Addicts: Common Signs Of Deception

Addicts are adept at hiding evidence of their addiction. Deception is the rule, not the exception. Physicians are trained to identify addiction, but without training common signs of addiction can easily be overlooked.
For example, it is a misconception that addicts are easily identified by looking for needle or track marks on their arms (http://bit.ly/1DTAgwB). Addicts also inject into veins hidden from view, such as the legs, feet, and groin. If a vein is not accessible, addicts can inject into a muscle (“muscle popping”) or just beneath the skin’s surface (“skin-popping”).
Moreover, injection is the least frequent way addicts abuse opioids.
Most addicts chew and then swallow a handful of painkillers, snort crushed painkillers, or snort powdered
heroin (http://bit.ly/1RzioYD). Also, heroin can be smoked in a glass pipe or the vapors inhaled after heating. Heroin can be swallowed orally or placed in the rectum (http://1.usa.gov/1sXjhEO). Lacing (combining) a marijuana joint with heroin (“dusting”) is common. Other ways to avoid detection are only limited by the ingenuity of the addict.
Some addicts “graduate” to injecting opioids to increase the intensity of the “high.” Most IV abusers say they could never have imagined they would eventually inject drugs. It’s the power of addiction in full force, like a rainstorm turning into a devastating tornado.
Injecting opioids is a sign of an extreme problem with addiction.
When confronted, the addict may well look you straight in the eye, immediately extend both arms to show you that they are free of needle or track marks, and lie to you.
Addicts are notorious at lying because lying goes hand in hand with addiction.
So discovering the truth becomes somewhat of a cat-and-mouse game. However, you can usually discover the truth if you look for some of the many signs of addiction. Some are subtle, while others leave little room for doubt.
Signs Suggestive of Opioid Addiction
Addiction changes most areas of life. Because the changes develop gradually as the addiction takes hold, they may not raise suspicion unless you pay close attention. The following signs are suggestive but not proof of addiction. Assessment by a licensed healthcare provider is necessary for confirmation.
Changes Nearly Always Present
• Poor insight. Examples are not anticipating the negative social, legal or medical consequences of the addict’s actions or the addict appreciating the emotional pain addiction is causing family and friends.
The ultimate example of poor insight is denial of addiction.
• Poor judgment and decision-making. Examples are continuing to commit crimes to support the addiction despite repeatedly being apprehended or continuing to associate with active drug
abusers.
The ultimate example of poor judgment and decision-making is to inject opioids with a needle and syringe first used by someone else.
Lifestyle Changes
• Neglecting responsibilities. Example are not paying bills and not keeping appointments.
• Declining work performance or refusal to work. Examples include frequent absenteeism or coming late to work (especially on Mondays), declining job performance, frequent accidents at work, sleeping on the job, and frequent firings from jobs because of lackluster performance.
• Declining school performance or dropping out of school. Examples include frequent absenteeism, behavioral problems at school, taking drugs or weapons to school, and falling or failing grades.
• Frequently “borrowing” $20 or $30 (or more) with nothing tangible to show for it.
• Developing new friendships and abandoning healthier ones. Often, there is secrecy about who the new friends are and how the friendships began.
• Isolating from family.
• Working in industries where there is a greater likelihood of coming into contact with substance abusers. Jobs with high rates of drug abuse among employees are 1) accommodations and food service; 2) construction; 3) arts, entertainment, and recreation (http://1.usa.gov/1rpXmxJ). Non-drug users may be invited to experiment with drugs as a “rite of passage.”
• Wearing long-sleeve shirts and pants in warm weather to hide needle or track marks.
• Leaving home at all hours to find drugs. Addicts may be gone for days at a time without contacting family or friends or care about the worry this may cause.
• Decline in personal hygiene.
• Change in attitude that drugs aren’t bad and that non-drug users have it wrong.
Behavioral Changes
• Selfishness, such as not caring about the welfare of others. Sadly, this may (and often does) include the addict’s children.
• Frequent mood shifts, such as happy when “high” and irritable or depressed when coming down from the “high.” Addiction can perfectly mimic symptoms of manic-depressive illness (bipolar disorder) or other serious mental health disorders.
