Symptoms of Alcohol and Drug Abuse

Substance use disorders can transform a person’s entire world, affecting everything from their brain chemistry to their closest relationships. What begins as casual use can gradually evolve into a complex pattern of behaviors that feel impossible to control. The symptoms of alcohol and drug addiction often develop subtly at first, but understanding these warning signs can make the difference between early intervention and a prolonged struggle with addiction.

Symptoms and Signs of Substance Use Disorders

Substance use disorders (SUDs) represent a significant public health challenge in the United States. For example, statistics from the 2023 National Survey on Drug Use and Health (NSDUH) reveal that among those 12 and older, 47.5% (just shy of 135 million people) consumed alcohol in the past month, and 16.8% (47.7 million people) used an illicit drug. When it comes to addiction, 17.1% (48.5 million people) within this same age group had a substance use disorder in the past year ^[1].

These concerning statistics underscore the importance of proper diagnosis and treatment, which is why healthcare professionals rely on standardized diagnostic criteria to accurately identify and assess substance use disorders. While many people might recognize potential signs of addiction, only qualified healthcare professionals can provide an official diagnosis based on criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

The DSM-5 outlines the following specific criteria for diagnosing substance use disorders ^[2]:

• Loss of Control: Taking substances in larger amounts than intended and inability to cut down or stop use 
• Time Investment: Significant time spent obtaining, using, and recovering from substance effects 
• Cravings and Urges: Experiencing intense desires or cravings for the substance
• Failure to Fulfill Obligations: Inability to fulfill responsibilities at work, school, or home 
• Social Impact: Giving up social, recreational, or occupational activities due to substance use 
• Risky Behavior: Engaging in dangerous activities while under the influence
• Continued Use Despite Problems: Persisting in substance use despite physical or mental health issues
• Physical Dependence: Developing tolerance and experiencing withdrawal symptoms when use stops

While only healthcare professionals can make formal diagnoses, people can learn to recognize substance-specific warning signs that may indicate a need for professional evaluation and support.

Signs and Symptoms of Alcohol Use

Beyond the DSM-5 diagnostic criteria for alcohol use disorder, symptoms related to alcohol use can manifest during active intoxication and withdrawal. 

Signs of Alcohol Intoxication: The higher your blood alcohol concentration (BAC) climbs, the more profound alcohol’s impact becomes on your physical and mental functioning. The changes often start with seemingly minor shifts: words become harder to pronounce clearly, thoughts get fuzzy, and emotions flow more freely than usual. As a central nervous system depressant, alcohol can lead to a depressed mood, potentially contributing to the development of depression ^[3]. 

As intoxication progresses, judgment becomes increasingly clouded, making it harder to make sound decisions or even remember what’s happening. When BAC climbs further, some people experience gaps in memory (i.e., blackouts) where entire chunks of time simply vanish from their recollection ^[3]. 

At extremely elevated levels, the body’s vital functions can begin to shut down, potentially leading to unconsciousness. In the most serious cases, excessive alcohol consumption can cause lasting damage to the brain or even result in death ^[3].

Alcohol Withdrawal Symptoms: Once someone becomes dependent on alcohol and they abruptly stop or significantly reduce use, they can experience a potentially life-threatening response known as alcohol withdrawal. In themselves, withdrawal symptoms are signs of alcoholism.  

Some of the most common symptoms of alcohol withdrawal include ^[4]:

• Tremor
• Insomnia, vivid dreams
• Anxiety, agitation, and hypervigilance
• Irritability, cravings
• Nausea, vomiting, loss of appetite, sweating
• Headache, seizures, hallucinations
• Delirium tremens (DTs)

Signs of Opioid Use

Opioid use disorder (OUD) represents one of the most challenging public health crises facing society today, affecting more than 5.7 million people ages 12 and older ^[5]. The condition manifests through various physical, behavioral, and psychological symptoms that can significantly impact a person’s life.

