5 signs someone you love is struggling with substance misuse or addiction

Misuse of alcohol or drugs is more common than you might think. More than 21% of Americans used an illegal drug or misused a prescribed drug in the past year.  

And 30 million say they’ve had at least one day of binge drinking. (For men, that means having more than five alcoholic drinks in one sitting. For women, it’s four drinks.) 

Sometimes the misuse is an occasional or one-time thing. But for millions of people, it can bloom into addiction. Both can have a major impact on physical and mental health.  

Friends and family members tend to suffer too. And it’s not always easy to know how to help. That’s why it’s key to know the difference between substance misuse and addiction (also called substance use disorder).  

“Substance misuse is when a person uses drugs or alcohol in a way that’s harmful to themselves or others,” says Flora Sadri-Azarbayejani, DO. She’s a specialist in addiction medicine at Psyclarity Health in Boston. This may include: 

• Using more of a substance than they meant to 
• Using a substance longer than they planned 
• Using a substance in a dangerous way   

Substance use disorder happens when these habits affect a person’s day-to-day functioning. For example, their job or their home life. Not everyone who misuses substances will get addicted. But it does increase the risk.  

Here are 5 common warning signs that someone you love may have a problem. Plus, expert advice on how to help them get the care they need.  

Sign 1: They're more moody, irritable, or anxious 

We all get a little moody now and then. With substance misuse or addiction, the mood swings are more extreme than usual. The person may be happy one minute, then angry or depressed the next, says Heather Wilson, LCSW. She’s a behavioral health counselor in New Jersey. 

Your loved one may also act different. For example, they might be: 

• More aggressive 
• Paranoid (suspicious and fearful) 
• Impulsive 

Sign 2: They’re more of a loner  

Is your friend or loved one harder to get in touch with than usual? It may signal a problem.  

“They may start canceling plans or stop returning phone calls or texts,” says Wilson. This is often because they’re trying to hide their substance use, or they’re ashamed of it. And they don’t want to be around people they care about while they’re using, says Wilson.   

Sign 3: They’re ignoring their responsibilities  

You may notice them missing work or school. Or maybe they’ve stopped cleaning their house or paying bills on time. “This can be a sign that something is taking over their life, and they’re struggling to cope,” says Dr. Sadri-Azarbayejani. 

Sign 4: Their appearance has changed 

The theme here is “different than usual.” Is your messy brother Mike still a mess? That’s likely just Mike being Mike. But if your super stylish friend stops caring about how she looks? Well, that could be a red flag.  

Some substances can also have physical side effects, says Wilson. Common signs include: 

• Rapid weight loss 
• Skin sores 
• Bloodshot eyes 

Sign 5: They’re making bad choices 

Driving drunk or high. Having unprotected sex. Damaging other people’s property. Risky behaviors like these can be signs of substance misuse or addiction.  

And they can put the person in danger. That’s one reason why it’s key to step in and help your loved one get treatment. 

The signs are there. Now what? 

Worried about someone you love? It’s important to reach out and see if they need help. Here are a few tips on how to start the conversation. 

Leave judgment behind  

Pick a time when they’re sober and you’re both feeling calm. Then bring up your concerns and see if they’re willing to talk. Focus on letting them know that you’re worried and why. 

Stick to the facts and try not to judge them. And be as specific as possible. For example, mention that they canceled plans on you three times in the past month.   

Try using “I” phrases like “I’ve noticed” or “I’m worried.” They can’t dispute how you feel. On the other hand, saying things like “You never hang out anymore” may feel like a personal attack. 

Listen to their side 

Now listen to what your loved one has to say. This can be a difficult thing to do. Don’t interrupt or try to offer solutions right away. “Just let them know that you’re there for them, and you’re willing to help in any way you can,” says Dr. Sadri-Azarbayejani. 

What if your first attempt at talking doesn’t go well? You can try again later. 

Ask questions 

Try to get a clear sense of what substances they’re taking and how often. This can help you figure out how to help them. Just know that they may not be honest with their answers. 

Offer support 

Don’t expect to solve their problems in your first chat. But do suggest ways you can be there for them. That might include: 

• Finding resources like local support groups 
• Going to therapy or support group sessions together 
• Being available to talk  

Get professional help  

Your loved one doesn’t have to go it alone. And neither do you. It can be helpful for you to talk to substance use experts. This could include speaking to: 

• Their provider 
• A therapist (your loved one’s or your own) 
• A help line  

Another trustworthy option: The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) help line. Call 1-800-662-HELP. 

What’s the bottom line?  

Remember, you can’t force your loved one to get help or change their behavior. “The person must want to recover for themselves,” says Wilson. And not just to please family or friends. 

The good news: With help and support, your loved one can change their behavior and live a happy and healthy life. They just need to be ready to take the first step. 

Article sources: 

Statistics on substance use: Monitoring the Future Monograph Series; National Center for Drug Abuse Statistics 
Treatment overview: Centers for Disease Control and Prevention 

Talking to a loved one: Hazelden Betty Ford Foundation; Gateway Foundation