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use of substances that interfere with functioning and the fulfillment of
responsibilities at home, work, school, etc; (2) use of substances that
impair functioning in dangerous situations such as driving or use of
machines; (3) use of substances that may lead to arrest for unlawful beha-
viors; (4) substance use that seriously interferes with relations, marriage,
child rearing, and other interpersonal responsibilities (p. 182). Substance
abuse may lead to slurred speech, lack of coordination, unsteady gait,
memory loss, fatigue and depression, feelings of euphoria and lack of
social inhibitions (p. 197).
Short Tests
Several tests may be helpful in determining whether substances are used
to an extent that may be causing serious problems functioning on the job.
They are as follows.
Miller (2001) reports that two simple questions asked of substance
abusers have an 80% chance of diagnosing substance abuse: “In the past
year, have you ever drunk or used drugs more than you meant to?” and,
“Have you felt you wanted or needed to cut down on your drinking or
drug abuse in the past year?” Miller reports that this simple approach has
been found to be an effective diagnostic tool in three controlled studies
using random samples and laboratory tests for alcohol and drugs in the
bloodstream following interviews.
Stewart and Richards (2000) suggest that four questions from the
CAGE questionnaire are predictive of alcohol abuse. CAGE is an anach-
ronism for Cut, Annoyed, Guilty, and Eye-opener (see the questions
below). Since many people deny their alcoholism, asking questions in an
open, direct and non-judgmental way may elicit the best results. The four
questions are:
1. Cut: Have you ever felt you should cut down on your drinking?
2. Annoyed: Have people annoyed you by criticizing your drinking?
3. Guilty: Have you ever felt guilty about your drinking?
4. Eye-opener: Have you ever had a drink first thing in the morning
(Eye-opener) to steady your nerves or get rid of a hangover? ( Bisson,
Nadeau, and Demers, 1999, p. 717 )
Stewart and Richards (2000) write, “A patient who answers yes to
two or more of these questions probably abuses alcohol; a patient who
answers yes to one question should be screened further” (p. 56).
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