Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement

Table 2 Markers of potential concern for substance use/substance use disorder

Life domain	Markers
Physical	Declining physical health including nausea and abdominal pain
	Looks fatigued
	Disheveled
	Unexplained weight loss
	Dilated pupils, redness in eyes
	Muscle in-coordination
	Poor personal hygiene
	Sniffing
	Administration scars (needle entry marks)
Daily functioning	Unaccountable increase in expenditure
	Difficulty managing daily living tasks (including budgeting, staying on top of household tasks)
	Poor punctuality
	Possession of substances, hiding substances
	Accessing of prescription drugs in the home
	Difficulty managing underlying health conditions (e.g., epilepsy, diabetes)
Home life	Absconding from home (adolescents)
	Receiving packages in the post which they are eager to intercept
	Driving offences
	Accidental injuries, including road traffic accidents
	Increased risk of injury and assault (both to self and others)
	Difficulties fulfilling chores and/or parenting responsibilities
	Social services involvement
	Debts
	Gambling
	Housing problems and homelessness
Educationand work	Truancy/absence from school/college or work
	Deterioration in academic/work performance
	School detention, suspension, expulsion
	High turnover of short-term employment
	Official warnings and disciplinary procedures at work
Social	Social withdrawal
	Social exclusion
	Marginalized
	Sudden change in social groupings
	Part of a ‘bad crowd’ (gangs, friends much older than peers)
	Friendship and intimate relationship problems
	Domestic violence
Mental health	Apparent deterioration in mental state and health
	Signs of emotional or physical withdrawal from others
	Paranoia
	‘Unexplained’ onset and/or change of mood swings
	Presenting as exhilarated or with excessive confidence
	Low mood and depression
	Irritability, agitation
	Anxiety
	Paranoia
	Confusion, delusions and/or hallucinations
	Emotional lability
	A&E admissions due to mental health condition
Behaviour	Early use of experimentation with drugs including early onset vaping/smoking (e.g., under 12 yr)
	Excessive use of energy drinks
	‘Unexplained’ onset of behaviour that seems ‘out of character’
	Change in personality/demeanor
	Lack of constructive interests and activities
	Disengagement of ‘healthy’ leisure activities (change in interest)
	Increased energy, restlessness and disinhibition
	Conduct problems and/or oppositional behaviour
	Irritable, agitated, aggressive and/or violent behaviour
	Risk taking behaviour (shoplifting, theft from home and/or others)
	Risky/compulsive sexual behaviour (promiscuity, risk of pregnancy, sexually transmitted infections)
	Solitary drug use
	Missing appointments
	Parenting issues leading to safeguarding concerns
	Self-harming behaviors
Speech and cognition	Changes in cognitive functioning at different times of the day
	Difficulty sustaining concentration
	Increased alertness
	Confusion
	Memory problems and loss
	Change in usual speech presentation (e.g., slurred, rapid or rambling speech)
	Reference to ‘needing’ substances (e.g., to help sleep, improve confidence) rather than use for fun or enjoyment
	Unexplained improvements in functioning