• Frequent conflicts with family, friends, teachers, or coworkers.
• Denial or anger when confronted about using.
• Going from a functional (working, school) to a non-functional person.
• Lying, even when it serves no useful purpose. Addicts may even come to believe their own lies.
• Not having sufficient funds to pay bills despite earning a good income.
• Manipulating family and friends to support the addiction. For example, an addict may befriend an enabler for the sole purpose of perpetuating the addiction.
• Refusing to allow an intimate relationship to end when the partner of the addict burned out by the person’s addiction wants out. The addict’s behavior can escalate to threats of violence or to violence.
General Medical Changes
• Not taking care of physical, mental, or dental health problems as they arise.
• Poor eating habits with weight changes (usually weight loss).
• Impairment of ordinary motor skills. Examples are difficulties driving a vehicle or operating machinery.
• Frequently switching physicians.
• Seeing more than one physician at a time (doctor shopping).
• Traveling long distances to find physicians who will prescribe painkillers.
• Shopping at different pharmacies to avoid being caught at doctor shopping.
• Using painkillers when the pain is lessening or has resolved.
• Developing new addictions, such as with nicotine (cigarettes) , alcohol, cocaine, methamphetamine, or marijuana.
• Unusual and possibly devastating infections from injecting drugs (http://bit.ly/1sLSJGU). Examples include infections of the skin (cellulitis), blood (sepsis), bone (osteomyelitis), heart valves (endocarditis), brain (abscess, meningitis), liver (hepatitis C), and immune system (HIV/AIDS).
• Pulmonary embolism or fibrotic lungs from injecting drugs (http://bit.ly/1sLSJGU).
• Feeling tired most of the time.
• Dizziness, most often on arising from a sitting or lying position.
• Nasal bleeding from snorting opioids (as is also true from snorting cocaine). Nasal septum perforations or nasal abscesses can develop.
• Impotence in men, irregular menstrual cycles in women, and decreased sex drive in both sexes.
• Frequent visits to emergency rooms or urgent care centers with non-specific complaints of pain to “score” opioids.
• Self-inflicted injuries to obtain opioids from emergency rooms.
• Accepting a painful medical procedure to obtain a prescription for opioids when a less intensive treatment would suffice. For example, having a tooth pulled rather than the cavity filled.
• Personality changes, such as rudeness, irritability, and problems with anger management.
• New or worsening mental health problems. Common examples are anxiety, panic attacks, hallucinations, paranoia, manic-like symptoms, and depression.
• Failing a professional or home drug test.
• Passing a drug test that does not screen for the opioid the person is abusing. Oxycodone, hydrocodone, and methadone, as examples, require special testing and may not record as positive for “opiates” on a home drug test.
• Using someone else’s urine to falsify a drug test.
• Refusing to take a drug test.
Medical Changes When Getting “High”
• Breathing is slow, shallow or stops due to respiratory depression or failure. The principal cause of death from an opioid overdose is respiratory failure.
• Sedation to where it may be hard to wake the person despite verbal or physical prodding. Sedation increases the risk of an overdose
death.
• Rapid response to an injection of naloxone (Chapter 10).
• Changes in blood pressure, heart rate (pulse) and body temperature as the body loses its ability to remain medically stable.
• Confusion, such as not knowing the time of day or where the person is.
• Falling asleep (“nodding off”) in the middle of an activity.
• Dizziness, often on arising from a sitting or lying position.
• Nausea and vomiting.
• Small (“pinpoint”) pupils, which may prompt the addict to wear sunglasses to hide the smaller pupils.
• A spaced-out, glassy-eyed look.
• “Dry” most everywhere. Examples include constipation, dry mouth, dry eyes, dry nose, dry skin with itching, and difficulty starting the urine stream (urinary retention).
Medical Changes When Withdrawing from Opioids
• Joint, muscle and back pain similar to the flu, but much worse. Symptoms can be intolerable.
• Dilated pupils, which may prompt the person to wear sunglasses because of increased sensitivity to light or to avoid detection.
• Uncontrollable yawning.
• Goose bumps.
• Insomnia.
• Chills and shivering even in warm weather or when covered with a blanket.
• Dizziness.