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Residential Property Management Community Manager PPA
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Online Technical Account Manager
Massage Therapy Clinical Therapist
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Highlights and documents I have written

Creating Customer Loyalty

End user Training

Many occupational hazards of adult life will be greatly alleviated by massage:

  • aching back and shoulder after a long office stint

  • exhaustion or overstrained muscles from physical labor or excessive exercise

  • circulatory problems from too little exercise by sedentary workers.

Massage Therapy

Being a Male Therapist


730 Hour Certification


Massage can benefit you right down to the cellular level!

Contact Marcus Ball Directly at (408) 896-5555, or MarcusBall@MarcusBall.com



Behavioral Signs of Substance Use and Abuse

A combination of the following signs should alert you to the possibility that a patient is using illicit substances and to the importance of exploring that possibility through an interview and/or laboratory testing:

  1. Sudden decline in school achievement. Since alcohol and other types of drug intoxication interfere with learning, it is not surprising that rapidly deteriorating school performance frequently results. Poor functioning in school that contrasts sharply with earlier adequate functioning, especially in the absence of a school change or other obvious explanation, should arouse suspicion.
  2. Cigarette smoking.
  3. Marked shift in the childís peer reference group, especially association with known or suspected drug users.
  4. Serious erosion of parental trust in the child.
  5. Support by the child for the idea of legalizing marijuana.
  6. Marked personality changes. Although childhood and especially adolescence are often marked by mood swings and some instability, evidence of social withdrawal, a new guardedness in communication with other family members, inexplicable depression or other evidence of psychological disruption such as changes in sleeping patterns, are all possible indicators of drug involvement.
  7. Withdrawal from extracurricular activities that were previously important to the child, such as athletics, religious or youth programs, band, etc.
  8. Cutting classes, tardiness or truancy from school.
  9. Deterioration in appearance and personal hygiene.
  10. Increased secretiveness unexplained phone calls, heightened hostility to inquiry, sudden onset of hypersensitivity.
  11. Going out every night. Youth who are intensely involved with weekday social activity consisting primarily of "hanging around" (as opposed to scheduled youth activities or activities on weekends) may be drug involved.
  12. Unexplained disappearance of family funds, or family and personal possessions (this may be related to a need for money to purchase drugs.)
  13. Aggressive behavior such as recurrent fighting, violent hostility, or other evidence of social alienation.
  14. Heavy use of over-the-counter preparations to reduce eye reddening (e.g., injected conjuctiva produced by acute marijuana intoxication), nasal irritation (resulting from "snorting" cocaine), or tell-tale bad breath (produced by alcohol or cigarettes).

Physical Symptoms of Alcohol and Other Drug Use

Behavioral manifestations, not physical appearance, are the red flags of alcohol and other drug use. Generally, physical symptoms or sequelae of substance abuse will not be obvious. For example, smoking marijuana or crack cocaine may not usually cause coughing, wheezing, or other obvious irritation of the upper respiratory system. While a reddening of the eyes of occurs, eye irritation can have a variety of other causes, so this symptom is hardly pathognomonic. Even acute intoxication with marijuana may not be apparent. Many experienced marijuana users are able to hide the outward signs of the drugís intoxicating effects, thereby disguising their use and fooling even the most astute physicians.

Although some clinicians have noted a quality of listlessness, unhealthy pallor and complaints of tiredness in their young, drug-using patients, these symptoms may not always be apparent even in advanced stages of use. While weight loss and other evidence of malnutrition may occur following continued use of cocaine or other stimulant drugs, these signs are unlikely to result from recently initiated or occasional use.

Evidence of I.V. Drug Use

Given the risks of such secondary infections as hepatitis and AIDS, and of anaphylactic reaction to the injected material, any evidence or admission of I.V. drug use should be regarded as indicating a need for assessment by an experienced drug treatment professional.

Since alcohol and other drugs are not used in vacuum, your knowledge of the individual, how they are getting along with their families, their teachers, and their peers is invaluable.

