The Department of Transportation mandates that all employees be provided with training material discussing the effects of alcohol and controlled substance use on an individual’s health, work and personal life.

This document is intended to help individuals understand the personal consequences of substance abuse.  It will further help supervisors in a DOT environment with the identification of common signs and symptoms and paraphernalia, to establish a basis for reasonable suspicion testing.

Definitions of Common Signs/Symptoms of Drug and/or Alcohol Use

  • Lack of Coordination: Inability to perform acts or arrange items in the proper relative order.
  • Constricted Pupils: Narrowing or compressing of the pupil of the eye.
  • Blackout: Temporary, but not necessarily total loss of consciousness. Forgetfulness of events occurring over periods of time also constitutes a blackout.
  • Bloodshot or watery eyes: Extreme reddening of, or water-filled eyes. May also have a glassy-like film over eyes.
  • Sleepy or stuporous condition: Dazed or confused look or reaction to an otherwise normal situation (e.g. not recognizing a familiar object or individual).  Lethargic, Metal or physical inactivity. Lack of emotion, feeling, or enthusiasm to things generally found exciting or interesting.
  • Aggressive or antagonistic behavior: Hostile behavior (e.g. physical fights, loud, verbal, abusive conversations.)
  • Slurred speech: Indistinct, incoherent word pronunciation (e.g. nonsense-sounding syllables and/or sentences during a conversation.)  Also may have long pauses between words.
  • Slowed reaction rate: Delayed stimulus response to circumstances or events (e.g. non- instantaneous, startled reaction to loud, unexpected, frightening noise.)
  • Dulled mental processes: Not very alert or responsive. Lacking mental agility.
  • Avoidance:  A person who has done something they know they should not be doing (such as drugs or alcohol) will go to great efforts to avoid a person of authority.

It is important for supervisors to have face time with their employees, at punch in and throughout shifts, to be observant for any signs or symptoms of drug and/or alcohol use. Regular face time with employees also enables a supervisor to determine when behavior and appearance is out of the normal for an employee.


Alcoholic beverages are the most widely used psychoactive drugs known to man.  Alcoholism ranks as one of the major health threats in the nation along with cancer and heart disease.  Although used routinely as a social legal drug, alcohol can also have negative physical and mood-altering effects.  These physical or mental alterations in a driver may have serious personal and public safety risks.

Health Effects of Alcohol Use

Ninety-five percent of all alcohol consumed is absorbed into the body through the stomach, small intestine and colon.  Complete absorption into the blood requires 2-6 hours or more.  The rate of absorption into the blood stream is influenced by the presence of food in the system, the time period of consumption, the driver’s body weight and metabolism.   Once alcohol is in the bloodstream, alcohol quickly goes to every cell and tissue in the body.  Alcohol causes red blood cells to coagulate together in sticky wads, slowing circulation and depriving tissues of oxygen.  Alcohol in the blood can cause anemia by reducing the production of red blood cells.  Alcohol decreases the ability of white blood cells to destroy bacteria and de-generates the clotting ability of blood platelets.   Alcohol kills brain cells, which is permanent damage.  Long-term alcohol use causes loss of memory, impaired judgment, and learning ability due to the damage done to the brain cells.

Alcohol affects the central nervous system of the body more than any other bodily function.  Because alcohol is a depressant, it inhibits the control mechanisms of the brain which results in unrestrained activities in various parts of the brain.  An extremely high dose of alcohol can depress the central nervous system to a point where breathing may stop completely, resulting in death.

Besides the effects alcohol has on the central nervous system, it causes damage and destruction to the tissue cells in the body including brain cells.  Excess alcohol use can depress the appetite and prevent the absorption of amino acids, vitamins and other nutrients, which contribute to malnourishment of the body.  Alcohol hampers the liver’s ability to metabolize fat which leads to fatty liver disease and cirrhosis of the liver.  Alcohol increases the blood pressure in people with hypertension, which can lead to life threatening heart problems. 

A Large Does of Alcohol Can Cause:

  • blurred vision
  • impairment in perception
  • decreased mental alertness
  • decreased physical coordination

An average of three or more servings per day of beer (12 oz.), whiskey (1 oz.), or wine (6 oz.) over time, may result in the following health hazards:

  • Dependency
  • Fatal liver disease
  • Kidney disease
  • Pancreatitis
  • Ulcers
  • Decreased sexual functions
  • Increased cancers of the mouth, tongue, pharynx, esophagus, rectum, breast, and malignant melanoma
  • Spontaneous abortion and neonatal mortality
  • Birth defects

Withdrawal from heavy alcohol use can lead to:

  • Severe tremors
  • Convulsions
  • Death

Anyone wishing help should seek medical attention.

