Addiction can bring a lot of heartache to families and friends of loved ones who are struggling with alcohol or drug abuse – often, without the family and friends knowing the cause. Even for the individual who is struggling, it may be difficult to spot whether an addiction has occurred.
Becoming aware of and recognizing the signs and behaviors that are common with addiction can help individuals, or their families and friends, determine whether the condition is at the root of the challenges.
Myths about Addiction
The first step in spotting addiction is knowing what it is – and what it isn’t. An accurate definition of addiction comes from the American Society of Addiction Medicine, which states that addiction is a chronic physical and mental disorder affecting the chemical pathways that regulate motivation, reward, memory, and pleasure responses. This disorder results in the individual pursuing substance abuse or other related behaviors. Addiction is also referred to as a substance use disorder.
Honest assessment of addiction in oneself, a family member, or a friend can be hindered by the following inaccurate beliefs:
- Addiction is a character flaw or a conscious choice. Many people believe that addiction is a matter of willpower and that people can just turn addiction off by deciding not to be addicted anymore. However, a large amount of research, such as an article from The Lancet, shows that drug abuse can physically harm neurochemistry, like the dopamine and opiate systems in the brain. This damage, in turn, can interfere with an individual’s ability to control use of the abused substance. In some cases, this physical alteration of the brain’s chemical pathways can last for months or even years, damaging the individual’s ability to rely on willpower.
- A person has to be using a lot drugs or alcohol on a frequent basis in order to be addicted. As indicated by the American Society of Addiction Medicine, some people who are addicted to alcohol or drugs binge less frequently or may not use extremely heavy amounts during regular consumption. However, this does not indicate that addiction is not an issue. A more reliable indication is if the person is unable to control the amount consumed or is unable to stop using the substance, along with other symptoms discussed below.
- People who are addicted are dirty, homeless, or otherwise easily recognized. While some people who struggle with drug abuse may begin to neglect grooming and appearance, others may be meticulously careful about appearance to hide an addiction. In addition, a person’s financial or social circumstances are not reliable indicators of whether they might become addicted to drugs.
- Movies and TV shows accurately portray what addiction looks like. As with many aspects of television and movies, addiction is often stereotyped or overplayed in entertainment. Even “true crime” shows can exaggerate addictive behaviors to sensationalize events and garner ratings. Research and an understanding of how addiction affects people is a more accurate source of information.
- Addiction only happens to poor people, entertainers, or criminals. Some of the most frequent users of drugs and alcohol are high-level business people, and even doctors and nurses can struggle with addiction, as exemplified by an article from Substance Abuse. Stereotyping can obscure the truth about substance abuse and addiction, making it harder to spot addiction in loved ones or even in oneself.
Addiction is a complicated disorder that has been studied through decades of research, and it is still not fully understood. However, research continues to demonstrate that addiction is a brain disorder and that it can be recognized, diagnosed, and treated.
Diagnostic Criteria of Addiction
The main source of information on recognizing and diagnosing addiction is the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. As described through an article from the American Journal of Psychiatry, the DSM-5 incorporates the most current understanding of behaviors and symptoms that are associated with substance use disorders. The resulting 11 behaviors and symptoms include:
- Consuming more of the substance than was originally intended
- Wanting to reduce or stop use but being unable to control it
- Spending a lot of time thinking about the substance, using it, or recovering from use
- Experiencing uncontrollable cravings or urges to use the substance
- Being unable to keep up with work, school, or other responsibilities because of use
- Having relationship problems due to substance use
- Preferring substance use instead of previously favored social or recreational activities
- Engaging in dangerous activities while using, such as risky sexual behaviors
- Continuing to use the substance even when faced with severe consequences
- Developing tolerance (a need to increase dose or frequency of use to get the same effect)
- Experiencing withdrawal symptoms if use of the substance is stopped
These behaviors and symptoms form the basis of diagnosing substance use disorders and addiction. The DSM-5 establishes that a person who experiences 2-3 of these symptoms may have a mild substance use disorder; experiencing 4-5 symptoms indicates a moderate disorder, while 6 or more of the symptoms indicate that a severe substance use disorder or addiction is present.
