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Signs and Symptoms of Substance Use and Misuse Disorders

Although different drugs have different physical effects, the symptoms of addiction are similar. If you can recognize yourself in the following signs and symptoms of substance use/misuse and addiction, know that there is help and hope for you.

Common Signs of Substance Use/Misuse

Neglecting responsibilities:at school, work, or home (failing classes, skipping work, neglecting your children)

Using drugs under dangerous conditions or taking risks while under the influence: such as driving while intoxicated, using unclean needles, or having unprotected sex

Problems in your relationships:such as fights with your partner or family members, an unhappy boss, or loss of friends

Experiencing legal trouble:such as arrests for disorderly conduct, stealing, vandalism, driving while intoxicated

Common Signs and Symptoms of Addiction

You’ve built up a tolerance to substances:You need more of the drug to experience the same affects you used to attain with smaller amounts.

You use a drug to avoid or relieve withdrawal symptoms: If you go too long without drugs, you experience symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.

Loss of control over your drug use:You often use substances or use more than you planned, even though you told yourself you wouldn’t. You may want to stop using the drug, but you feel powerless. 

Your life revolves around substance use:You spend a lot of time using and thinking about drugs, figuring out how to get them, or recovering from the drug’s effects.

You’ve abandoned activities you used to enjoy: such as hobbies, sports, socializing, because of your substance use.

You continue to use drugs, despite knowing it’s hurting you: It’s causing major problems in your life- blackouts, financial issues, mood swings, depression, paranoia- but you continue to use the substance. 

Signs that a friend or loved one may be misusing substances:  

Those suffering from substance use/misuse disorders often try to conceal their symptoms and downplay their problem. If you’re worried that a friend or loved one might be misusing drugs, look for the following warning signs:

Physical signs: Bloodshot eyes, pupils larger or smaller than usual, changes in appetite or sleep patterns, sudden weight loss or weight gain, deterioration of physical appearance, personal grooming habits, unusual smells on breath, body, or clothing, tremors, slurred speech, or impaired coordination. 

Behavioral signs: Drop in attendance or performance at work/school, unexplained financial problems, borrowing or stealing, engaging in secretive or suspicious behavior, sudden change in friends, favorite hangouts, or hobbies, frequently getting intro trouble (fights, accidents, illegal activities, legal trouble).

Psychological signs: Unexplained changes in personality or attitude, sudden mood swings, irritability, or angry outbursts, periods of unusual hyperactivity, agitation, or giddiness, lack of motivation, appears lethargic or “spaced out”, appears fearful, anxious, or paranoid

If you believe a loved one or friend may have a substance use/misuse disorder or addiction, here are a few things you can do:

Speak up:Talk to the person about your concerns and offer your help and support without judging them (look at the LANGUAGE MATTERS page). The earlier an individual can enter into treatment, the better. Don’t wait for your loved one to hit bottom. List specific examples of your loved one’s behavior that you are concerned about and help them find ways to seek help.

Take care of yourself:Stay safe. Don’t put yourself in dangerous situations. Don’t get so caught up in someone else’s problem that you neglect your own needs. Make sure you have people you can talk to and lean on for support. There are a lot of local groups and resources that you can use for support. 

Avoid self-blame:You can support a person with a substance use/misuse/addiction and encourage treatment, but you cannot force someone to change. You cannot control your loved one’s decisions. Letting the person accept responsibility for their actions is an essential step along the way to recovery. 

Don’t:

Attempt to punish, threaten, bribe or preach. Don’t try to be a martyr. Avoid emotional appeals that may only increase feelings of guilt and the compulsion to use drugs. Don’t cover up or make excuses for your loved one, or shield them from the negative consequences of their behavior. Don’t take over their responsibilities, leaving them with no sense of importance or dignity. Don’t hide or throw away drugs. Avoid arguing with them if you believe they are under the influence. Don’t every participate in substance use with them. And don’t feel guilty or responsible for their behavior. 

Substance Use/Misuse and Mental Health

Dealing with drug or alcohol addiction and co-occurring mental health disorders

When you have both a substance use/misuse disorder and a mental health illness, such as depression, anxiety, or bipolar disorder, it is called a co-occurring disorder or dual diagnosis. Dealing with substance use, alcoholism, or addiction is never easy, and it’s even more difficult when you’re also struggling with mental illness. But there is hope. There are plenty of treatments and steps you can take to help you on the road to recovery. With the right support, self-help, and treatment, you can overcome a co-occurring disorder, reclaim your sense of self, and get your life back on track. 

What is the link between substance use/misuse and mental health?

In co-occurring disorders, both mental illness and the drug or alcohol addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties, and relate to others. To make it more complicated, the co-occurring disorders also affect each other. When a mental illness goes untreated, the substance use/misuse problem usually increases too. But you’re not alone. Co-occurring substance use/misuse problems and mental illness are more common than people realize. 

-Roughly 50% of individuals with severe mental disorders are affected by substance use/misuse disorders

-37% of individuals with alcohol misuse disorders and 53% of substance use/misuse disorders also have at least one serious mental illness

-Of all people diagnosed with a mental illness, 29% misuse either alcohol or drugs

While substance use/misuse disorders and mental illness don’t get better when they’re ignored- in fact, they are likely to get much worse- it’s important to know that you don’t have to feel this way. There are things you can do to conquer these challenges, repair your relationships, and start enjoying life again. 

