Several changes are associated with substance abuse in teenagers.

Behavioral Changes
 Increased irritability, including aggressive or violent outbursts
 Other behaviors: defiance, uncooperativeness, hostility
 Ignoring authority figures, rules, and curfews
 Increased associations with law enforcement
 Increased conflicts at school with students and staff
 Poor academic performance
 Decreased motivation and interest in school and hobbies
 Truancy and/or skipping extracurricular activities
 A change in friends or social circles
 Withdrawing from friends and family
 Acting secretive or increased demand for privacy
 Avoiding eye contact
 Finding drugs or paraphernalia in a teen’s room

Psychological Changes
 Mood swings, emotional instability, other changes in personality
 Uncontrollable laughing for no apparent reason
 Loud, obnoxious behavior
 Slurred or rapid speech
 Extreme fearfulness, paranoia
 Lethargy and decreased motivation
 Drowsiness followed by bursts of energy
 Poor concentration and memory problems
 Family history of substance abuse

Physical Changes
 Bloodshot eyes
 Dilated or pinpoint pupils
 Teeth clenching
 Poor hygiene
 Poor appetite and weight loss
 Weight gain
 Unexplained nosebleeds or runny nose
 Sleep disturbances
 Excessive thirst
 Nausea and vomiting
 Shakiness, tremors, sweating
 Headache, stomachache
 Nausea, vomiting, diarrhea, constipation
 Coordination problems
 Seizures
 Frequent unexplained illness
 Accidents, injuries
 Needle track marks, skin infections (intravenous drug use)
 Wearing long sleeves or turtlenecks year round (to cover needle track marks)
 Constant scratching (opiate use)
 Burns on fingers or lips (from smoking marijuana or crack cocaine)
 Decayed teeth, missing teeth (methamphetamine use)
 Smelling like alcohol or drugs
 Smelling like perfume, incense, breath freshener (to mask the smell of alcohol and drugs)

Other Considerations
 Missing cash or other valuable items from the home (that can be pawned for drugs)
 Hidden stashes of alcohol or drugs
 Missing medications, alcohol, tobacco products from the home
 Drug paraphernalia
 Drug residue or remains (seeds, stems, powders)

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