In addition to these diagnostic criteria, there are other behaviors that may manifest as a result of addiction behavior and that can help the individual or loved ones determine whether addiction is present. These behaviors often show up as unexpected or uncharacteristic activities or responses by the person to their daily circumstances. These behaviors may vary depending on the substance or the individual. They include:
- Secrecy or hiding of behaviors, such as use or theft of prescription pills or alcohol
- Neglect of appearance, including personal grooming and clothing
- Sudden changes in peer relationships or social circle
- Changes in sleeping or eating patterns
- Sudden emotional changes, including uncharacteristic outbursts or apathy
- Unexpected drops in grades or disciplinary consequences at work
- Blackouts, forgetfulness, or lack of focus
- Physical signs, such as unexplained bruising, achiness, red eyes, or sweating
Some of these symptoms are discussed in the specific examples below.
Examples of Recognizing Substance Abuse by Substance Type
As noted above, addiction can look different depending on the type of drug being used. Because of this, it can be helpful to know what different types of addiction might look like. The following sections give some examples of situations that might indicate addiction, to assist individuals in recognizing it in themselves or to help loved ones see it in a family member or friend.
Situation 1: A parent of a teenager finds that alcohol in the house has been running out faster than expected. The teen’s grades have dropped in recent months, and the youth seems depressed or sullen. The youth is also sleeping later than usual, and has begun spending time with a completely different group of friends.
The missing alcohol may not necessarily mean the youth is addicted; the teenager may simply have experimented with alcohol. However, that would be enough of an issue; a number of studies like one from the Journal of Substance Abuse indicate that the younger people are when they first start drinking, the higher the chance that those people may have a substance use disorder later in life. Nevertheless, if missing alcohol is a regular occurrence, it could, in combination with the other symptoms, indicate that addiction is present.
Situation 2: An individual begins to realize that, despite a desire to cut back on drinking, having one light alcoholic beverage in the evening regularly leads to consuming three or four beverages at a time. The individual has been forgetting what happens during parties when these unintended binges occur, and frequently calls in sick to work due to regular hangover symptoms. As a result, the individual may have missed deadlines and is facing disciplinary action at work.
A hallmark of addiction is the inability to control use of the substance. Individuals who are struggling with substance use disorders often consume more of the substance than intended, which can happen very easily with alcohol at a party or at home. Again, drinking heavily on a nightly basis is not the only form of alcoholism. Regular but infrequent bouts of bingeing can also be indicative of an alcohol use disorder, as explained by the Substance Use and Mental Health Services Administration (SAMSHA).
Situation 1: An elderly family member has been dealing with chronic pain related to illness, and the doctor provided the family member with an opioid drug prescription to manage the pain. Recently, the prescription has been running out faster than expected, and the family member often seems distracted or unfocused. The person’s breathing is shallow or uncharacteristically slow, and the family member often seems depressed or anxious if it seems the drug’s effects are wearing off.
One of the biggest addiction threats in the US right now has to do with prescription painkillers. These highly addictive drugs can easily lead to tolerance if taken incorrectly, which in turn can result in addiction. This has become a particular issue for up to 17 percent of people over 60, as described by a Treatment Improvement Protocol from SAMHSA. However, most people are still unaware of the prescription drug addiction issues faced by older individuals.
Situation 2: A spouse has started spending more time with a particular coworker, and since that time, the loved one’s behavior has changed. At first, pieces of singed tin foil are found in the trash. The spouse becomes less likely to go along on family outings that used to be enjoyed together. Arguments with the spouse about these behaviors become frequent, and the person often spends time alone in the bathroom or in other more secluded areas of the house. Later, bruising is noticed around the inner elbows. Often, the spouse seems distant, vacant, or unfocused.
Along with other symptoms of drug abuse, finding drug paraphernalia can indicate addiction to a drug. Singed tin foil, empty pen casings, teaspoons, and other items can indicate that an individual is smoking heroin or other opiates. On the other hand, if paraphernalia isn’t found, other physical signs, such as bruising around injection sites, can indicate regular drug use that does not require paraphernalia.
