How to recognize early warning signs of substance use in a loved one

Watching someone you care about go through a change can be really tough, especially if you suspect it’s because of substance use. Whether it’s a family member whose mood swings seem out of the blue, a mate whose started being really secretive, or a colleague whose work has really gone downhill, knowing how to spot the early warning signs of substance use can be the difference between sorting it out early and a real crisis situation.

Knowing how to spot the signs of substance use in a loved one is not about being a detective or making accusations. It is about being ready, just in case, with as much knowledge as you can get your hands on, that might just save their life. Substance use disorders affect millions of families, and the sooner you can spot the signs, the better their chances of getting better.

This guide is here to help you understand the changes in behaviour, the physical symptoms, and the environmental clues that might suggest your loved one is struggling with addiction or misuse of alcohol. You’ll learn when you need to act fast, how to have a sensitive conversation, and where to turn for help when you need some expert advice.

Why Early Detection Matters

If you can spot the signs of substance use early before it progresses into a full-blown addiction, you can help them get the right treatment and make a real difference to their long-term prospects. When you catch it early, there are more treatment options available and the chances of a good recovery are much higher.

Substance use disorders develop gradually, often sneaking up on you. At first, it might seem like just a phase, but if you can spot the signs pretty early on, you can do something about it before it gets out of hand. Family members often make excuses for the changes they see, hoping they’re just a passing phase, not serious substance abuse.

People who misuse substances often start out just experimenting with things, but then gradually it becomes a regular part of their routine, often as a way to cope with stress, anxiety, or depression. Eventually, the brain gets used to the constant hit of chemicals, and it becomes dependent on them. That is when the addiction takes hold. Of course, denial is a big part of the problem for both the person using and their loved ones. They might genuinely think they’re in control, while you might hope that sorting the problem out won’t make things worse. This mutual denial can let the problem get worse and worse.

If left untreated, substance use can have long-term effects on the brain, making it harder and harder to make rational choices about your own consumption. That’s why willpower alone is rarely enough to overcome addiction, and professional help becomes necessary.

Behavioural Signs to Look Out For

One of the most obvious signs of substance misuse is sudden personality changes. Your loved one might become more aggressive and short-tempered, or be plagued by mood swings without any apparent reason. You might also see them become irritable over nothing, or less enthusiastic about things they used to love. Someone who was once patient and even-tempered might become quick to anger, or a social butterfly might suddenly become a hermit.

As substance use takes hold, you might notice changes in who your loved one is hanging out with. They might ditch long-standing friends for new people they are reluctant to introduce to you. They may become secretive about their plans and whereabouts, or get defensive when you ask them about it. Avoiding family gatherings, turning down invitations they used to jump at the chance to go to, or only spending time with people who seem to be enabling their substance use are all warning signs.

Performance at work or school can also be a big indicator. You might notice that your loved one is missing deadlines, is less productive, getting bad grades, or getting into trouble with their employer. These problems may start off small but get worse over time as substance use takes over their life.

Sleep patterns can also reveal substance use. Some people might become extremely restless with stimulants, while others sleep the day away when using depressants. Some individuals may even experience a reversal of the normal day-night cycle, sleeping during the day and staying awake at night. This can indicate serious substance use problems. Hygiene and self-care start to slip away as substance use takes the top spot over other basic needs. This can mean wearing the same worn-out clothes over and over again, not showering for days, not paying attention to dental care, or simply not giving a darn about how you look in the mirror. The way someone lets their personal hygiene slide can be a pretty clear sign of how much time they’re spending chasing after a fix and how much self-worth has gone down the drain.

As substance use gets a solid foothold, secretive behaviour becomes a lot more common. Expect your loved one to start taking lots of private phone calls and snapping them shut when you try to get near them, locking their doors all the time when they used to leave them open, sticking personal belongings in weird places, or becoming super defensive about what they’re doing. They might try to cover their tracks by clearing their browser history, changing passwords on their devices, or making up some wild story about where they were.

The way someone communicates with you can also give you some pretty red flags about whether they’re struggling with a substance use disorder. Expect them to start making up more and more outlandish excuses for why they were out of touch, constantly making up alibis for why they changed their plans, or blaming everything on the world outside of themselves. More often than not, the shame and fear of being found out are driving these communication changes.