Social Issues Related to Alcohol Use

  • Alcohol is implicated in 200,000 deaths each year
  • 50% of deaths by motor vehicles and fires are alcohol related
  • 67% of murders are alcohol related
  • 33% of suicides are alcohol related
  • 67% of all incidents of domestic violence are alcohol related
  • 33% of all cases of child abuse are alcohol related
  • 24% of our national expenditure for hospital care is alcohol related
  • 7% increase in the chances of divorce or separation when alcohol is abused in a family
  • 30,000 people will die each year from alcohol caused liver disease, cirrhosis, or pancreatitis
  • 10,000 people will die each year due to alcohol-related brain disease or suicide

Workplace Issues Associated with Alcohol Use

  • Increased absenteeism
  • Unexplained leaving of the workplace
  • Increased mistakes and errors in work performance
  • Needless risk-taking
  • Deterioration in personal appearance
  • Poor concentration
  • Inconsistent work quality
  • Increased Workers’ Compensation claims
  • Increased accidents in the workplace

Typical Presentation for Breath Alcohol Contents (BrAC)

  • BrAC 0.02-0.04%
    Buzzed, decreased concentration, decreased reaction time, impaired judgment
  • BrAC of 0.08%
    Diminished vision, further decreased reaction time, loss of judgment and mental impairment
  • BrAC of 0.12%
    Confused, unsteady movements, difficult balance and slurred speech
  • BrAC of 0.25% or higher
    Nearing impaired consciousness, may not respond
  • BrAC of 0.40% or higher
    Death may occur

Keep in mind that a person who consumes a lot of alcohol on a regular basis will develop a tolerance and may not appear to be as impaired as what they really are.

Signs of Alcohol Use

  • Physical: eyes glazed or bloodshot; flushed skin; slowed reaction time; impaired motor skills; stumbling/swaying/loss of balance; displays additional effort and carefulness trying to walk.
  • Behavioral: moody, irritable; some people will laugh; non-sensical responses to basic questions.
  • Speech: slurred speech; thick and/or loud speech pattern; pauses while trying to talk.
  • Odor: distinctive smell on breath.

Sobering Issues

Time is the only sobering agent that works!  Contrary to public opinion, steam baths, black coffee, and exercise have no effect on the rate at which alcohol is metabolized.  A person will feel more alert. However, they will still be intoxicated!  

Aspirin taken while under the influence of alcohol increases the blood alcohol level by 34%.  Aspirin blocks the action of the enzyme that breaks down alcohol before it reaches the bloodstream.  The use of any medication while alcohol is in the body requires extreme caution and consultation with a physician.  

It takes at least 8 hours for the average person to expel all alcohol from their system once they have stopped consumption.


  1. Marijuana
  2. Cocaine
  3. Opiates
  4. Amphetamines
  5. PCP

These substances relate to the second column of the table below.

Paraphernalia  Subtance
Creamy, white, granular powder 2,4,5
Single-edged razor blade 2
Cigarette papers 1
Angel Dust, Hog 5
Pipes (made from bone, brass or glass) 1,2,3
Injection needles 2,3,4
Small mirror, crushed aluminum can with pin holes 2
Crank, Crystal, Speed 4
Sealable plastic bags, aluminum foil or folded paper jackets 1,2,3,4,5
Piece of smooth metal 2
Roach clip, hollowed-out cigar 1
Rolled dollar bill, half straw or metal tube 2
Lighter, alcohol lamp or small butane torch 2
Screw cap vial 2,5
Smack, Dollies, China, White 3
Clear liquid 5


Health Effects of Marijuana Use

The most prominent effects of marijuana use are on the central nervous system and the cardiovascular system resulting in deterioration of motor coordination, memory and thinking ability, increased heart rate and blood pressure, and bloodshot eyes. 

There are more than 520 chemicals found in marijuana.  Out of those chemicals, THC is the primary mind-altering ingredient.  In the past 10 years, the strength of marijuana has increased from .05 to 4% THC content to as high as 11% THC content.  3 to 5 joints a week today equivalent to 15 – 40 joints a week 10 to 15 years ago, more than 100 week in 1960s.  

THC concentrates in fatty areas of the body, the brain, and sexual glands.  It takes 30 days for the THC from one marijuana joint to be eliminated from the body.  Elimination from the body will be longer for people with chronic use and/or with more than average fat stores. The 3 or more joints a week marijuana smoker is never free from the effects of marijuana acting on the brain. Delayed decision making and distortions of time estimates is very common in marijuana users.

