone known to use these substances can be a critical sign of opioid intoxication or overdose, necessitating immediate medical attention.
- Non-responsive (fixed)
- Dilated – sensitivity to light
- Constricted
- Convergence
- Tracking
- Drooping eye-lids
- Bloodshot


- PCP (Phencyclidine)
- THC – (Marijuana or Cannabinoids
- Amphetamines
- Cocaine
- Opioids
- Codeine, Morphine, Heroin, Synthetics are: Hydrocodone, Hydromorphone, Oxycodone, Oxymorphone

Drug Retention Times in the body
Alcohol.………………………………1 hour per drink (assumes the body metabolizes at the rate of 1 drink per hour)
Marijuana.………………………….Infrequent use (monthly) ………………….Stays in system for 2-3 days
Moderate use (weekly)………………………..Stays in system for 3 days to 1 week
Heavy use (3-7 days a week)………………Stays in system 30 days after quitting
Cocaine………………………………..Stays in system 2-3 days
Amphetamines…………………..Stays in system 2-3 days
Opiates (Codeine, Morphine, Heroin, etc.)……………………..Stays in system 2-3 days
Phencyclidine (PCP)…………………………………..Stays in system 1-7 days (Heavy use – up to 30 days)
Prescription Drugs
Barbiturates………………………………………..Short Acting – 2-3 days
Long Acting 1-3 weeks
Benzodiazepines………………………………..1-14 days

Flash Card Practice
Let’s get to know some of acronyms that you will see or hear! If you are already an experienced supervisor or manager this will be a review to test your knowledge.
- Click on the 4 arrows to enlarge the window to full screen after you are in the practice tool.

Flash Cards!
Did you complete all of the interactive clicks in this lesson?
-
Interactive hot spots on eye indicator chart
-
Flash Cards