CHAPTER 6

Changes in Personality, Thinking,
Behavior, and Appearance

Personality

Personality Changes

The individual who is abusing substances has a tendency towards unpredictable personality changes. He/she may seem like a totally different person when using than when not using drugs or alcohol. He/she may have frequent mood swings and may appear to be defensive. A person may appear to be very depressed and suicidal. He/she may experience anxiety, fear and paranoia, especially when abusing marijuana, cocaine, crack or hallucinogens. The substance abuser may appear to be irritable most of the time. The individual may become angry very easily and have sudden, violent outbursts. He/she may also become solitary and withdrawn.

Immaturity

Emotional development stops when substance abuse begins. The individual may behave immaturely or have difficulty interacting with others. He/she may blame others for his/her problems and have trouble cooperating in a group setting. Others may feel that they have to be careful of what they say to this individual because of the unpredictability of his/her response.

The person may have "tunnel vision," a narrow attitude in which he/she is unable to see different perspectives on problems. He/she may have difficulty in solving complex problems. The individual may become self-centered, focusing only on himself/herself, and experience difficulty with the give and take of a relationship. The user often focuses on immediate gratification and is concerned only with his/her own immediate enjoyment. He/she may appear selfish and inpatient.

Self Esteem

The user may feel helpless, hopeless, lonely, sad, frightened, or guilty. The individual may no longer have any self-respect. Some individuals may even acknowledge this, openly degrading themselves in front of peers, family, or others by making statements such as, "I'm worthless," or "I don't have it any more." Other users may appear to be have an inflated sense of self-worth. This is generally overcompensation for low self-esteem. The individual may not take care of himself (clothes, personal hygiene, etc.) as well as he/she once did. This person may not participate in activities that he/she previously enjoyed. The person may take the easy road, set few or no goals, and have a pessimistic view of the future.

Suicide

Some users may experience depression and become suicidal. A person may have given up on life, and the drugs have contributed to a negative attitude about himself/herself and the world. This individual believes there is no hope, and therefore does not wish to live; nor does he/she believe he has any purpose left in life. He feels he is only a burden to those he knows and loves. This individual may also attempt suicide in a way that he thinks might not be successful in an effort to get a message to his loved ones that he needs help.

Suicide may be attempted via a drug overdose or in a variety of other ways. Signs that signal suicidal intent include low self-esteem, feelings of loneliness, hopelessness, helplessness or isolation. The individual may talk or write about death, or collect dangerous items such as razor blades, knives, guns or pills. The individual may give away prized personal possessions, talk or write about failure or worthlessness, break up with a boyfriend/girlfriend, quit a job, or dramatically change his/her eating or sleeping habits. Attempted suicide by friends or family may trigger similar attempts in the person at risk.

Changes in Relationships with Others

The individual may change his/her group of friends. He/she may begin to associate with a group that has a reputation for being drug users or troublemakers. With adolescents, the new crowd may be older than the user. They may not introduce new friends to family members. The appearance of the new group of friends may suggest drug use; for example, if they wear clothing with drug emblems, have bumper stickers supporting drug use, or display physical signs of intoxication. The user may admit that the friends use, but deny his/her own use of drugs or alcohol. These individuals often reject non-using friends, even ones they've known for years. They often become rebellious toward authority and rules or laws.

Adolescents may gain sudden popularity. They may receive strange phone calls or calls at odd hours, after which they may leave suddenly. This may be a sign not only of drug use, but also of drug dealing. Sudden sexual activity or promiscuity suggests a change in attitude and relationships, usually an indicator of drug use. Sometimes users will offer sexual favors in exchange for drugs.

Family relationships may change. The user's personality changes may be so dramatic that the family may feel like the user is now a stranger. The user may stop communicating with his/her family. He/she may isolate himself/herself from the family. The user may become defensive and argumentative; there may be increased conflict with family members. He/she may become angry more easily; the family may feel as if they are "walking on eggshells" around the user. He/she may become violent and physically or verbally abusive. Drug and alcohol abuse often contributes to domestic violence, divorce, separation, or sexual, physical or emotional abuse.

Lack of Motivation

"Amotivational syndrome" is the scientific term for this lack of motivation or desire due to drug use. It is most commonly associated with marijuana use, but can be seen with the use of other drugs as well. The user loses the desire to learn or solve problems and has difficulty in retaining knowledge. Goals become almost non-existent, with the exception of the intent to get more drugs. Activities that the individual once found enjoyable may be abandoned. Often, drugs place the user in a state of "anhedonia"--that is, a lack of pleasure in anything except using drugs. Everything is described as boring or stupid, except for drug use, hanging out with using friends and "partying."

