Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

344 IV. SPECIAL POPULATIONSStimulants and CocaineDependence or abuse of stimulants and cocaine is difficult to detect in theworkplace; they produce no odor and no hangovers. Users are often workerswho were once industrious but now have difficulty concentrating and stayingalert. Physical signs of cocaine or stimulant abuse do become apparent. Frequentunexplained absences, lateness, inability to sit still, and excessive trips tothe restroom, along with paranoia, irritability, and hypomanic symptoms,should lead the employer to suspect stimulant, especially cocaine, abuse.Crashing, depression, and abuse of sedatives are also signs.MarijuanaThe marijuana-dependent individual who smokes daily will have deficits invocational, social, and psychological functioning. Common findings includeinability to concentrate, difficulty with judgement and fine motor coordination,memory impairment, and social withdrawal. Lethargy, depression, and aloss of goal-directed behavior are common. In the workplace, the results can bedangerous to the individual user, coworkers, and the general public, dependingon the occupation of the user.Opiates and OpioidsBoth legal and illicit opiates and opioids are major problems in the workplace.The heroin addict is frequently absent and late. He or she is prone to accidentsbecause of heroin intoxication (lethargy, somnolence, difficulty concentrating,impaired motor coordination and judgment) or withdrawal. Injuries resulting indisability and theft or embezzlement to support the dependence are common.The abuse of legally prescribed opiates has increasingly been portrayed in thelay press. Regular use of these substances leads to a high level of tolerance andto a withdrawal syndrome identical to that of heroin. Use of “hard drugs,” suchas heroin or opiates, has stigmatized many individuals in the past. For thosewho are motivated to quit, compassion and support in the workplace can makea big difference in successful abstinence from this class of substance, and personsmaintained on methadone or buprenorphine are frequently able to workwell.Sedatives/HypnoticsAs is the case with the prescription opioids, employees become adept at concealingtheir dependence on these medications. Intoxication can be dangerousif the employee is required to drive, operate equipment, or perform complex