Physical Warning Signs and Symptoms

You’ll often see some pretty clear warning signs of substance use in someone’s eyes. Bloodshot or glassy eyes that just won’t go away, even after they get some sleep and use eye drops, can be a good indicator that they’ve been up to something lately. Pupils that are too big or don’t react to light right can mean they’ve been using some kind of stimulant, or it could mean they’ve been using opioids if they seem too small. Repeatedly tearing up or rubbing their eyes, or getting involuntary eye movements, can also be a sign that they’re struggling with a substance use problem.

Weight and appetite changes happen a lot when people get into substances. Losing a bunch of weight fast and losing interest in food, especially with stimulants, is pretty common. On the other hand, some substances or the whole lifestyle change that comes with addiction can cause someone to gain weight fast. Stopping eating altogether or suddenly getting ravenous for sweets or junk food can also be signs of a substance use problem.

The way someone’s skin looks can also give you some warning signs that they’re using substances. You might notice they look really pale or flushed, or that they have all these unexplained bruises or scars in weird places, or even needle marks on their arms. They might look way older than they really are, or get all these weird skin problems from the stuff they’re using. Some substances can even cause some pretty nasty dental problems.

Coordination and fine motor skills problems become a lot more common with substance use problems. You might notice them stumbling around or having trouble walking in a straight line, getting mixed up for no reason when they talk, or having trouble doing simple things like buttoning their shirt. All these signs can be a sign that they’re under the influence, or just getting withdrawal symptoms from some kind of substance.

People who use substances a lot often get a bunch of respiratory problems. You might notice a lot of coughing that just won’t quit, or a persistent runny nose that’s not from any old cold. Nosebleeds that aren’t explained, or strange breathing patterns like really slow breathing or gasping for air, can all be warning signs of a substance use problem.

Fluctuating energy levels are yet another thing that can be a sign of substance use. Some people go through cycles of total hyperactivity followed by extreme fatigue, reflecting the back and forth of getting a rush and crashing off a stimulant. Others might seem like they can’t sit still, they’re so fidgety and restless, while some will seem totally zonked out all the time.

Your dentist might also notice some pretty clear signs of substance use in someone’s teeth. You might see a bunch of teeth rotting out, especially the ones in the front, or maybe they’ve got persistent bad breath that no amount of toothpaste and flossing can fix. They might even be grinding their teeth in their sleep, and that can be a real pain to stop.

Temperature Regulation Issues

You might notice your loved one seems to be sweating all over the place, even when the heat is off, or they complain of being freezing cold when their friends and family are just fine. Maybe they’re always getting chills like they have a cold, but you don’t. They might be unable to pick the right clothes for the weather, too, like wearing a parka in the middle of July.

Substance-Specific Warning Signs

Alcohol Abuse Indicators

You’ll know when someone’s got an alcohol problem from the smell of booze on their breath, but it’s not always that easy. They might be using mouthwash or mints all the time to cover up the smell of alcohol. Or they might be using way too much cologne or perfume to cover up the smell of booze all the time. Another one is when they get defensive or angry when you ask them about their drinking. That is just a major red flag.

People with an alcohol use disorder will often start drinking by themselves instead of with friends and family. They might hide all the liquor in the house, or start drinking as soon as they get up in the morning. They might even get anxious if they can’t have a drink.

The physical symptoms of an alcohol abuse problem are pretty clear, too. Maybe they’re getting hangovers all the time, even though they claim they only drink a little bit. Or maybe they’re starting to black out and forget what happened. They might even get withdrawal symptoms like shaking in the mornings, which always get better after they have a drink.

Tolerance indicators are another thing when someone needs to drink more and more to get the same effect or when they get visibly drunk even after having a lot to drink. Immediate physical signs of marijuana use include red or bloodshot eyes that linger long after use, pupils that are dilated and look like they’ve got a glazed over look to ’em, and strong, sweet, or skunky smells hanging around on clothing, in hair, or on personal belongings even after a good wash.

Behavioral changes associated with cannabis use include getting the munchies, which are episodes of extreme hunger that often occur for sweet or high-calorie foods at the most unusual times. You’ll also start to notice slower reaction times in conversation or when doing physical stuff, and people might have trouble holding onto short-term memory, which really starts to impact their daily life. Plus, they’ll have a hard time concentrating on tasks that used to come easily.