Marijuana Use Causes:

  • Deterioration of motor coordination
  • Deterioration of memory and thinking ability
  • Increased heart rate and blood pressure
  • Emphysema-like condition
  • Respiratory tract and sinus infections
  • Depression of the body’s immune system response, making users more susceptible to infection
  • Chronic smoking causes changes in brain cells; long-term brain damage may occur
  • Chronic smoking of marijuana in males causes a decrease in testosterone and reduced sperm count including temporary sterility
  • Smoking of marijuana in females can cause a decrease in fertility
  • Marijuana contains cancer-causing substances
  • The health effects of smoking (1) marijuana cigarette is equal to smoking (25) commercial tobacco cigarettes

Workplace Issues Related to Marijuana Use

  • Delayed decision making
  • Diminished concentration
  • Impaired short-term memory
  • Impaired signal detection (a risk for users who are operating machinery)
  • Impaired tracking and visual distance measurements
  • Erratic cognitive function
  • Distortion of time estimation
  • Erratic sleep patterns

Signs of Marijuana Use

  • Physical: reddened, bloodshot eyes; chronic fatigue; emphysema like condition; impaired vision; irritating cough and chronic sore throat.
  • Behavioral: euphoric feeling, lowered inhibition, increased & false sense of well-being; lack of motivation; lackadaisical “I don’t care” type attitude.
  • Speech: slowed speech, talkativeness.
  • Odor: pungent aroma; distinctive smell on clothing.

Acute effects can last 3-4 hours.


Cocaine has immediate effects on the central nervous system. Cocaine is a powerful physical and mental stimulant which produces a condition of hyperstimulation lasting about 30 minutes, and characterized by over-alertness, euphoria and a feeling of great power.  The drug produces a constriction of peripheral blood vessels, a rise in body temperature and metabolic rate, dilated pupils, and an increase in heart rate and blood pressures.  Over­-dosage may lead to extreme anxiety, fever, convulsions, cerebral infarction, heart problems and ensuing death.

Health Effects of Cocaine Use

  • The most psychologically addictive drug affecting a neurotransmitter in the brain is known as dopamine.  Cocaine depletes dopamine, which causes the survival-oriented normal drives in the body (hunger, thirst, sleep) to change to the drive to obtain cocaine.
  • Regular use may upset the chemical balance of the brain.  As a result, it may speed up the aging process by causing damage to critical nerve cells.  Parkinson’s Disease could also occur.
  • Cocaine causes the heart to beat faster, harder and rapidly increases blood pressure.  It also causes spasms of blood vessels causing strokes and heart attacks.
  • Strong dependency can occur with one “hit” of cocaine.  Usually mental dependency occurs within days for “crack” or within several months for snorting coke.  Cocaine causes the strongest mental dependency of all the drugs.
  • Treatment success rates are lower than with other chemical dependencies.
  • Cocaine is extremely dangerous when taken with other depressant drugs.  Death due to overdose is rapid.  Fatal effects are usually not reversible by medical intervention.

Workplace Issues Related to Cocaine Use

  • Extreme mood and energy swings create instability.  Sudden noise causes a violent reaction.
  • Lapses in attention and ignoring warning signals increase probability of accidents.
  • High cost frequently leads to theft and/or dealing.
  • Paranoia and withdrawal may create unpredictable or violent behavior.
  • Performance is characterized by forgetfulness, absenteeism, tardiness, and missing assignments.

Signs of Cocaine Use

  • Physical: increased physical activity and fatigue; insomnia; runny or irritated nose; profuse sweating; dry mouth; dilated pupils/visual impairment; formication (sensation of bugs crawling on skin); high blood pressure; heart palpitations.
  • Behavioral: isolation and withdrawal from friends/normal activity; paranoia; wide mood swings; restlessness.
  • Speech: talkativeness.
  • Odor: N/A

Acute effects can last 5-20 minutes  Chronic users have tolerance and effects are longer.


Narcotic drugs alleviate pain and depress body functions and reactions.  Often used as painkillers for surgery and other medical treatments. 

Health Effects of Opiate Use

  • IV needle users have a high risk of contracting hepatitis or AIDS when sharing needles.
  • Increased pain tolerance as a result, a person using opiates may severely injure themself and fail to seek medical attention as needed.
  • Narcotic effects are multiplied when combined with other depressant drugs causing an increased risk for an overdose.
  • Because of tolerance and dependency combined, there is a serious financial burden for the users.  They need more and more of the drug to get high and they have severe withdrawal symptoms if they are not getting a fix.

