Substance abuse is so prevalent that it needs to be considered in any health or psycho-social assessment. This is especially true if a patient complains of any psychiatric symptoms. Anxiety, sleeplessness, depression, psychosis, and many common complaints may be clues that there is a substance abuse issue for the patient. In addition, certain medical conditions should alert the clinician that substance abuse may be the problem. For example, chronic gastritis is common in alcoholism, a perforated nasal septum may be caused by severe cocaine use, and needle marks almost always mean intravenous drug abuse.