Paraphernalia discovery can turn up all sorts of things, such as rolling papers, pipes of various sorts, vaporizers designed just for pot, little plastic bags with plant residue in them, or even items they have made themselves out of household objects to smoke the substance. Of course, there may also be burnt plant material smells or ash found in places where it should not be.

Long-term effects of regular pot use include a real lack of motivation for things that used to bring a person satisfaction, breathing problems from smoking that show up as a persistent cough or throat irritation, or noticeable changes to their cognitive function that affect their work or school performance.

Stimulant Use Warnings

Hyperactivity signs of stimulant use include excessive talking, often flitting from topic to topic and jumping all over the place. People cannot sit still for more than a few minutes as they are always on the go. Additionally, they may go for days without catching any sleep.

Physical indicators of stimulant use include pupils that remain dilated even in bright light, a rapid heart rate visible in the neck pulse, excessive sweating without doing anything, and significant weight loss over a short time because their appetite is just gone.

Behavioral changes during stimulant use include increased confidence that can tip over into wild plans or grandiose ideas, increased risk-taking that’s often reckless, paranoia that’s completely unfounded, and a change in personality that shows up as aggressive tendencies.

Crash symptoms occur when the stimulant effects wear off and include extreme fatigue that puts people right out for hours, depression that feels like it came out of nowhere, intense cravings for more of the stimulant, and an increase in appetite as the body tries to get itself back on track.

Opioid and Prescription Drug Abuse

Sedation signs of opioid use include people nodding off mid-conversation, like they’re in a coma, or slurring their words despite not having had a drink. Their eyelids droop, and sometimes they look completely disconnected from what’s going on around them.

Respiratory indicators can be a real dead giveaway and are a major cause of overdose death, slow or shallow breathing patterns that get to the point where the breathing rate drops below normal. This requires immediate medical attention.

Behavioral patterns associated with prescription drug abuse can include people doctor shopping to get multiple prescriptions, taking their medication more often than they should or in larger doses, crushing pills to snort or inject instead of swallowing them as directed, or taking prescription painkillers long after the original medical condition has cleared up.

Withdrawal symptoms from opioids are like having an extreme case of the flu. They include muscle aches, nausea and vomiting, anxiety and restlessness, sleep disturbances, and desperate behavior to get more of the medication.

Depressant and Sedative Misuse

Coordination problems associated with depressants can include stumbling around, having trouble keeping their balance, slurring their words and stumbling over their speech, and having trouble walking in a straight line.

Cognitive impairment from depressants can manifest as confusion about time, place, or events that just happened, memory problems affecting both short-term and long-term recall, and people can’t seem to focus on even simple tasks. And poor decision-making is a real problem.

Physical symptoms include a slow pulse rate that you can feel in the wrist or neck, low blood pressure that can cause dizziness or even fainting, slow breathing patterns that are super dangerous, and extreme drowsiness that makes it hard to stay awake even in serious situations.

Combination risks arise when depressants are mixed with other depressants or with alcohol, which can lead to some really bad interactions that can be life-threatening. Even prescribed medications can become lethal when mixed in the wrong combination.

Environmental and Social Warning Signs

Finding paraphernalia can be a pretty clear indication of substance use, like discovering pipes for smoking this or that, or needles and syringes, which might indicate intravenous drug use. Or maybe it’s burned spoons or bottle caps for heating up drugs, or small mirrors or razor blades for preparing powdered goodies. And often people make their own smoking devices out of household items.

Discovering substances themselves might mean finding pills that aren’t prescribed to your loved one, often in unmarked containers or plastic bags. Or there’s white powders or crystalline substances in small amounts, unusual plants or plant materials that don’t belong in the house, or little baggies with residues or unknown substances. Financial red flags often appear alongside substance use disorders and can include money going missing from wallets, purses, or household accounts without anyone being able to explain where it went. You might also notice important items have vanished, such as a high-end phone or a family heirloom piece of jewellery, which could be easily sold to get cash quickly. Additionally, you may see people putting off paying bills even though they have a decent income or receiving constant requests for cash without any legitimate reason to explain why it is needed.

