Physical Exam for Teen Alcohol and Drug Use

A physical exam is not as useful as the medical history in diagnosing teen substance use (alcohol, cigarettes, inhalants, and other drugs). Unless the teen is under the influence of alcohol or drugs at the time, there will likely be no signs of use or abuse.

If your teen is suspected of having a substance use problem, the doctor will look for physical signs of recent or past use. The exam may include:

• Weight and general appearance. The doctor will look for signs of poor nutrition or signs of infections.
• Blood pressure, heart rate, and temperature. If your teen is under the influence of alcohol or other drugs, these values may be increased or decreased.
• Skin. The doctor will look for needle tracks or sores on the neck (jugular area), inside of the elbows, groin area, or penis that may indicate injection of drugs. Pus-filled acne on the teen's skin may indicate use of sedatives, stimulants, or LSD. Burns on the lips or multiple small skin ulcers in various stages of healing may indicate use of a stimulant drug.
• Eyes. If your teen is believed to be under the influence at the time of the exam, the doctor may test for rapid eye movements and pupil size and reaction to light.
• Nose. Evidence of injury to the lining in the nose or to the center partition could indicate that a teen has been inhaling substances.
• Lungs. Coughing and abnormal lung sounds could indicate use of cigarettes or other inhaled or smoked drugs.
• Heart. Heart rhythm irregularities, inflammation of the lining of the heart (endocarditis), or lack of blood supply to an area of the heart (ischemia) may indicate abuse of certain drugs.
• Digestive system. The doctor will ask about problems with vomiting, constipation, diarrhea, or abdominal pain.
• Nervous system. The doctor will check the teen's thinking and problem-solving abilities by asking questions or having him or her solve math problems.

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