Dual diagnosis and denial

Complicating a dual diagnosis is denial. Denial is common in substance use/misuse. It’s often hard to admit how dependent you are on alcohol or drugs or how much they affect your life. Denial frequently occurs in mental disorders as well. The symptoms of depression or anxiety can be frightening, so you may ignore them and hope they go away. Or you may be ashamed or afraid of being viewed as weak if you admit you are struggling. Substance use/misuse and mental illness can happen to any of us. And admitting you have a problem and seeking help is the first step on the road to recovery. You have nothing to be ashamed of and you are not alone. 

The chicken or the egg: 

What comes first? Substance misuse or mental illness?

Substance use/misuse and mental illness such as depression and anxiety are closely linked, and while some substance misuse can cause prolonged psychotic reactions, one does not directly cause the other. However:

Alcohol and drugs are often used to self-medicate the symptoms of mental health disorders. People often misuse alcohol or drugs to ease the symptoms of an undiagnosed mental illness, to cope with difficult emotions, or to temporarily change their mood. Unfortunately, misusing substances causes side effects and in the long run often worsens the symptoms they initially helped to relieve.

Alcohol and drug use/misuse can increase the underlying risk for mental illness.Mental health disorders are caused by a complex interplay of genetics, the environment, and other outside factors. If you are at risk for a mental illness, misusing alcohol or other drugs may worsen an underlying mental health issue. There is some evidence, for example, that certain misusers of marijuana have an increased risk of psychosis while those who misuse opioid painkillers are at greater risk for depression. 

Alcohol and drug use/misuse can cause symptoms of a mental illness worse.Substance misuse may sharply increase symptoms of mental illness or even trigger new symptoms. Misuse of alcohol or drugs can also interact with medications such as anti-depressants, anti-anxiety medications, and mood stabilizers, making them less effective at managing symptoms. 

Do I have a substance misuse disorder and co-occurring mental illness?

It can be difficult to diagnose a substance use/misuse problem and a co-occurring mental illness. It takes time to tease out what might be a mental disorder and what might be an alcohol or drug issue. The signs and symptoms vary depending upon both the mental illness and the type of drug being misused. 

-Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?

-Have you noticed a relationship between your substance use and your mental health? For example, do you feel depressed when you use alcohol?

-Has someone in your family been diagnosed with either a mental health disorder or an alcohol/substance misuse disorder? 

-Do you feel depressed or anxious even when you’re sober? 

-Do you have unresolved trauma or a history of abuse?

-Have you previously been treated for either addiction or mental health disorders? 

Signs and symptoms of substance misuse 

While these questions do not encompass all that may identify a substance misuse disorder, they are helpful in beginning to explore what you may be facing:

-Have you ever felt you should cut down on your drinking or drug use?

-Have you tried to cut back, but couldn’t?

-Do you ever lie about how much or how often you use alcohol or other drugs?

-Are you going through prescription medication at a faster than expected rate?

-Have your friends or family members expressed concern about your alcohol or drug use?

-Do you ever feel bad, guilty, or ashamed about your drinking or drug use?

-On more than one occasion, have you done or said something while drunk or under the influence of drugs that you later regretted?

-Have you ever blacked out from drinking or drug use?

-Has your alcohol or drug use caused problems in your relationship?

-Has your alcohol or drug use gotten you into trouble at work or with the law?

Signs and symptoms of common mental health disorders that 

co-occur with substance use/misuse disorders

Depression

-Feelings of helplessness and hopelessness, strong feelings of worthlessness or guilt

-Loss of interest in daily activities

-Inability to experience pleasure

-Appetite, weight, or sleep changes

-Loss of energy, difficulty concentrating

-Anger, physical pain, reckless behavior

Anxiety

-Excessive tension and worry, irritability or feeling “on edge”

-Feeling restless or jumpy

-Racing heart or shortness of breath

-Nausea, trembling, or dizziness

-Muscle tension, headaches

-Difficulty concentrating

-Insomnia

Mania in Bi-polar Disorder

-Feelings of euphoria or extreme irritability, anger or rage

-Unrealistic, grandiose beliefs

-Decreased need for sleep, hyperactivity

-Increased energy, rapid speech and racing thoughts

-Impaired judgement and impulsivity

Treatment for substance use/misuse and mental illness

The best treatment for co-occurring disorders is an integrated approach, where both mental health and substance use are treated simultaneously. Whether your mental health or substance use disorder came first, long-term recovery depends on getting treatment for both disorders by the same treatment provider or team. 

Treatment for your mental health may include medication, individual or group counseling, lifestyle changes, and peer support

Treatment for substance use/misuse disorders may include detoxification, managing withdrawal, behavioral therapy, and support groups to maintain your sobriety.

Keep in Mind

There is always hope: Both mood disorders and alcohol and drug misuse are treatable conditions. Recovering from co-occurring disorders takes time, commitment, and courage. Individuals CAN and DO get better with commitment and patience.

It’s important to maintain your sobriety during treatment:If your doctor needs to prescribe medication for your mental illness, mixing it with drugs or alcohol could have serious negative effects. Similarly, many treatment options are far less effective if you’re under the influence of mind-altering substances.

Relapses are a part of recovery: Don’t get too discouraged if you relapse. Slips and setbacks happen, but with hard work, most people can recover from their relapses and move forward with positive change.

Peer support can help: Peer Recovery Coaches are a form of support in your community that can be highly effective in supporting your treatment plan. There are also groups such as Alcoholics Anonymous or Narcotics Anonymous. A peer support environment gives you a chance to lean on others who know exactly what you’re going through and learn from their experiences. 

Any program you participate in should be licensed and accredited with the treatment methods backed by research. Additionally, you should make sure the program has experience with your specific disorder.

-Treatment should address both substance use and mental health. 

-You should share in the decision-making process and be actively involved in setting goals and developing strategies for change.