Be on the lookout for behavioral signals.  Behavioral changes or problems that have developed since a childís last visit are often evident after even brief interviews with the patient and parent. Usually, children who are involved with alcohol and other drugs send out behavioral signals and frequently such changes or problems will emerge during the routine questioning you undertake as part of your examination.

Using Opportunities to Discuss Substance Abuse

The amount of time you can spend with any patient is very limited, but even that required for a routine physical examination can be used to explore possible substance use and encourage a drug-free lifestyle. The routine chest examination provides an excellent opportunity to ask about cigarette smoking and marijuana use. Since the youngster may believe that you can detect use of these substances by your chest auscultation, he or she will usually respond openly to direct, but nonjudgmental inquiry. Routinely asking about alcohol use in the childís school and among his or her peers readily leads to questions about personal use. This questioning is likely to be non-threatening to your patient in the context of your concern for his or her overall health and well being.

Reactions to Your Questions

An important clue to more serious involvement with substance abuse is marked defensiveness about the essence of alcohol or other drug use or any kind of emotional response to your routine questions. If this reaction occurs, it provides a further basis for inquiry, indicating the patient that the topic seems to be a sensitive one and making the patient aware that you wonder why.

Why are they Using Drugs?

The drug use may be the patientís way of self-medicating anxiety or dealing with problems in living or a lack of self-esteem. But even though drugs may temporarily alleviate some of these feelings, substance abuse is destructive to emotional maturation and other aspects of growth and development. Thus, objective confirmation can sometimes be a relief to all concerned, making it easier for both the youngster and the parent(s) to acknowledge that a problem requiring their attention exists.

How to Respond to Isolated or Minimal Use

If use has, in fact, been relatively isolated, the child may find evidence in your concern reassuring of adult love, especially if the use is not moralistically condemned, but treated as a potential health hazard. Avoiding a moralistic stance without in any way condoning use is important.

  • The Alcohol Argument - Young people are sometimes very indignant that adult use of alcohol or tobacco is socially acceptable, but their drug use is not. Emphasizing that abuse of all drugs, including alcohol and tobacco, is a serious medical and social problem and that your concern is with the health and development hazards, regardless of the drugís legal status or social acceptability, may help to defuse the argument.
  • The intoxication Issue - Making the point that intoxication with any substance is undesirable at any age and especially while undergoing marked developmental changes and acquiring the necessary skills for adult life, may also be useful. Since using marijuana is a form of intoxication more analogous to getting drunk, the argument that the adolescentís "joint" is like the adultís before dinner cocktail loses much of its force.
  • The Health and Developmental Implications of Use - Frank acknowledgement of the seriousness of adult alcohol, tobacco, and other drug use can make it clear that you are not advocating a double standard. You should make clear to your patient that your concern is with the health and developmental implications of use. Moreover, just as there is good reason to be particularly concerned about diet and other health habits during pregnancy, there are equally good reasons for concern about behavior that can potentially interfere with healthy childhood or adolescent development.


The American Society of Addiction Medicine (ASAM)
ASAM is an association of 3,000 physicians dedicated to improving the treatment of alcoholism and other addictions by educating physicians, medical students, and the general public, and promotion addiction research and prevention.
4601 North Park Avenue #101, Arcade Level
Chevy Chase, MD  20815
(301) 656-3920

National Association of Alcoholism and Drug Abuse Counselors (NAADAC)
With 17,000 members, NAADAC is the largest national organization of alcoholism and drug abuse professionals across the country who treat addicted individuals and families.
1911 N. Fort Myer Dr. Suite 900
Arlington, VA 22209
(703) 741-7686 or (800) 548-0497

The International Nurses Society on Addictions (IntNSA)
IntNSA is a professional specialty organization for nurses that is committed to the prevention, intervention, and treatment of addictive disorders, including alcohol and other drug dependency, nicotine dependency, eating disorders, dual and multiple diagnosis, and process addictions such as gambling.
1500 Sunday Drive, Suite 102
Raleigh, NC  27607
(919) 783-5871


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