The following indicators or warning 

signs are associated with alcohol and 

drug addiction, and other physical 

and mental disorders. Use this list in 

psychological fi rst aid situations. If 

several symptoms are present, refer 

the person for alcohol and drug 

assessment. This list is not to be 

used as a substitute for a screening or 

qualifi ed clinical assessment.

Physical/Emotional Indicators

 Has smell of alcohol on breath or 

marijuana on clothing

 Has burned fi ngers, burns on lips,

or needle track marks on arms

 Slurs speech or stutters, is incoherent

 Has diffi culty maintaining eye 

contact

 Has dilated (enlarged) or 

constricted (pinpoint) pupils

 Has tremors (shaking or twitching 

of hands and eyelids)

 Is hyperactive and overly energetic

 Appears lethargic or falls asleep 

easily

 Exhibits impaired coordination or 

unsteady gait (e.g., staggering, 

off balance)

 Speaks very rapidly or very slowly

 Experiences wide mood swings 

(highs and lows)

 Appears fearful or anxious; 

experiences panic attacks

 Appears impatient, agitated, 

or irritable

 Is increasingly angry or defi ant

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Personal Attitude/

Behavior Indicators

 Talks about getting high, uses 

vocabulary typical among 

drug users

 Behaves in an impulsive or 

inappropriate manner

 Denies, lies, or covers up

 Takes unnecessary risks or acts in 

a reckless manner

 Breaks or bends rules, cheats

 Misses interviews, appointments,

or meetings or arrives intoxicated

 Fails to comply with program 

requirements without easily 

verifi able reasons (may be verbally

uncooperative to disguise the 

problem or divert attention)

Cognitive/Mental Indicators

 Has diffi culty concentrating, 

focusing, or attending to a task

 Appears distracted or disoriented

Makes inappropriate or 

unreasonable choices

 Has diffi culty making decisions

 Experiences short-term memory loss

Experiences blackout

 Needs directions repeated frequently

 Has diffi culty recalling known 

details

 Needs repeated assistance 

completing ordinary paperwork 

(e.g., application forms)

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Information Clearinghouses

National Mental Health Information Center 

(NMHIC)

P.O. Box 42557, Washington, DC 20015

(800) 789-2647 (English and Español) 

(866) 889-2647 (TDD)

www.mentalhealth.samhsa.gov

National Clearinghouse for Alcohol and Drug 

Information (NCADI)

P.O. Box 2345, Rockville, MD 20847-2345

(800) 729-6686 (English and Español) 

(800) 487-4889 (TDD)

www.ncadi.samhsa.gov

Treatment Locators

Mental Health Services Locator

(800) 789-2647 (English and Español)

(866) 889-2647 (TDD)

www.mentalhealth.samhsa.gov/databases

Substance Abuse Treatment Facility Locator

(800) 662-HELP (4357) (Toll-Free, 

24-Hour English and Español Treatment 

Referral Service)

(800) 487-4889 (TDD)

www.fi ndtreatment.samhsa.gov

Hotlines

National Suicide Prevention Lifeline

(800) 273-TALK (8255)

SAMHSA National Helpline

(800) 662-HELP (4357) (English and Español)

(800) 487-4889 (TDD)

Workplace Helpline

(800) WORKPLACE (967-5752)

www.workplace.samhsa.gov/helpline/

helpline.htm

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Possible Alcohol and 

Substance Abuse Indicators

Tips for First Responders