One 17-year-old adolescent in treatment had been a straight A student. He had been captain of the football team and the wrestling team, worked part-time, helped out with household chores, and was described as pleasant by his parents. Within a few months of beginning marijuana and alcohol use, he was failing classes, had dropped out of football and wrestling, was fired from his job, refused to take part in any family activity, and was in frequent arguments with his parents. He didn't feel that he had time for any of that "boring stuff" anymore. Obviously, this is an extreme case of a "good" child affected by drug use, but it illustrates the strong influence drugs can have on an individual.

Thinking

Concentration and Memory

Drugs and alcohol interfere with mental alertness and memory. Concentration becomes almost impossible for the individual using drugs or alcohol. Drugs disturb the thinking process; the user's problem solving and decision making skills are impaired and the senses are affected. Alcohol and depressants impair and slow down thought, stimulants distort thinking, and hallucinogens may make the user experience delusional thinking. Hallucinogens may produce unpredictable "flashbacks"--hallucinations that occur days, months, or years after the drug has been taken.

The person's short- and long-term memory also becomes impaired. A person may break his/her train of thought in the middle of a sentence and be unable to resume. He/she may fumble for words and have difficulty forming thoughts into speech. Users often have difficulty in learning and retaining information. They may experience blackouts--periods of time where they were conscious but do not remember anything.

Values and Beliefs

The substance abuser usually violates his/her value system by, for instance, engaging in illegal activity, or simply by using drugs. The individual may change his/her beliefs in order to accommodate the use and behavior. For example, a person may have the value that stealing is wrong. When he/she begins stealing from family to support his/her drug use, that belief may change. The user may rationalize that this isn't stealing, it's just borrowing from family. This violation of values often leads to guilt. Some users may reject God or religion and some users even become involved with devil worship or the occult.

Denial and Lying

As discussed in a previous chapter, the substance user may be in denial of the problems that drugs or alcohol are causing. Also, they will often lie to cover up their drug use. While in denial, a user may dispute that use of drugs or alcohol is harmful, blame others for his/her problems, and often states, "I can stop using anytime I wish." He/she may state that everyone does it, and then minimize his/her own use. Even though a user is in denial, he/she will lie to protect his/her use of drugs and alcohol. Users often live in fear of their drug use being discovered. They are often paranoid that they will get caught using or doing something wrong. They are often good manipulators or con artists. The user may have an excuse for any problem and may give only vague, evasive answers to questions about use or behavior. Users often lie about their use, where they have been, and their behavior.

Behavior

Sleeping Pattern Change

The individual may sleep for long periods of time on a regular basis, and then may go through a period where he/she will sleep only for short increments of time. The individual also might wake up early in the morning and be unable to go back to sleep, have difficulty in going to sleep, have a need for increased sleep, or have insomnia. He/she may sleep most of the day and stay up all night. Stimulants may cause sleeplessness, while depressants and narcotics may produce sedation and excessive sleep. The sleeping may interfere with daily activities.

Eating Habits

When doing certain drugs, food may no longer be greatly desired or appetizing to the user. This may lead to a sudden loss of weight. Stimulants, especially amphetamines, are widely used as diet pills because they suppress the appetite. Heavy users of cocaine and alcohol usually find that they don't desire food. Conversely, other drugs can cause tremendous hunger, in which case unusual weight gain may result. A common example of this is when the user has "the munchies" after smoking marijuana and goes on a eating binge, usually eating foods with a high fat or sugar content.

Lack of Everyday Energy

With most drug use, the individual may frequently complain of being tired. Speech, actions and reactions may become slower. Projects, job responsibilities, homework or household chores may be left incomplete. Many of these individuals don't feel any better with sleep, and have an especially hard time with the morning hours. With cocaine, crack, or amphetamine use, the user may appear to have sudden bursts of energy. He/she may be quite irritable and appear "wired." Work performance may actually increase at first, but eventually the individual will "crash" and have a lack of energy without the drug.

Irresponsible Behavior

The individual often becomes irresponsible as his/her priorities change. Irresponsible behavior may include being late for scheduled appointments, work, or school; unexplained absences; oversleeping; or coming home late. The individual may stay out overnight without telling the spouse or parents. Users often disappear for short periods of time and may spend time sitting in the car alone. They may slack off on completing household chores and other responsibilities. This may include missing deadlines on projects at work, not completing homework assignments, avoiding family events, or "forgetting" to do something for a spouse or friend. This irresponsible behavior leads to further lying and feeling of guilt and worthlessness.

