Personality Changes

• Direct statements indicating distress
• Constant sadness or tearfulness
• Constant anxiety or irritability
• Unprovoked anger or hostility
• Expressions of hopelessness or worthlessness

Behavioral Changes

• Deterioration in quality of work
• A negative change in performance
• Repeated absences from important activities
• Continual seeking of special accommodations
• Repeated trouble getting along with others

Physical Changes

• Deterioration in physical appearance
• Visible weight changes
• Excessive fatigue
• Sleeping much more or much less
• Coming to work bleary-eyed or smelling of alcohol
• Needle marks or bandages

Workplace Changes

• Patient or staff complaints
• Unusual pattern of prescribing of drugs
• Inappropriate orders
• Personal administration of drugs to patients
• Unreachable when on call

Other Factors to Consider

• Personal losses (e.g., divorce, deaths)
• Decreased self-care (e.g., discontinuing exercise)
• Expression of concern noted by peers
• A hunch or gut-level feeling on your part that something is wrong