Workplace Issues Related to Opiate Use

  • Side effects such as nausea, vomiting, dizziness, mental clouding and drowsiness place the user at high risk for an accident.
  • Causes impairment of physical and mental function

Signs of Opiate Use

  • Physical: impaired mental functioning and alertness; physical fatigue and drowsiness; possible puncture marks (“tracks”); dry mouth; facial itching; impaired coordination; impaired respiration; constricted pupils; nausea; vomiting.
  • Behavioral: mood changes; depression and apathy.
  • Speech: low, raspy speech.
  • Odor: N/A

Acute effects last 3-6 hours.


Central nervous system stimulant that speeds up the mind and body.

Health Effects of Amphetamine Use

  • Regular use causes strong psychological dependency and increased tolerance.
  • High doses may cause toxic psychosis resembling schizophrenia.
  • Intoxication may induce a heart attack or stroke due to increased blood pressure.
  • Chronic use may cause heart or brain damage due to severe constriction of capillary blood vessels.
  • Euphoric stimulation increases impulsive and risk-taking behavior, including bizarre and violent acts.
  • Withdrawal may result in severe physical and mental depression.

Workplace Issues Related to Amphetamine Use

  • Since the drug alleviates the sensation of fatigue, it may be abused to increase alertness during periods of overtime or failure to get rest.
  • With heavy use or increasing fatigue, the short-term memory or physical enhancement reverses and becomes impairment.

Signs of Amphetamine Use

  • Physical: rapid respiration; profuse sweating; redness in nasal area; runny/bleeding nose; dilated pupils; increased heart rate and blood pressure.
  • Behavioral: hyper-excitability and restlessness; confusion; panic; heightened aggressiveness; impulsive; risk taking.
  • Speech: talkativeness.
  • Odor: N/A

Effects can last from 3-4 hours when snorted or injected, or from 8-12 hours when ingested in pill form.

Phencyclidine (PCP)

Often used as a large animal tranquilizer.  Abused primarily for its mood-altering effects.  Low doses produce sedation and euphoric mood changes.  Mood can rapidly change from sedation to excitation and agitation.  Larger doses may produce a coma-like condition with muscle rigidity and a blank stare.  Sudden noises or physical shocks may cause a “freak out” in which the person has abnormal strength, violent behavior, and an inability to speak or comprehend.

Health Effects of PCP Use

  • The potential for accidents and overdose emergencies is high due to the extreme mental effects combined with the anesthetic effect on the body.
  • PCP, when combined with other depressants, including alcohol, increases the possibility of an overdose.
  • If misdiagnosed as LSD induced, and treated with Thorazine, can be fatal.
  • Irreversible memory loss, personality changes, and thought disorders may result.

Workplace Issues Related to PCP Use

  • Not common in workplace primarily because of the severe disorientation that occurs.
  • There are four phases to PCP abuse:
  • Acute toxicity causing combativeness, catatonia, convulsions and coma.  Distortions of size, shape and distorted perception are common.
  • Toxic psychosis with visual and auditory delusions, paranoia and agitation.
  • Drug-induced schizophrenia.
  • Induced depression which may create suicidal tendencies and mental dysfunction.

Signs of PCP Use

  • Physical:   nystagmus (spasmodic, involuntary jerky eye movement); profuse sweating; impaired coordination; dilated pupils; dizziness; nausea; muscle rigidity; zombie blank stare and disjointed walking.
  • Behavioral: severe confusion and agitation; violent and combative; extreme mood swings; anxiety; paranoia.
  • Speech: incoherent; incomplete or repetitive verbal responses.
  • Odor: N/A
  • Acute effects can last 8-12 hours
  • However it goes into your body fat and can cause hallucinations later
  • Flashbacks, the user may experience psychedelic effects long after use of the drug ends
  • Chronic users report problems with memory, speech, and concentration
    • Can last for 6 months to 1 year AFTER last use

Workplace Issues and Substance Abuse

  • An employee under the influence of drugs or alcohol is 5 times more likely to file a worker’s compensation claim
  • 47% of work accidents nationally are related to abuse of drugs and/or alcohol
  • 20% of industrial fatalities have a drug and/or alcohol connection
  • Marijuana users have 85% more injuries than employees who do not use
  • Substance abusers are 3 times more likely to use sick benefits and have attendance/tardiness problems than their non-using peers
  • 97% of employed substance abusers admit to drug use while on the job
  • Alcohol and Marijuana are the most common drugs used in the workplace