Social isolation patterns start to show up in people who start avoiding family gatherings that they used to enjoy, begin to decline invitations to social events where getting smashed wouldn’t be a good look, start spending all their time with mates who also get smashed and then cut ties with friends who don’t, or just cut off everyone who’s expressing worry about their behaviour.

When someone’s living space starts to change, you get a sense of what’s going on. There might be weird smells that refuse to budge no matter how much you clean, discovering what you suspect is leftover from a blast on a surface, finding hidden stashes in weird places around the house or in personal stuff, or just getting a feeling that there are areas the person is keeping off-limits.

Legal troubles can creep up alongside a substance use disorder and this can include a record of being arrested for substance- related offenses, getting court dates for driving under the influence or other charges that’s related to getting smashed, showing up to a list of previous legal consequences, or picking up more and more driving fines because it looks like they’re making dodgy decisions while driving.

When to Spring into Action

Emergency situations that call for a 911 call are things like the person is completely out cold and won’t wake up no matter how much noise you make or how hard you try to rouse them, if their breathing is getting weak and is below eight breaths a minute or is getting all irregular, if they’re having a seizure, if they’re having chest pains that could be a sign of something serious, or if they’re getting so agitated it’s putting themselves or other people at risk.

If the person is showing signs of an overdose, they need medical help ASAP, and this can include the tell-tale blue lips or fingernails, which means they’re not getting enough oxygen, gurgling sounds coming from their throat or chest, a pulse that’s really hard to find, or a feeling that their skin is cold to the touch. Don’t keep them awake if they can’t; just do what the emergency dispatcher says.

There are times when you need urgent medical attention, and this can include mixing stuff up, especially combining downers and booze, swallowing something you don’t know what it is or what it’s going to do to you, or showing all the symptoms of a bad withdrawal, such as the shakes, seeing things, or being really, really anxious.

When you make that call to get help, you need to be able to give the people who show up as much info as possible about what happened, including exactly what you think your mate had, when they last used it, if they’ve got any underlying medical issues or if they take any regular meds, and what symptoms you’re seeing right now. Stay with them, keep the person awake if you can, and do exactly what the emergency dispatcher says.

Save lives by having the sense to get them medical help right away. Loads of people put off calling in because they’re worried about getting in trouble, but most states have Good Samaritan laws that give you protection if you’re getting help for someone in an overdose situation.

How to have a chat with your Mate

Timing is everything when having a chat about substance use worries. Try to have the talk when they’re sober and alert, when you’re both in a private place where you won’t get interrupted, make sure you’ve got plenty of time to have a solid conversation that won’t get cut short, and try to pick a time when they’re not stressed or angry.

Having the right way of going about it is also crucial, and this means focusing on feeling and observation rather than just slating and accusing. Use “I” statements to explain what you’ve seen and how it makes you feel, for example, “I’ve noticed a lot of changes in your behaviour that are making me really worried” rather than “You’re clearly getting smashed”. Do not assume what might be going on. Stick to what you have actually seen.

Before you start trying to have a calm and rational conversation you can do a few things that might help, such as researching treatment options in your area, getting a list of contacts and numbers together, talking to some experts about how to approach the conversation, and actually thinking about what you want to say and how to say it rather than just winging it.

Boundary setting is essential when trying to get your mate the help they need. You need to be clear that you will not enable their behaviour, even if that means setting some limits on what you are willing to do to help them get well again.You can make it clear you’re there for them, but you won’t make it easy for them to keep on making the same mistakes. This might mean saying no to giving them cash or covering for them, but saying yes to helping them get to treatment or driving them to appointments.

You can take steps to get your mate the help they need, either by having a quiet chat with them or by getting a pro in to sort things out for you. Family interventions work best when you get a load of mates, and family round to have a chat and offer treatment options, and a professional intervention service will get a trained expert in to make sure things go smoothly.

When your mate makes it through the worst of it it’s time to start building on what you’ve done alread,y and this can include things like going with them to treatment assessments, getting them to treatment groups in your area, being there for them emotionally throughout the recovery process and all the while making sure you set some boundaries to keep yourself safe too.

