Substance use disorder: Signs and symptoms

People may use substances for many reasons. A substance is anything that can affect how you think, feel or behave. This can include pain medications, illegal drugs and alcohol.¹

Substance use often starts as a way to cope, feel better or fit in. Stress, sadness, curiosity and pressure from others can all play a part, especially for teens.

Substance use disorder (SUD) is when a person keeps using alcohol or drugs despite the harm it causes. People with SUD may feel a strong need to use these substances. Stopping can also cause withdrawal symptoms and strong cravings. This can make daily life harder.¹

Using drugs or alcohol again and again can change how the brain works. SUD can affect how a person thinks, feels and acts. It can change judgment, decision-making, learning, memory and self-control. These changes can last after the substance wears off. Over time, a person may need more to feel the same effects. This is sometimes called building a tolerance.¹

SUD includes a full spectrum of substance use problems. Some people are able to stop or change their substance use before becoming addicted. Addiction is considered a severe progression on the spectrum of SUDs.2 Addiction isn’t a lack of willpower. It’s a disease that changes the brain and can make it hard to stop. Treatment can help people recover and live healthy lives.³

People may start using substances again after they stop, sometimes called a relapse. That does not mean treatment has failed. Like other long-term health conditions, treatment may need to continue and change over time.³

The signs of SUD can look different from person to person. Knowing what to look for can help you decide when it's time to get help for yourself or someone you care about. Common signs of SUD include:⁴

• Frequently missing school or work, or a drop in performance
• Lack of energy and motivation, weight loss or gain, or red eyes
• Poor hygiene
• Behavior changes in relationships with family and friends
• Money issues

People may be affected by substances differently. For example, depressants, such as prescription anxiety medicine, typically cause drowsiness. Stimulants, such as cocaine, may cause increased energy and aggression.⁴

The effects of substances often fall into 2 groups:⁵

• Intoxication: The short-term effects of a substance. You may feel sleepy, calm, excited or have strong emotions. It can also affect your thinking, judgment and coordination.
• Withdrawal: Symptoms that happen as the substance leaves your body. They can include nausea, vomiting, diarrhea, sweating, trouble sleeping, muscle cramps and mood changes.

You might not notice some of the subtle signs. Pay attention to your intuition. If you see some of these signs, your loved one may have an unhealthy relationship with substances. Or, you may recognize some of these habits in your own life.

Symptoms of SUD can vary by substance, but may include:⁵

• Taking more of a prescribed medication or for longer than directed
• Cravings
• Withdrawal symptoms
• Needing more to get the same effect
• Problems keeping up with work, school or home responsibilities
• Spending time getting, using or recovering from the substance
• Trying to cut back or stop, but not being able to
• Using it even when it makes a physical or mental health problem worse

No single thing causes SUD. Risk comes from a mix of factors. The more risk factors a person has, the higher the chance of addiction. These may include:^{4, 6}

• Family history of addiction
• Mental health conditions like depression, attention-deficit/hyperactivity disorder (ADHD) or PTSD
• Peer pressure, especially for teens
• Starting drug use at a young age, when the brain is still developing
• Stress at home or family conflict
• Using highly addictive drugs like cocaine, stimulants and opioid pain medicines

If you have chronic pain and are concerned about taking medications that have the potential to lead to addiction, consider other interventions. These may include physical therapy, meditation, yoga, acupuncture or cognitive behavioral therapy (CBT). There are also pain medications that do not have addiction potential. Talk to your provider to find a plan that works best for you.⁷

If you feel like your alcohol or drug use is out of control, help is available. The sooner you seek help, the greater your chances for a long-term recovery.

Talk to your healthcare provider if you’re using substances regularly and are unable to stop on your own.

There is no one right way to help a loved one who has SUD. But family support can make a big difference.

When someone has SUD, it can affect everyone around them. Support groups, family therapy and counseling can help the person in treatment and their loved ones too.

Helping a loved one can be stressful. Caregivers should take care of their own health, too. Family and friends may notice changes in mood or behavior first. Their support can help a loved one connect with treatment, resources and services and stay on the path to recovery.⁸