Substance Use Disorder: Identifying the Red Flags
The signs and symptoms of substance use disorder can be different for each person and can be categorized as physical, psychological, or behavioral.
If you or someone you know is regularly using a substance like alcohol, tobacco, or opioids in a way that causes harm to oneself or others, you may be concerned that they are experiencing a substance use disorder.
SUD is a challenging and complicated condition that impacts over 21 million individuals in the United States. This number is greater than the number of people who have any type of cancer combined.
It is crucial to understand that substance use disorder (SUD) is not caused by a person’s behavior or lack of willpower, as many misconceptions suggest.
Instead, biological factors that are beyond an individual’s control play a significant role in the development of the condition. The activation of the brain’s reward center is the primary reason for most SUDs. Whether a person is addicted to alcohol, stimulants, or opioids, the rewarding feeling obtained from substance use, which involves an abnormally high release of dopamine, can be overwhelming.
Continued use of the substance may cause changes in the brain’s structure and function, leading to intense cravings, withdrawal symptoms, learning and memory problems, and changes in personality.
Identifying the indications and indications of substance use disorder is often the initial step in seeking assistance and getting treatment.
Types of substance use disorder
Substances for which an individual can form a substance use disorder include:
- hallucinogens, including LSD and phencyclidine
- inhalants
- heroin or prescription medications
- sedatives, hypnotics (sleep-inducing medications), or anxiolytics (anti-anxiety medications)
- stimulants like amphetamines or cocaine
- tobacco
Dependence on two or more substances is common. For example, evidence suggests that among people with heroin use disorder:
- over 66% are also dependent on nicotine
- nearly 25% have alcohol use disorder
- over 20% have use disorder
Similarly, among those with cocaine use disorder:
- nearly 60% have alcohol use disorder
- about 48% are dependent on nicotine
- over 21% have cannabis use disorder
Signs and symptoms of substance use disorder
The indications and manifestations of substance use disorder can vary greatly from person to person, depending on factors such as the type of substance, the duration and severity of use, and the individual’s personality. The following are some common symptoms of substance use, but it is important to note that they can vary.
Physical signs of substance use disorder
- sudden weight loss or gain
- pupils that are smaller or larger than usual
- bloodshot eyes
- changes in appetite and sleeping patterns
- slurred speech
- impaired coordination or tremors
- deterioration of physical appearance or changes in grooming practices
- runny nose
- unusual odors on breath, body, or clothes
Psychological signs of substance use disorder
- feeling paranoid, anxious, or fearful
- unexplained change in personality
- feeling “spaced out”
- lack of motivation
- feeling excessively tired
- periods of excessive energy, mental instability, or restlessness
- sudden
- increased agitation or anger
Behavioral signs of substance use disorder
- beginning to act in a secretive or suspicious way
- experiencing problems in relationships due to the condition
- using more than originally intended (being unable to control the substance use)
- neglecting family and friendships, as well as duties at home, school, or work
- getting into legal trouble, including driving under the influence, fights, or accidents
- suddenly changing hobbies, friends, or activities
- using the substance under conditions that may not be safe, such as sex without a condom or other barrier method, driving under the influence, or using syringes that are not sterile
- experiencing sudden unexplained financial problems, which may include frequently asking for money or stealing
- frequently trying to avoid or relieve withdrawal symptoms
- experiencing increased tolerance for the substance, which may cause the person to use more and more of it
- noticing that life revolves around substance use and recovering from use, e.g., always thinking about using or consumed with how to get more
- no longer engaging in previously enjoyed activities due to substance use
- continuing to use despite negative health consequences
What is the process for diagnosing substance use disorder?
Healthcare professionals may use a brief screening to evaluate a person’s risk for SUD, followed by a more in-depth assessment and a referral to a licensed alcohol and drug counselor, psychologist, or psychiatrist for further evaluation.
The UNCOPE questionnaire is a commonly used brief screening tool for substance use disorder.
The UNCOPE screening consists of a set of questions designed to identify the risk of substance use disorder, and it has been found to be effective in identifying SUD based on both the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4 and DSM-5).
