By Lauren Smith

Updated: 20 June 2023 & medically reviewed by Dr. Kimberly Langdon

Often people are in deep denial about their substance abuse and are only nudged toward help when their loved ones recognize the signs of addiction and raise the alarm. Learning to read these markers, sometimes subtle, may help you save someone's life.

Man drinking in foreground, concerned women and child in background, kitchen,  clear alcohol

General warning signs of addiction

External signs of addiction can vary widely depending on the substance abused: people who use opioids will appear dopey and sedated while those who take stimulants can be hyperactive and anxious. But there are general warning signs of addiction that accompany many substances, signs of growing physical and psychological dependence, and the effects of drug use on personality, relationships, and health.

These warning signs include:

  • Changes in personality, energy levels, and appetite

  • Disinterest in activities they’ve previously enjoyed

  • Self-isolation and distancing from family members and previous friends

  • Increased conflict with loved ones

  • Falling in with a new social circle, possibly revolving around drug use

  • Declining performance at work or school, including frequent absences and lateness

  • Failing to fulfill responsibilities, from childcare to chores

  • Change in physical appearances, such as neglected hygiene and grooming; rapid weight loss or gain; appearing disheveled or wearing dirty clothes; not showering, shaving, or applying cosmetics as they previously would

  • Financial difficulties, including overspending, asking to borrow money, not paying bills on time, and even theft

  • Defensiveness or anger when asked about their substance use

  • Secrecy, lying, and unexplained absences

  • Lack of motivation

  • Irritability

  • Worsening symptoms of mental illness, including depression, anxiety, paranoia, obsessiveness

  • Possession of drug paraphernalia

  • Arrests and other legal troubles[1]

While the above warning signs serve as indicators of substance abuse and potential addiction, they can also serve to identify behavioral addictions or process disorders. For example, increased conflict with loved ones, failure to fulfill responsibilities, and secrecy are all signs of porn addiction.

Signs of alcohol addiction

Alcohol is the most commonly abused substance in the United States, with around 5.3% of Americans meeting the criteria for alcohol use disorder (AUD). An additional, 25.8% of American adults report binge drinking, which can easily escalate to alcoholism.[2] In fact, the normalization of binge drinking, especially among young people, may mask the development of alcoholism, meaning it's all the more important to be aware of these signs.

Signs of alcohol use disorder include symptoms of intoxication and withdrawal and the behavioral and personality changes that accompany heavy drinking. They include:

  • Slurred speech

  • Staggering, unsteady gait

  • Impaired coordination

  • Slow reaction times

  • Blurry vision

  • Sleepiness

  • Sexual dysfunction

  • Blackouts and memory loss

  • Mood swings

  • Aggression and violence

  • Only engaging in activities that involve alcohol

  • Seeming to need alcohol to have fun

  • Insomnia and irregular sleeping patterns

  • Making excuses for drinking, including that they need it to relax

  • Drinking at unusual times, such as early in the morning

  • Smell of alcohol on their breath or the scent of something used to disguise the odor, such as mints or mouthwash

  • Signs of hangovers: sleeping late, headaches, sensitivity to light and sound, vomiting, dizziness, irritability, and excessive thirst[3]

  • Signs of alcohol withdrawal: anxiety, sweating, insomnia, irritability, shakiness, hand tremors, nausea and vomiting, loss of appetite, dilated pupils, pale skin, seizures, fever, extreme agitation, and hallucinations[4]

  • Frequently drinking out of opaque cups or bottles, which they may claim contain water, coffee, soda, or juice

  • Hiding alcohol bottles throughout the house and secretly disposing of empties

  • Stealing alcohol from the household liquor cabinet, watering down what remains in the bottles

  • DUIs and legal troubles

Warning signs of opioid addiction

Opioid addiction has exploded in the US over the last 25 years, driven by lax prescribing of opioids such as oxycodone (OxyContin and Percocet), hydrocodone (Vicodin), and others. Detecting the warning signs of prescription opioid misuse in a loved one may prevent them from escalating to even riskier street opioids such as heroin and fentanyl. Read here to learn more about the warning signs of heroin use.

These warning signs include:

  • Sedation and sleepiness

  • Decrease in activity and motivation

  • Small pupils

  • Continuing to take a prescription opioid for frequently or longer than prescribed after surgery or an accident

  • Visiting several doctors to obtain prescriptions for opioid painkillers. Some may travel out of state to visit known pill mills where doctors write prescriptions en masse.

  • Stealing or borrowing medication from other people

  • Pretending to lose a prescription so another will be written

  • Dismissing non-opioid treatments for pain

  • Preoccupation with obtaining more opioids

  • Financial troubles, borrowing and stealing money

  • Withdrawal symptoms which may resemble the flu, including nausea, vomiting, swearing, shaking, and dilated pupils

  • If they’ve escalated to intravenous heroin, they may wear long sleeves to hide the signs of injection, known as track marks

  • Presence of drug paraphernalia, such as burnt or missing spoons or bottle caps, syringes, missing shoe laces or belts, small bags with powder residue

  • Overdoses: difficulty breathing, pinpoint pupils, unconsciousness[5][6][7]

Warning signs of cocaine addiction

Specific signs of cocaine addiction include:

  • Extreme mood swings, from the excessive confidence, chattiness, and excitability of cocaine high to the depression and fatigue of a comedown

  • Chronic nose bleeds, frequent runny nose and sniffing, hoarse voice

  • Presence of drug paraphernalia including razor blades and mirrors

  • White powder residue around the nose and on surfaces

  • Erectile dysfunction

  • Insomnia

  • Weight loss

  • Flat affect when not using cocaine, inability to feel pleasure

  • Financial difficulties due to the expense of cocaine

  • Paranoia and delusions[8]

Related: warning signs of cocaine addiction

Warning signs of methamphetamine addiction

Specific signs of methamphetamine (meth) abuse include:

  • Increased wakefulness

  • Decreased appetite

  • Weight loss

  • Dental problems known as “meth mouth," starting with bad breath, cavities, and swollen gums and progressing to stained, blackened, crumbling teeth and tooth loss[9]

  • Itching and scratching leading to skin sores

  • Memory loss

  • Insomnia

  • Violence and aggression

  • Paranoia

  • Hallucinations[10]

Read here for more specific details on the warning signs of meth abuse.

Warning signs of cannabis addiction

Cannabis (marijuana) has been legalized in many jurisdictions and can be safely used as a medication for pain and nausea, among other conditions. However, it’s still possible to develop a physical and psychological dependence on cannabis. Studies have estimated the prevalence of addiction—known as marijuana use disorder—among cannabis users at between 10% and 30%. Marijuana use disorder is most likely to develop when people start using the drug during adolescence.[11]

Tell-tale signs of cannabis abuse include:

  • Sleepiness, lack of motivation

  • Impaired short-term memory, making it difficult to learn and retain new information

  • Impaired motor skills, possibly leading to accidents and injuries

  • Chronic bronchitis

  • Paranoia

  • Psychosis[12]

Read here for more signs of marijuana abuse