Substance abuse is on the rise
Learn how to identify the signs and symptoms of substance abuse and when to seek help.
Opioid overdoses are on the rise
Our nation is in the midst of an unprecedented opioid epidemic.1 Nearly 841,000 people have died since 1999 from a drug overdose. Over 70% of drug overdose deaths in 2019 involved an opioid.2
Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased over six times since 1999.3 Overdoses involving opioids killed nearly 50,000 people in 2019, and nearly 73% of those deaths involved synthetic opioids.4
People struggling with substance abuse may need help from the medical community, family, friends, support groups, employers or organized treatment programs to overcome drug addiction and stay drug-free.
What are the signs and symptoms of drug or substance abuse?
Drug addiction often starts with social or experimental use. For some, the drug use becomes more frequent. The risk of addiction and how quickly dependence strikes varies by individual and by substance. Some drugs have a much higher risk and cause dependency much faster than others. For example, opioids are some of the most addictive drugs in the world.
As time goes on, users can develop a tolerance to drugs and require higher doses to achieve the original effect. Soon they may need the drug just to feel good. As use increases, individuals may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings or make them feel physically ill (symptoms of withdrawal).
Addiction is a complex condition that cannot be limited to one simple or causal explanation. Genetics, environment, medical or physical history, and mental health can all influence the development of addiction.
Drug addiction symptoms or behaviors can include:
- Needing to use the drug regularly — this can be daily or even several times a day
- Intense urges for the drug
- Needing more of the drug to get the same effect
- Needing to maintain a consistent supply of the drug
- Spending money on the drug, even though they may not be able to afford it
- Not meeting obligations and work responsibilities
- Cutting back on social or recreational activities because of drug use
- Doing things they normally wouldn’t do to get the drug, like stealing
- Driving or doing other high risk activities while under the influence of the drug
- Focusing more time and energy on getting and using the drug
- Failing in attempts to stop using the drug
- Experiencing withdrawal symptoms when attempting to stop taking the drug
Indications that family members or coworkers are using could include:
- Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
- Physical health issues — lack of energy and motivation
- Neglected appearance — lack of interest in clothing or grooming
- Changes in behavior — being secretive about plans with others; or drastic changes in behavior and relationships with family and friends
- Spending money — sudden requests for money without reasonable explanation; money or items missing, indicating they being sold to support drug use
When is the right time to seek emergency help?
Seek emergency help if someone you know has taken a drug and:
- May have overdosed
- Shows changes in consciousness
- Has trouble breathing
- Has seizures or convulsions
- Has signs of a possible heart attack, such as chest pain or pressure
- Has any other troublesome physical or psychological reaction to use of the drug
What causes drug addiction and substance abuse?
Like many mental health disorders, several factors may contribute to development of drug addiction and dependence. The main factors are:5
- Environment. Environmental factors, including family beliefs and attitudes or exposure to a peer group that encourages drug use, may play a role in initial drug use.
- Genetics. Once drug use is initiated, the development into addiction may be influenced by inherited (genetic) traits, which may delay or speed up the disease progression.
- Changes in the brain. Addiction may occur when repeated use of a drug modifies the pleasure sensors in the brain. The addicting drug causes physical changes to some nerve cells (neurons) in the brain. Neurons use chemicals called neurotransmitters to communicate. The effects can remain even long after discontinued use.
What are some of the primary risk factors for substance abuse?
Addiction does not discriminate by age, gender or economic status. However, certain factors can affect the likelihood and speed of developing an addiction:6
- Family history of addiction. Drug addiction is more common in some families and likely involves genetic predisposition. If blood relatives, such as a parent or sibling, have alcohol or drug problems, there is a greater risk of developing a drug addiction.
- Being male. Men are more likely to have problems with drugs than women are. However, progression of addictive disorders is known to be faster in females.
- Having another mental health disorder. Mental health disorders such as depression, attention-deficit/hyperactivity disorder (ADHD) or post-traumatic stress disorder, can increase the likliehood of becoming dependent on drugs.
- Peer pressure. Peer pressure is a strong factor in starting to use and abuse drugs, particularly for young people.
- Anxiety, depression and loneliness. Using drugs can become a way of coping with these painful psychological feelings and can make these problems even worse.
- Taking a highly addictive drug. Some drugs, such as stimulants, cocaine or painkillers, may result in faster development of addiction than other drugs. However, taking drugs considered less addicting — so-called "light drugs" — can start someone on a path to further drug use and addiction.
How can I spot a specific substance abuse problem?6
Drug use and intoxication signs and symptoms can vary by substance. If someone you know has a substance abuse problem, visit the Substance Abuse and Mental Health Services Administration website for helpful recovery and addiction treatment options and locations.
SAMHSA National Helpline:
1-800-662-HELP (4357)
1-800-487-4889 (TDD)
Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms. Signs and symptoms may include:
- Inability to limit alcohol consumption
- Spending a lot of time drinking or recovering from alcohol use
- Feeling a strong craving or urge to drink alcohol
- Failing to fulfill obligations at work, school or home due to repeated alcohol use
- Continued use of alcohol despite physical, social or interpersonal problems
- Giving up or reducing social and work activities or hobbies
- Using alcohol in during unsafe activities, such as driving
- Developing a tolerance to alcohol and needing more to feel its effect
- Experiencing withdrawal symptoms - such as nausea, sweating and shaking - or drinking to avoid symptoms
- Behavior problems and mental changes such as inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination.