Situation 1: A student who had been on Adderall therapy to help control attention deficit hyperactivity disorder (ADHD) no longer receives the prescription due to improved conditions. However, the parent has noticed that pills from an old bottle have gone missing after the student had a particularly difficult testing period in school. The student has begun to display erratic emotional behavior, including lashing out, aggression, and symptoms of depression. The student seems confused, isn’t eating as much as usual, and doesn’t sleep well. The student’s grades on the tests were lower than typical for the youth.
Prescription stimulants such as Adderall are often used to treat ADHD; however, as demonstrated in some news items like one from The New York Times, sometimes young people will begin taking them due to the belief that the drugs will help with focus and study at school. This kind of use can lead to addiction to stimulants, which are similar in chemical structure to highly addictive and dangerous amphetamines.
Situation 2: A friend has stopped showing up for what were once regular recreational activities. When the friend is seen, they seem distracted and agitated, and appear to have lost an alarming amount of weight. In addition, the friend’s skin seems to be pocked with open sores, and their teeth are damaged. The friend also seems to be apathetic or uninterested about topics or events that used to be exciting for the person, and seems blank and distant.
Some stimulants, such as methamphetamine, leave easy-to-see physical evidence of their use. The incriminating “meth mouth” includes rotting or broken teeth and bad breath, and the feelings of crawling skin that the drug can cause result in the person picking at the skin until sores form, leaving sometimes disfiguring scarring. Some people start using stimulants to lose weight, while others hope for increased energy and pleasure. However, the high level of neural stimulation can result in a condition called anhedonia, where the person is unable to feel pleasure at all when not using the drug. In this case, the outward signs of addiction can be more than obvious.
Hallucinogens and Club Drugs
Situation: A friend attended a huge party a while back and, since then, has been behaving oddly. The person has seemed alternately spacey and paranoid, and recently had a panic attack. The individual also seems to be mixing up expressions about senses, talking about tasting colors and seeing sounds. Large parties or raves are the person’s new regular activities, and the individual has been spending time with a new circle of friends. The person has been engaging in atypical, risky behaviors, one of which resulted in injury.
As described by the National Institute on Drug Abuse, addiction to hallucinogens and some club drugs can lead to visual disturbances and other symptoms of persistent psychosis if used frequently enough at high doses. These drugs can also lead to mood changes and paranoia, as well as physical injury. Oftentimes, young people will use cough syrup that contains dextromethorphan as a hallucinogen. Household chemicals can also be used as inhalants in an attempt to experience hallucinations or a pleasure high. In this case, the individual may notice that these items are running out faster than expected or are even emptied mysteriously.
Many of the situations above may be encountered with use of other drugs, and sometimes multiple different scenarios may be found in combination when the person is using particular drugs or multiple drugs at once. For example, marijuana can act both as a stimulant and a depressant, and can also lead an individual to experience psychosis, as described by Current Psychiatry. On the other hand, an individual who is using research chemicals or designer drugs like bath salts may have wildly bizarre behaviors, including violent outbursts.
Sometimes these signs of addiction or substance abuse are obvious. Sometimes they’re more hidden or subtle as described above. If substance abuse is suspected, keeping all of these potential signs or symptoms in mind can help an individual determine whether intervention is necessary for oneself or a loved one.
Getting a Professional Diagnosis: The First Step in Getting Help
Even if signs of substance abuse or addiction are obvious, it can be important to get a professional diagnosis when addiction is suspected. Working with a professional, research-based treatment program can help to properly apply the diagnostic criteria above and make an accurate diagnosis for the individual. While it can be tempting to self-diagnose or make the decision without professional help, those who have experience working with addiction can identify more subtle elements of the addiction, such as co-occurring disorders or polydrug abuse.
Once an appropriate diagnosis is made, it is then possible to get personalized treatment that is most likely to help the individual overcome the various elements of substance abuse and addiction. This treatment can help the individual get on the path to recovery and look forward to returning to productive, meaningful daily life.