How to spot signs of addiction

Man's hand reaching for a glass of whiskey on ice

Many people can hide a problem with drinking or using drugs, sometimes for years, until it becomes severe.

For someone who abuses opiates such as heroin or oxycodone, the drugs make them feel “normal.” So they can get along seemingly well — until the drug wears off.

Why can’t they stop, some may wonder. This is exactly the same question the person who misuses drugs or alcohol asks themselves over and over. Someone might realize that staying in the cycle of using drugs or drinking excessively is dangerous, and they might want to quit, but they can’t. It’s a frightening place to be — for the user and for all who care about them.

To determine if you should refer someone to a mental health professional, look for these signals:

  • Signs of withdrawal after a short period of not using. Those signs can include shaking, nausea, anxiety, increased heart rate or blood pressure, sweating, runny nose or diarrhea.
  • Lying about use, especially about how much or often they’re drinking or using drugs.
  • Defensiveness or anger when confronted about drinking or drug use.
  • Hiding or sneaking alcohol, drugs or supplies.
  • An inability to keep promises to stop or cut down.
  • Drinking or using drugs at inappropriate times, such as at work, school or just before or while driving.
  • Signs of needle punctures and track marks (scars, bruising, and visible dark veins) usually on the arms.
  • An ability to drink more than most people and keep functioning, also known as high alcohol tolerance.
  • More than one significant consequence such as a second DUI offense or a second write-up at work.
  • Blackouts, which are periods of time when drinking/using drugs that they cannot remember.

How do you know if the problem is abuse or addiction?

Someone who abuses alcohol or uses drugs may or may not become addicted. An assessment by a credentialed mental health professional is the best way to find out if someone has a substance use disorder.

When does a problem become a substance use disorder?

Any time someone has significant trouble getting to work or school, paying bills, showing up for family members, alcohol or drug use could be the reason. But how do you know? Here are some signs.

If the problem has advanced to a substance use disorder, a person typically experiences all four of these:

Can’t control drinking or drug use

This doesn’t mean someone loses control every time they drink or use drugs. Instead, it means someone can’t always predict whether they will drink or use drugs more than they had intended. An example of this is when someone plans to just have one drink and ends up closing down the bar.

Struggle with functioning, socializing, health

Typically, others will notice someone is having problems long before the person sees it in themselves. It may take a while for someone to realize they have a problem because nothing bad may have happened — yet. An example of this is someone who drives while intoxicated may arrive home OK, many, many times. So they keep doing it. A person who misuses drugs might keep using street drugs, despite the risk that some may contain fentanyl, a synthetic opioid that can kill them.

Obsess about alcohol or drugs

Someone may not think about alcohol or drugs 24/7, but at times they can’t think about anything else. Take for example a smoker’s behavior after a few hours without a cigarette. Someone with an alcohol abuse problem may be so sidetracked by thoughts of the next drink they can’t focus on the PTA meeting they’re sitting in or they miss the meeting.

Feel anxious when the supply is out

Fear of withdrawal can make a person with an alcohol or drug use problem vigilant to ensure they have enough of the alcohol or drug on hand — or a reliable source for it. If their supply is in doubt, the person can get anxious. So for someone with a drug use disorder, going on a family vacation where they can’t control their supply can feel threatening.

How does an addiction affect the brain?

When we repeat a behavior, our brain creates new nerve pathways that make the behavior easier and more automatic. Picking up a new sport or learning to play an instrument is difficult at first, but once these connections get made, you don’t have to “think” about it anymore; your brain just does it. This happens when we take drugs over time. The brain makes changes to make it easier to function with the drug in our system.

Unfortunately, these changes occur in the lower parts of the brain, the limbic system, that regulate our basic survival drives like hunger and thirst. Over time, we develop a “drug hunger” we call a “craving” that can get so strong that we find ourselves doing what we thought we would never do. This is when the drug use becomes an addiction.

The difference between alcohol addiction and heavy drinking is whether or not alcohol stimulates that reward pathway in the limbic system. In nine out of 10 people, it doesn’t. In one out of 10 people, alcohol indirectly stimulates this pathway, creating the addiction. Whether a person is in the nine out of 10 or in the one out of 10 depends on their genes. Alcohol addiction has a very strong genetic component. For nearly every person with an alcohol addiction, you can find another in their family tree.

Does one addiction often lead to another or occur at the same time as another addiction?

Substance use disorders or other addictions such as those to sex, gambling and spending, all come from changes to certain pathways in the brain. How vulnerable a person is to a compulsive behavior has to do with a person’s genes, their environment and early life experiences. It’s common to see someone shift from one addiction to another one, say from alcohol to sex or cocaine to gambling.


Help for substance use disorders

Ohio State is a leader in the treatment of substance use disorders in central Ohio.

Learn more


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