People use cannabis by smoking, eating, or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or other illegal drugs, and is often considered a “gateway drug”.
Signs and symptoms of recent use can include:
- A sense of euphoria or feeling "high"
- A heightened sense of visual, auditory and taste perception
- Increased blood pressure and heart rate
- Red eyes
- Dry mouth
- Decreased coordination
- Difficulty concentrating or remembering
- Increased appetite
- Slowed reaction time
- Paranoid thinking
Long-term (chronic) use is often associated with:
- Decreased mental sharpness
- Poor performance at school or work
- Reduced number of friends and interests
Opioids are narcotic, painkilling drugs produced from opium or made synthetically. This class of drugs includes heroin, morphine, codeine, methadone, oxycodone and fentanyl, to name a few. According to the CDC, 91 Americans die every day from an opioid overdose.
Signs and symptoms of opioid use and dependence can include:
- Euphoria or feeling "high"
- Reduced sense of pain
- Drowsiness or sedation
- Slurred speech
- Problems with attention and memory
- Constricted pupils
- Lack of awareness or attention to surrounding people and things
- Problems with coordination
- Depression
- Confusion
- Sweaty, clammy skin
- Runny nose or nose sores (if snorting drugs)
- Needle marks (if injecting drugs)
Barbiturates and benzodiazepines are prescription central nervous system depressants. They're often used and abused in search for a sense of relaxation or to forget stress-related thoughts or feelings.
Barbiturate drugs include phenobarbital, amobarbital (Amytal),secobarbital (Seconal Sodium) and more.
Examples of benzodiazepines include sedatives such as diazepam (Valium), alprazolam (Xanax, Niravam), lorazepam (Ativan), clonazepam (Klonopin) and chlordiazepoxide (Librium).
Signs and symptoms of recent use can include:
- Drowsiness
- Slurred speech
- Lack of coordination
- Euphoria or an exaggerated feeling of well-being
- Problems concentrating or thinking
- Memory problems
- Involuntary eye movements (nystagmus)
- Lack of inhibition
- Slowed breathing and reduced blood pressure
- Dizziness
- Depression
Stimulants like amphetamines, meth (methamphetamine), cocaine and methylphenidate (Ritalin) are often used or abused in search of a "high," or to boost energy, improve performance at work or school, or to lose weight or control appetite.
Signs and symptoms of recent use can include:
- Feeling of exhilaration and excess confidence
- Increased alertness
- Increased energy and restlessness
- Behavior changes or aggression
- Rapid or rambling speech
- Dilated pupils
- Delusions and hallucinations
- Irritability or changes in mood
- Changes in heart rate and blood pressure
- Nausea or vomiting with weight loss
- Impaired judgment
- Nasal congestion and damage to the mucous membrane of the nose (if snorting drugs)
- Insomnia
- Paranoia
- Depression as the drug wears off
Club drugs are commonly used at clubs, concerts and parties. Examples include Ecstasy or Molly (MDMA), gamma-hydroxybutyric acid (GHB), flunitrazepam (Rohypnol, or roofie) and ketamine. These drugs are not all in the same category, but they share some similar effects and dangers, including long-term harmful effects.
Because GHB and Rohypnol can cause sedation, muscle relaxation, confusion and memory loss, the potential for sexual misconduct or sexual assault is associated with the use of these drugs.
Signs and symptoms of use of club drugs can include:
- Hallucinations
- Paranoia
- Dilated pupils
- Chills and sweating
- Involuntary shaking (tremors)
- Behavior changes
- Muscle cramping and teeth clenching
- Reduced inhibitions
- Heightened or altered sense of sight, sound and taste
- Decreased coordination
- Poor judgment
- Memory problems or loss of memory
- Reduced consciousness
- Increased or decreased heart rate and blood pressure
Use of hallucinogens can produce different signs and symptoms, depending on the drug. The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP).
LSD use may cause:
- Hallucinations
- Greatly reduced perception of reality, for example, interpreting input from one of the senses as another, such as “hearing colors”
- Impulsive behavior
- Rapid shifts in emotions
- Permanent mental changes in perception
- Rapid heart rate and high blood pressure
- Tremors
- Flashbacks, a re-experience of the hallucinations — even years later
PCP use may cause:
- A feeling of being separated from their body and surroundings
- Hallucinations
- Problems with coordination and movement
- Aggressive, possibly violent behavior
- Involuntary eye movements
- Lack of pain sensation
- Increase in blood pressure and heart rate
- Problems with thinking and memory
- Problems speaking
- Impaired judgment
- Intolerance to loud noise
- Sometimes seizures or coma
[2] CDC. (2015). MMWR, 62;1-5
[3] CDC. (2013). Vital Signs, 1487-1492
[4] Department of Health and Human Services (Updated 2016, June). Fact Sheet: The Opioid Epidemic [Web log post].
[5] Prescription Drug Abuse. (2005-2017) WebMD, LLC [web log post].
[6] Substance Abuse and Addiction. (2005-2017) WebMD, LLC [web log post].