Reckless/Impulsive Behavior

The individual may become involved in dangerous activities or act without thinking. The individual often feels invulnerable; the continued use and reckless behavior without consequences increases this false feeling of confidence. The user often becomes a thrill seeker, enjoying life "on the edge." The user's behavior usually becomes more impulsive over time. He/she begins to take more dangerous risks. Common examples of reckless behavior include driving under the influence, gambling, stealing, vandalism, and fighting. The structure in the individual's life disappears, replaced by chaos and a need for immediate gratification. Often, the substance abuser finds himself/herself involved with the law. He/she may have legal consequences for reckless or impulsive behavior that was an illegal act.

The user may sell his/her possessions for money to buy drugs. He/she may claim that these possessions are borrowed or stolen. Users may steal things from home to sell. They may also steal thing like alcohol from the liquor cabinet; pills from the medicine cabinet; or household products, such as glue or paint, to inhale to get high.

The individual may be having many problems at work or school. Work problems (discussed in an upcoming chapter) may include missing work, being late for work, disrespect for supervisors, more accidents, problems with co-worker, leaving the work area frequently, and receiving secretive phone calls. Adolescents may have problems in school such as a drop in grades, failing classes, tardiness, skipping classes, discipline problems, suspension, dropping out of activities, falling asleep in class, lack of motivation, neglecting schoolwork, disrespect for teachers and rules, dropping out or getting expelled from school.

Appearance

Physical Health

A drug or alcohol user generally has more health problems due to a weakened immune system. These problems include chronic cough, frequent colds, flu, fatigue, or stomach aches, chest pains, hangovers, headaches, nosebleeds, sinus problems, and/or other frequent illness. They may have injuries or bruises from falling or fighting while under the influence.

The individual's physical appearance may change. This includes the eyes, nose, mouth, skin and overall hygiene. The eyes may be bloodshot, puffy, or glassy and the pupils may be dilated or constricted. The person may have droopy eyelids, a sleepy appearance or a fixed stare. He/she may have difficulty controlling eye movements. The user may have a runny nose, or sores in the nose. There may be sneezing or nosebleeds. The mouth may be dry and the user may frequently lick his lips. The user may have chronic bad breath or smell of alcohol, marijuana, or tobacco. The skin may be cold and clammy, itching and burning, tight, swollen or puffy. The user may have sudden acne or purple or red spots on the body. Jaundice, a condition characterized by yellowing of the skin and the white of the eyes, may occur. The person may perspire excessively or have a high body temperature. The user may have discolored fingers or injection marks along the veins. The individual may wear long sleeves or high collared shirts, even on warm days, to cover the injection marks. They may have tattoos or burn marks, possible done while under the influence or used to disguise injection marks. They may show changes in personal hygiene and develop an unkempt appearance.

Overall Appearance

The individual's appearance may change. He/she may begin to wear clothing that displays drug-oriented graffiti or decals-particularly T-shirts and hats. The user may change his/her hairstyle or makeup to fit in with the drug culture. One adolescent in treatment had dyed her hair black, wore heavy black eye makeup, lots of silver and black costume jewelry, baggy men's clothes and concert T-shirts. This was typical for the drug-using group at her school. The individual may wear drug-oriented jewelry such as medallions with marijuana leaves, spoons, marijuana leaf rings, small pipes or other objects that symbolize drugs.

Additionally, users may wear certain name brand or designer clothing that is popular among the drug-using crowd or among gang members. As his/her self-esteem plummets, the user may no longer care about appearance or even cleanliness and basic hygiene. The user may become sloppy or stop washing his/her clothes, hair or body. The individual's language may begin to include words or slang terms associated with drug use; he/she may also become more belligerent and use more vulgar language.

The conditions of the individual's home or personal property may signal drug use. His/her house, room, or car may be dirty and messy due to a lack of motivation to do anything but use drugs or alcohol. The individual's bedroom may display drug posters or paraphernalia; the room may also have a fan in the window even in winter, to air out the smell of smoke. He/she may begin listening to music that supports drug use. The car may show signs of drug use, such as bumper stickers that support drug use, empty beer cans or liquor bottles, or unexplained dents or scratches from drinking and driving.