a medication for pain creates a sense of distance from the real world. Trying to
add a column of numbers or serve food to customers will become confusing and
an individual may be unable to decide what to do first.FREQUENT ABSENCES
Some drugs can create periods of wakefulness that lead to a “crash.” The indi-
vidual may sleep because of fatigue or to sleep off the effects of a pain- or
anxiety-relieving drug that causes drowsiness. Individuals simply don’t wake up
to go to work or experience periods of withdrawal from reality that result in an
inability to remember to go to work or school.INABILITY TO GET ALONG WITH COLLEAGUES
As the addiction worsens, individuals have difficulty with interpersonal rela-
tionships for several reasons. One reason is the simple fact that nothing really
matters anymore except getting more of the drug. In addition, the disorgani-
zation and frequent absences make a drug abuser an unpopular colleague. Co-
workers begin to suspect there is a problem and put pressure on the individual
to “clean up their act.” This can deteriorate into very unpleasant episodes at
work and at home.CHANGES IN APPEARANCE AND PERSONAL HYGIENE
The altered mental state experienced by drug abusers also changes their percep-
tion of themselves. The addicted individual may be unaware of how they look or
even forget to take a shower and change clothing regularly. The need to find
more of the drug can also be time consuming and interfere with regular activi-
ties that include personal hygiene.SLURRED SPEECH OFF HOURS
A side effect of the most abused drugs is slurred speech and staggering gait. Re-
sponses are slowed and the individual may appear to be intoxicated. Frequently a
drug abuser will make a great effort to appear normal during working or school
hours. However, after hours may become the time to take more of the drug and
the side effects are more pronounced or obvious.(^66) CHAPTER 4 Substance Abuse