Which of the following may indicate an underlying substance abuse issue in an inmate?

Exhibiting confusion or disorientation can be significant indicators of an underlying substance abuse issue in an inmate. Substance abuse can alter cognitive functioning and perception, leading to symptoms such as confusion, memory problems, or disorientation. This behavior may reflect the physiological and psychological impacts of drugs or alcohol on the individual's brain, signaling a need for further assessment or intervention regarding possible substance misuse.

The other options suggest characteristics that are generally not associated with substance abuse issues. For example, a stable demeanor typically indicates emotional and cognitive stability, while requesting medical attention for a cold generally points to physical health issues rather than substance abuse. Displaying enthusiasm for group activities often reflects a positive engagement with others and is not indicative of substance misuse. Understanding these signs is crucial for appropriate assessment and support for inmates who may be struggling with addiction.