Substance Misuse: 5 Signs To Watch For

If someone close to you is dealing with a substance use disorder, you want to do everything you can to make sure they get the help they need. But unless you’re an expert in addiction medicine, you may not always immediately recognize the signs that someone is misusing drugs or alcohol. And if you suspect they do have a use disorder, you may be unsure about the best way to approach them.

Here are the five most common warning signs that someone may have a substance use disorder—and what you might say to them about what you’re noticing.

A change in behavior

If someone is misusing drugs or alcohol, you’ll always notice at least some behavioral changes. The signs we see most commonly are mood swings, increased irritability, secrecy, social withdrawal, and unexplained absences from work, school, social events, and family gatherings.

What you might say: “I’ve noticed that when family comes over, you stay in your room and don’t want to talk to anyone. You used to be a lot more social and interactive when family or friends would come over. Can we talk about this?”

Physical signs and symptoms

Depending on what type of substance is being misused, a person can exhibit different physical signs and symptoms. For example, they could have bloodshot eyes or dilated or constricted pupils, as well as sudden weight gain or weight loss or an increase or decrease in appetite. Tremors, slurred speech, and poor coordination are other signs.

These symptoms may also be due to a medical condition, so the best approach is to encourage your loved one to see a health care professional to get checked out, and if possible, try to accompany them to the appointment.

What you might say: “I’ve noticed some physical symptoms that aren’t normal for you, like [fill in the blank]. I think it would be good to make an appointment with a medical professional to get it checked out, and I’m happy to go with you.”

Neglecting responsibilities

When a person becomes increasingly dependent on a substance, they usually start falling behind in their responsibilities, whether they involve work, school, home, or any other aspects of their life. For example, it could be that a person starts calling in sick to work two or three times a week, or a teenager’s grades start to decline. Maybe someone used to be really involved with their share of household chores, and now they’re barely doing anything.

What you might say: “I’ve noticed lately that you’ve started neglecting your responsibilities. You used to get to work a half hour early, but now you’re either going in late a lot or calling in sick. Is this something you want to talk about? How can I help?”

Increased risk-taking behavior

Be on the lookout if a person starts to engage in risky behavior, such as driving under the influence, practicing unsafe sex, or spending a lot of time and money on gambling.

What you might say: “I’m really concerned that you’ve been driving under the influence. Is it because you don’t want to spend the money on an Uber or it is it because of something else? What can I do to help?”

A change in social circles

With younger people especially, one common sign that someone may have a substance use disorder is when there’s a big change in their social circles. You notice that they’re no longer hanging out with any of their usual friends, and now they’ve started getting together with new people. You may not know this new set of friends, or if you do, you might recognize some of these same signs and symptoms of substance use in them, as well.

What you might say: “It’s been a while since I’ve seen you getting together with friends you used to hang out with, and now I see you’ve got new friends, and they don’t seem like people that you would normally hang out with. Can we talk about this change?”

Communicating with care

No matter what signs you’re seeing, when you’re talking to a loved one about suspected substance misuse, you want to engage them with empathy, care, and support. People who have a substance use disorder are already dealing with many stigmas, and they can feel extremely marginalized. If you use accusatory language, they will be less open to hearing what you have to say, so it’s important to create an environment where they’re not going to feel judged or threatened. This will help them feel safe and be more willing to open up to you.

And there’s another conversation that’s vitally important: If you suspect that your loved one is misusing opiates, or if they admit to it but say they’re not ready to get help, encourage them to practice harm reduction. Make sure they have a Narcan kit and urge them never to use alone. This way, if they do overdose, they have a better chance of surviving it because the other person can call for help.

Finally, if you’re struggling to help a loved one with a substance use disorder, don’t neglect your own mental health in the meantime. Self-care is just as important as taking care of other people, and a lot of people forget that.

• One man’s return from rock bottom after an opioid addiction.
• Learn how Northwell Health’s Wellbridge Addiction Treatment and Research Center can help you get past substance use disorder.
• A few warning signs of alcohol dependency.