The questionnaire includes the following inquiries:
- Have you continued to use alcohol or drugs longer than you originally planned?
- Have you ever neglected some of your usual responsibilities because of your substance use?
- Have you ever wanted to cut back or quit using the substance but could not?
- Has a loved one or anyone else ever told you they objected to your alcohol or drug use?
- Have you ever found yourself preoccupied with the thought of using alcohol or drugs?
- Have you ever used alcohol or drugs to soothe emotional pain, such as sadness, anger, or boredom?
To make a formal diagnosis of substance use disorder, healthcare professionals typically rely on the 11 criteria listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- feeling as if you have to consume the substance regularly (daily or several times a day) and more than originally planned
- spending a large portion of your time finding, using, and/or recovering from the substance
- craving the substance
- needing more of the substance to get the same effect
- experiencing withdrawal when you stop taking the substance
- being unable to meet obligations at home, work, or school because of using the substance
- recurring thoughts of quitting but not managing to quit successfully
- continuing to use despite the problems it causes in relationships
- continuing to use despite mental or physical health problems caused or worsened by it
- giving up or cutting back on social or recreational activities due to the substance use
- using the substance under situations that may be unsafe, such as driving under the influence or using syringes that are not sterile
The DSM-5 specifies that the severity of substance use disorder can be classified as mild, moderate, or severe based on the number of symptoms a person experiences within a 12-month period.
The following number of symptoms are required to diagnose a person with mild, moderate, or severe SUD, according to the DSM-5 criteria:
- Mild: 2–3 symptoms
- Moderate: 4–5 symptoms
- Severe: 6 or more symptoms
Dual diagnosis
A dual diagnosis refers to the presence of both a substance use disorder and a mental health disorder in an individual.
Diagnosing individuals with both substance use disorder and a mental health condition, also known as a dual diagnosis, can be more complicated. This is because it can be challenging to differentiate between overlapping symptoms of withdrawal and those of mental illness.
The National Survey on Drug Use and Health found that in 2019, approximately 9.5 million adults in the United States were affected by both a mental illness and a substance use disorder.
Individuals who have both a substance use disorder and a mental health condition, also known as a dual diagnosis, may experience more severe and persistent symptoms, which may be harder to treat than those with just an SUD.
Next steps
Signs and symptoms of substance use disorder vary from person to person. The most noticeable signs include:
- disinterest in school, work, or other activities
- physical health issues like bloodshot eyes, lack of energy, or weight loss or gain
- lack of interest in grooming or keeping clean
- behavioral changes like acting in a secretive manner, increased irritability or changes in mood, or being fearful or paranoid
- financial problems
Recognizing these signs and symptoms may be the first step toward recovery.
If you or someone you know is experiencing signs and symptoms of a substance use disorder, seeking help is an important step towards recovery. It is recommended to consult with a trusted healthcare professional to determine the best course of action.
However, if you are not ready to seek professional help or would like to explore more resources, the following organizations offer additional support groups and resources:
- The Substance Abuse and Mental Health Services and Administration’s (SAMHSA) national helpline is a free and confidential 24-hour referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
- Alcoholics Anonymous and Narcotics Anonymous are well-known 12-step groups for individuals recovering from alcohol or drug addiction.
- Double Trouble in Recovery is a 12-step fellowship for people managing both mental illness and substance use disorders.
5 sources
- Common comorbidities with substance use disorders research report: What are some approaches to diagnosis? (2020).
drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/what-are-some-approaches-to-diagnosis - DSM-5 criteria for addiction simplified. (2020).
addictionpolicy.org/post/dsm-5-facts-and-figures - Key substance use and mental health indicators in the United States: Results from the 2018 national survey on drug use and health. (2018).
samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf - Proctor SL, et al. (2016). The UNCOPE: An effective brief screen for DSM-5 substance use disorders in correctional settings.
pubmed.ncbi.nlm.nih.gov/27136373/ - Surgeon General issues landmark report on alcohol, drugs and health. (2016).
niaaa.nih.gov/news-events/news-noteworthy/surgeon-general-issues-landmark-report-alcohol-drugs-and-health