Signs & Symptoms of Possible Substance Use

In professions such as veterinary medicine, where competent treatment is a necessity, concerns about a colleague’s substance abuse can invoke anxiety, apprehension, and concern. Further, identifying your colleagues’ potential substance use issues may be complicated by your personal feelings, particularly because the personal and professional consequences of confrontation can be severe. However, the ramifications of remaining silent are often just as serious. Knowing the warning signs of potential substance use and intervening with empathy and compassion can alleviate a significant amount of distress.

Colleagues’ substance use can present a myriad of problems, both for the individual and the practice. The legal ramifications can be serious if substance use and wrongdoing, such as poor patient care, are substantiated and can include loss of license for the employee and/or the practice, unwanted and possibly damaging media coverage, and loss of clients.

Watch for subtle signs

Most often, substance use is done in secret, with great care taken to keep it that way, but subtle signs do serve as flags. You may notice changes in a colleague’s personal life, such as fewer conversations about long-term relationships or an influx of new relationships. You may observe increased tension in romantic or close family relationships, or decreased engagement with colleagues, such as fewer lunch invitations or weekend activities, because limiting contact is one way to keep substance abuse secret.

You may also observe signs of increased financial stress, such as showing unusual intensity about income, working longer hours, or over-scheduling patients. You may notice a change in demeanor toward patients, clients, and coworkers. Drugs that can be either used recreationally or sold or traded for another substance may be missing.

Once flags have been raised, the question becomes “What do I do now?” The answer is complex, because thoughtful intervention is required. First, be sure to protect patient safety and professional standards as required by your state’s licensing board, which can usually be found on your state veterinary board’s website. Then, when the legal and ethical requirements are clear, you can focus on intervening with empathy and compassion.

Start a conversation

Initiating a conversation with a colleague about concerns of substance use will be uncomfortable, at best, because of the fine line between professional and personal relationships. This is true for supervisors, subordinates, and peers, and each relationship dynamic has its own complexity. If the person using substances is a subordinate, it may be easier to focus on the technical job performance issues and to follow procedures with clear documentation. The situation involving equal peers adds another layer of complexity, and it may be necessary to include a supervisor. As a peer, you may struggle about going above a colleague’s head with your suspicions because there is the possibility of damage not only to your relationship with the person using, but also between those who support or disagree with your intervention. Finally, addressing concern about a direct supervisor’s substance use may cause fears of job loss and worry about negatively affecting others in the workplace. Revealing a person’s secret likely will make them defensive, fearful, and intensely vulnerable, and they can react with anger, deflection, and avoidance.

Show compassion

Showing compassion can decrease negative reactions. First, approach your colleague as someone who is struggling, perhaps with more than substance use, which often increases due to other stressors. Opening the conversation with an inquiry about the person’s general wellbeing may make him or her less defensive or angry when “the secret” is revealed. For example, instead of, “I’m concerned that you’re using drugs,” say, “I’ve noticed that you’ve not been yourself lately and you seem a bit withdrawn, and I wanted to see if there’s anything I can do to help. You’ve also been short with your patients, which is not like you.” Although this indirect statement does not address the actual concerns, it shows awareness of changes in behavior and their effects on the workplace. The conversation certainly may need to become more direct, but empathetic questions likely will help in the future if specific action becomes necessary.

If the behavior persists or gets worse, a more confrontational, but still compassionate, conversation will be necessary. Then, you should say, “Jamie, there’s something difficult I want to discuss that will be uncomfortable. Please know that I care about you and about our work. I’ve noticed (state the symptom or your concern), and I’m worried that patient care is at risk. I think you might be struggling with substance use. I can’t imagine how difficult that might be, but I have a duty to our patients to act ethically, so…” Insert the steps you need to take (eg, a report to the ethics board, mandating time off, terminating employment).

Substance use is a significant concern in veterinary medicine. It is important to identify the early warning signs and intervene quickly, with empathy and compassion, both to help a struggling colleague and to avoid any severe consequences for your clients and patients.

This article originally appeared in the September 2013 issue of Veterinary Team Brief.