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Warning Signs of Substance and Alcohol Use Disorder

Those with substance use disorder (SUD) often try to hide their symptoms and downplay their problem. If you're worried that a friend or family member may be misusing drugs, look for the following warning signs:

  • Bloodshot eyes, pupils larger or smaller than usual
  • Changes in appetite or sleep patterns
  • Deterioration of physical appearance, personal grooming habits
  • Runny nose or sniffling
  • Sudden weight loss or weight gain
  • Tremors, slurred speech, or impaired coordination
  • Unusual odors on breath, body, or clothing
  • Using causes difficulties in one's relationships
  • Engaging in secretive or suspicious behaviors
  • Frequently getting into legal trouble, including fights, accidents, illegal activities, and driving under the influence
  • Neglecting responsibilities at work, school, or home, including neglecting one's children
  • Sudden change in friends, favorite hangouts, and hobbies
  • Unexplained need for money or financial problems. May borrow or steal money.
  • Using drugs under dangerous conditions (driving while using drugs, using dirty needles, having unprotected sex)
  • Increased drug tolerance (the need to use more of the drug to experience the same effects one used to achieve with smaller amounts)
  • Misusing drugs to avoid or relieve withdrawal symptoms (nausea, restlessness, insomnia, depression, sweating, shaking, anxiety)
  • Loss of control over drug misuse (using more than intended, unable to stop)
  • Life revolves around drug use (always thinking of using, figuring how to get more, or recovering from use)
  • Abandoning enjoyable activities(hobbies, sports, and socializing) to use drugs
  • Continuing to use regardless of negative consequences (blackouts, infections, mood swings, depression, paranoia)
  • Appearing fearful, anxious, or paranoid, with no reason
  • Lack of motivation; appearing tired or "spaced out"
  • Periods of unusual increased energy, nervousness, or instability
  • Sudden mood swings, increased irritability, or angry outbursts
  • Unexplained change in personality or attitude

Adapted from: Exit Disclaimer: You Are Leaving 

Warning Signs from Commonly Misused Drugs

Signs of SUD often depend on what substance is being used. If you suspect someone you know may be misusing substances, and one or more of these signs are present, you can locate treatment options for detox and rehabilitation with the Indian Health Service Treatment locator.

Examples: Beer, wine, mixed drinks

Silhoutte of a woman holding her head
  • Underage drinking and/or binge drinking.
  • Needing greater quantities of alcohol to achieve the desired effects or to function "normally."
  • Drinking more alcohol to get rid of or ease alcohol withdrawal symptoms.
  • Attempts to stop or limit drinking are unsuccessful
  • Extensive amount of time needed to recover from the effects of alcohol.
  • Spending lots of time thinking about the next drink.
  • Drinking alone or trying to hide one's drinking patterns.
  • Discontinuing use causes withdrawal symptoms such as nausea, mood swings, irritability, tremors, inability to sleep, and overall sickness.
  • Displaying anger when questioned about one’s drinking patterns.
  • Acting as if drinking is more important than one's friends and family; isolating oneself from one's social support system.
  • Becoming anxious or stressed if a social gathering does not include alcohol.
  • Continuing to drink regardless of the negative physical or psychological difficulties.
  • Drinking frequently or in excess, which may include blackouts when drinking.
  • Making excuses to continue to drink and/or drinking at unacceptable times or places.

Examples: Xanax, Valium, GBH

  • Contracted pupils;
  • drunk-like effect;
  • difficulty concentrating;
  • clumsiness;
  • poor judgment;
  • slurred speech;
  • sleepiness.

Examples: glues, aerosols, vapors

  • Watery eyes;
  • impaired vision, memory and thought;
  • secretions from the nose or rashes around the nose and mouth;
  • headaches and nausea;
  • appearance of intoxication;
  • drowsiness;
  • poor muscle control;
  • changes in appetite;
  • anxiety;
  • irritability;
  • lots of cans/aerosols in the trash.

Examples: LCD, PCP

  • Dilated pupils;
  • bizarre and irrational behavior including paranoia, aggression, hallucinations;
  • mood swings;
  • detachment from people;
  • absorption with self or other objects
  • slurred speech
  • confusion.
  • Contracted pupils;
  • no response of pupils to light;
  • needle marks;
  • sleeping at unusual times;
  • sweating
  • vomiting
  • coughing, sniffling, twitching
  • loss of appetite

Examples: amphetamines, cocaine, crystal meth

  • Dilated pupils;
  • hyperactivity;
  • euphoria;
  • irritability;
  • anxiety
  • excessive talking followed by depression or excessive sleeping at odd times;
  • long periods of time without eating or sleeping;
  • weight loss;
  • dry mouth and nose.

Adapted from:

What are some signs and symptoms of someone with a drug use problem? Exit Disclaimer: You Are Leaving  - National Institute on Drug Abuse