Behaviors Suggesting Substance Abuse

October 6, 2011

HealthcareWhy attorneys need to know this.

Witnesses and parties who abuse substances usually have classic behavior patterns that can alert a vigilant attorney. This enhances litigation planning, client control, and handling expert witness testimony about pain or other symptoms based on medication response.

Experienced drug abusers can usually fool brief screening questionnaires for substance abuse like DIRE, ORT, SOAPP, and SISAP (see Attorneys Medical Deskbook, 4th, § 33: 10).

Abused substances include: prescription and non-prescription drugs, street drugs, and alcohol. The number of the following behavior patterns that are present in an individual correlates with the likelihood of having a substance abuse problem.

Substance abuse history.

1. History of prior abuse of cocaine, amphetamine, opiates, or alcohol.

2. Used alcohol, tobacco or abuse drugs from adolescence.

3. Is an active cigarette smoker.

4. History of repeated treatment for substance abuse followed by relapses.

History of legal trouble.

1. History of a drug-related or DUI conviction(s).

2. Repeated criminal prosecutions such as for theft, violent acts, possession or sale of drugs, etc.

Problem behaviors in general.

1. “Addictive life style” including marital dysfunction, divorce, chaotic family life, neglected or abused children, etc.

2. Poor impulse control.

3. History of one or more psychiatric diagnoses.

4. Poor work history including lateness, poor performance, excessive sick leave, frequent requests for pay advances, and no friends among co-workers.

5. Large debts and frequent attempts to borrow money from friends.

6. Few social and recreational activities.

7. Deteriorating relationships with family members and friends.

8. Has friends who also abuse substances.

9. Strong history of untruthfulness or fabrication.

10. Does not keep promises.

Problem behaviors with drugs.

1. History of selling prescription drugs, forging prescriptions, stealing drugs, or borrowing drugs from friends.

2. Warned of substance abuse problem by family or friends.

3. Spends excessive time trying to obtain abuse substances or trying to recover from their effects.

4. Drinks excessive coffee (caffeine is a drug).

5. Has a chronic pain disorder being treated with opiates.

6. Uses several different drugs at once, including alcohol; tobacco; and prescription, non-prescription, and street drugs.

7. Tends to use progressively larger doses of a drug, often without asking the prescriber.

8. Regularly visits many different physicians, clinics, and emergency departments seeking drugs. Claims to have disorders customarily treated with narcotics (e.g., chest pain, migraine, kidney stone). Leaves before diagnostic tests can be done.

9. Obtains prescription drugs from non-medical sources such as the Internet.

10. Often claims to have not responded as expected to drug treatment.

11. History of overdoses with multiple substances.

12. Medical records state that the patient was, or was suspected of, abusing drugs.

For a discussion of behaviors suggesting substance abuse, see Attorneys Medical Deskbook, 4th, §§ 33: 10, 10.10, 10.20, and 10.80.  For detailed questionnaires to detect substance abuse in a client or witness, or to prepare for deposition, see the companion volume Medical Questionnaires for Clients or Witnesses §§ 26–29.