Professional Resources and Treatment Options

There are immediate resources that you can call on 24/7, including the SAMHSA National Helpline at 1-800-662-4357, which will give you confidential treatment referrals and advice on what to do if someone you know is struggling with a substance use disorder or a mental health problem. You can also get stuff done with a text message via Crisis Text Line, or just dial 911 if things are really bad. Treatment types vary depending on what an individual needs and how bad their addiction is. Inpatient rehabilitation provides a 24-hour safety net with medical supervision and intense therapy sessions that last anything from 30 to 3 months. On the other hand, outpatient programs allow people to keep up with their work or school commitments while popping into therapy sessions a few times a week. Medication-assisted treatment involves drug counselors combining medication with counseling and behavioral therapies, providing patients with a more well-rounded type of care. Intensive outpatient care offers more frequent sessions than a standard outpatient program while allowing patients to continue living at home.

Beyond Therapy Group has been doing this for a while. We provide a range of mental health and addiction services for individuals and families who face significant challenges. Our team of experienced addiction recovery professionals does everything from one-on-one therapy to group therapy sessions, family therapy sessions, and even tailor-made treatment plans for each client individually. They know that addiction affects the whole family and do their best to help loved ones deal with the emotional fallout of supporting someone in recovery while still keeping an eye on their own mental health.

help for families includes Al-Anon for parents of alcoholics, Nar-Anon for parents struggling with drug addiction, family therapy to help work through relationship issues and communication patterns, and some educational programs that help families understand addiction is a mental health issue, not a moral failing.

Hope is everything when it comes to getting through the recovery process. Trust that addiction is a treatable condition, that people can recover with the right support and intervention. Setbacks are just a normal part of the journey, and long-term recovery often requires some ongoing support along with a few lifestyle changes that the whole family can get on board with.

Frequently Asked Questions

How can I tell if my loved one is just having a bad day or if they’ve got an addiction on their hands?

Normal bad days are temporary and short-term and are usually about something specific, like a work deadline or a relationship issue. These bad days usually pass when the stress is gone. On the other hand a substance use problem will tend to go on and on and can come with some really obvious physical symptoms like bloodshot eyes or coordination problems, and you’ll probably notice they’re being secretive, or their finances are in disarray, or they’ve stopped doing things they used to do, or you’ve even found some drug paraphernalia lying around. This sort of thing usually needs to go on for a while before you can be sure, but the key is to look for patterns of escalating behaviour that seem out of character.

What if I find some drugs or drug paraphernalia in my loved one’s stuff?

First of all, prioritize safety and approach the situation with care and understanding, especially if your loved one is under the influence. Get some photos if you can, and safely dispose of any bad stuff according to your local rules. Then have a calm conversation with them when they are sober. Focus on your concerns, not on accusing them of being a “junkie.” It might be a good idea to talk to a professional first, someone who can help you have a useful conversation and tell you what resources to have on hand.

Can someone get addicted to prescription drugs even if they have a valid prescription?

Yes, they can even if the prescription is for a legitimate medical reason. Some warning signs of prescription drug abuse include taking a medication more than you are supposed to, taking it more frequently than you should, or “doctor shopping” for more pills. Some medications have the potential to lead to physical dependence even if they are used correctly. Always follow the doctor’s instructions, tell them if you think you might be getting in too deep, and never ever give your prescription medications to someone else.

How long should I wait before getting some professional help if I suspect my loved one has an addiction?

Don’t wait around for the situation to get worse. Early intervention is the key to a better outcome. If you have seen a few red flags over a few weeks, such as physical symptoms and some changed behaviour, it is probably time to get some advice from an addiction specialist. Even if your loved one seems to be saying they are fine or even if they are in denial about their problem, do not give up. Get some professional help, as they can help you figure out what to do next.

What do i do if my loved one gets angry or denies having a problem when i bring it up?

Well, anger and denial are pretty typical responses to discovering someone has a substance use problem. This reaction usually occurs because they feel ashamed, worry about being judged, or their judgment is impaired by the addiction. Stay calm and avoid arguing about whether or not they have a problem, as that usually makes things worse. Instead, express how you have noticed some concerning behaviors and let them know you are there to support them no matter what. It is a good idea to seek help from a professional who knows how to work with resistant individuals and can guide you in having a constructive conversation with your loved one.