Signs of Drug Abuse and What to Do

What counts as drug abuse?

Doctors now use the term substance use disorder instead of "drug abuse" or "addiction". It is diagnosed when drug use causes significant problems or distress, judged by 11 criteria such as loss of control, cravings, neglecting responsibilities, using in risky situations, tolerance and withdrawal. The condition ranges from mild to severe. For the medical overview, causes and treatment, see drug abuse and substance use disorder.

Misuse includes:

• any use of illegal drugs such as cocaine, methamphetamine, heroin or illicit fentanyl
• taking prescription opioids, sedatives or stimulants in higher doses, more often, or for a different purpose than prescribed
• using someone else's prescription
• using over-the-counter medicines such as cough syrups or antihistamines to get high

Behavioral warning signs

• secretive behavior, lying, locked doors, unexplained absences
• new friends and loss of interest in old friends and hobbies
• falling grades, missed work, lost jobs
• borrowing or stealing money, or selling belongings
• mood swings, irritability, outbursts or hostility
• changes in sleep: up all night, or sleeping much more
• neglecting hygiene and appearance
• running out of prescriptions early, or getting medicines from several doctors
• finding pipes, foil, burned spoons, syringes, small bags or pill bottles that are not theirs

These changes can also come from depression, anxiety or other stresses. They are a reason to talk, not proof of drug use.

Physical warning signs

• bloodshot eyes, pupils that are very small or very large
• sudden weight loss or gain, or poor appetite
• frequent nosebleeds or a runny nose (snorting)
• needle marks, bruising or abscesses on arms or legs, often hidden by long sleeves
• tremors, slurred speech or poor coordination
• unusual smells on breath, body or clothing
• frequent sweating, nausea or "flu-like" illness between uses (withdrawal)

Signs linked to specific drugs

Barbiturate misuse and other sedative misuse are especially risky combined with alcohol or opioids.

Overdose: what to do

1. Call 911 or your local emergency number.
2. Give naloxone (Narcan) if opioids might be involved. It is available without a prescription in the US. It does no harm if opioids are not involved.
3. Check breathing. If they are not breathing normally, give rescue breaths or CPR if trained.
4. Place them on their side (recovery position) if breathing, to prevent choking.
5. Stay with them until help arrives. A second dose of naloxone may be needed after 2 to 3 minutes. See opioid overdose.

Many US states have Good Samaritan laws that protect people who call for help during an overdose.

Who is at higher risk

• a family history of addiction
• early first use, especially before age 18
• mental health conditions such as depression, anxiety, ADHD or PTSD
• trauma or adverse childhood experiences
• chronic pain treated with long-term opioids
• peers or a home environment where drug use is common

How to talk to someone about drug use

• Choose a calm, private time when they are sober.
• Describe specific behaviors you have noticed, using "I" statements ("I'm worried because you missed work three times this month").
• Listen without lecturing or labeling them.
• Offer concrete help, such as finding a doctor or treatment program together.
• Expect denial at first. Keep the door open.
• Set clear boundaries, and look after your own wellbeing through groups such as Al-Anon, Nar-Anon or SMART Recovery Family and Friends.

Getting help

A primary care doctor is a good first step. They can assess physical health, screen for mental health problems, start some treatments and refer to specialists. Treatment works and can include:

• medicines for opioid use disorder (buprenorphine, methadone, naltrexone) and alcohol use disorder
• behavioral therapies such as cognitive behavioral therapy and contingency management
• supervised withdrawal (detox) for alcohol, sedatives and sometimes opioids
• outpatient, intensive outpatient or residential programs
• peer support groups

In the US, the SAMHSA National Helpline (1-800-662-4357) is free, confidential and open 24 hours a day.

Frequently asked questions

What are the most common signs of drug abuse?

Common signs are behavior changes (secrecy, new friends, missing work or school), money problems, mood swings, sleep changes, neglecting appearance, and physical signs such as unusual pupils, red eyes, weight loss, nosebleeds or needle marks. One sign alone proves little; a pattern is more telling.

How can you tell if someone is on opioids?

People using opioids may look very drowsy, "nod off" mid-conversation, have pinpoint pupils, slurred speech, itching and slow breathing. Very slow or stopped breathing, blue lips or unresponsiveness signal an overdose: call 911 and give naloxone.

Is drug abuse a disease?

Substance use disorder is recognized as a medical condition that changes how the brain's reward, motivation and self-control systems work. Genes, environment and mental health all play a role. Like other chronic conditions, it responds to treatment, and relapse is a signal to adjust care.

What should I do if I find drugs in my teen's room?

Stay calm and talk with your teen when they are sober. Ask open questions, explain your concerns and set clear expectations. Speak with their pediatrician or a counselor, who can screen for substance use and mental health problems and recommend support.

What is the difference between drug abuse and addiction?

Older terms used "abuse" for harmful use and "addiction" for compulsive use with dependence. Today both fall under substance use disorder, graded mild, moderate or severe. "Addiction" is still used for the severe form, marked by loss of control and continued use despite harm.