Individuals who are dependent on drugs or alcohol raise difficult management issues for post-disaster programs. In the impact phase, individuals who are addicted to drugs will manifest physiological signs of withdrawal when the drug is unobtainable. Behavior and speech will identify drug users who understand the reality of not being able to obtain the needed substance. A list of the commonly observed psychophysiological manifestations of drug withdrawal should be available for all disaster personnel.
The degree of effort needed to assist an individual who is showing symptoms of drug withdrawal will depend on the life-threatening potential and the degree of pain and discomfort. The mental health worker needs to work closely with medical personnel to assist in the treatment of these survivors. After the acute phase is controlled, a psychosocial crisis intervention is the recommended method of assistance.
SIGNS OF DRUG ABUSE AND ADDICTION
The following signs of drug withdrawal can be expected from substance-abusing survivors when they have no access to drugs following a disaster:
• Apprehension or vague uneasiness and fear of impending catastrophe;
• Muscle weakness evident even on mildest exertion;
• Tremors that are coarse, rhythmic, nonpatterned, evident during voluntary movement and subsiding at rest.
• Psychoses and/or delirium, usually resembling delirium tremens ("DTs"); acute panic attacks may occur.
SIGNS OF ALCOHOL ABUSE AND ALCOHOLISM
Individuals who are addicted to alcohol will show differing signs of central nervous system irritability and general discomfort, but most will "weather" the acute stage of the post-disaster period. If the behavior and central nervous system signs are dysfunctional, the individual will pose a problem for the personnel in charge of managing the shelter. Generally, these individuals become difficult in a passive-aggressive manner, rather than actively and aggressively disrupting living areas. The following are signs and symptoms of alcohol withdrawal:
• Mild or early symptoms (impending delirium tremens) may appear in the first week after the last drink.
• Gastrointestinal, muscular, central nervous systems are affected.
• Vegetative (sleep) and characteristic psychological and behavior patterns may emerge.
• Advanced or severe manifestations, including the emergence of increased irritability, severe tremulousness, and auditory hallucinations, may be indications of imminent delirium tremens.