Common signs of opioid use or dependence include ^[5]:

• Cognitive Impairment: Problems with attention, memory, and confusion
• Mental State Changes: Reduced awareness of surroundings and euphoric feelings
• Speech and Coordination: Slurred speech and lack of physical coordination
• Physical Symptoms: Constricted pupils and constipation
• Mood Changes: Depression and agitation
• Drowsiness: Sedation and excessive sleepiness
• Nasal Issues: Runny nose and nose sores from substance snorting
• Injection Signs: Visible needle marks from injectable substance use

Symptoms Associated with Benzodiazepine Use 

As types of central nervous system depressants, benzodiazepines (e.g., Xanax, Ativan, Klonopin) are often used to treat anxiety, insomnia, seizures, and muscle spasms. Data from the NSDUH reveals that more than 3.6 million people misused prescription benzodiazepines in the last year ^[6]. 

Signs and symptoms of benzodiazepine use can include ^[5]:

• Drowsiness, slurred speech
• Dizziness, diminished coordination
• Irritability 
• Memory difficulty, rouble concentrating, cloudy thinking
• Frequent accidents or falls
• Involuntary eye movements
• Lack of inhibition
• Slowed breathing and decreased blood pressure

Signs of Stimulant Misuse

Stimulants are a broad drug class that includes illicitly manufactured substances such as methamphetamine and cocaine, as well as prescription medications sold under brands such as Ritalin, Concerta, and Adderall. While some prescription stimulants have therapeutic uses for attention-deficit hyperactivity disorder (ADHD), narcolepsy, and binge eating disorder (BED), most substances in the stimulant category can also be misused to boost energy or achieve a euphoric high ^[5].

Signs and symptoms associated with stimulant use include ^[5]:

• Excitement, overconfidence, insomnia, rapid speech
• Increased alertness, energy, and restlessness
• Dilated pupils
• Irritability, anxiety, paranoia, aggression
• Confusion, delusions, hallucinations
• Vomiting, nausea, weight loss
• Increased heart rate, blood pressure, and body temperature

Methods for Overcoming Addiction

Recovery from substance use disorders requires a comprehensive, individualized approach that addresses both the physical and psychological aspects of addiction. Treatment success often depends on combining various therapeutic methods and support systems tailored to each person’s specific needs and circumstances.

Formalized treatment typically begins with detox and then progresses through various levels of care that vary in intensity and structure, ranging from residential programs to outpatient services. Inpatient treatment provides 24-hour care in a controlled environment, ideal for those in the early stages of recovery. Additionally, outpatient programs, which vary in intensity and duration, offer more flexibility that allows people to maintain work and family responsibilities while also receiving individual or group treatment. 

Medication-assisted treatment (MAT) also plays a crucial role in many recovery journeys, particularly for alcohol and opioid use disorders. This evidence-based approach combines FDA-approved medications with counseling and behavioral therapies to provide a whole-patient approach. The medications help manage withdrawal symptoms and cravings, while therapeutic support addresses the underlying causes of addiction.

As part of both professional treatment and aftercare, support groups also play a vital role in long-term recovery, offering peer support and community connection. These groups provide opportunities to learn from others’ experiences, develop coping strategies, and build a network of understanding peers who share similar challenges.

Therapy for Addiction

Therapeutic interventions form a cornerstone of effective addiction treatment, offering essential tools and strategies for long-term recovery. The following evidence-based approaches have shown significant success in treating substance use disorders.

Cognitive Behavioral Therapy (CBT)	Teaches practical coping skills and strategies to manage triggers and prevent relapse, CBT helps people identify and change negative thought patterns and behaviors related to substance use.
Dialectical Behavior Therapy (DBT)	Combines mindfulness practices with emotional regulation skills, DBT aids people in managing intense emotions, improving relationships, and developing healthy coping mechanisms.
Motivational Interviewing (MI)	A collaborative approach that strengthens someone’s motivation for change, MI helps resolve ambivalence about recovery and enhances commitment to treatment.
Contingency Management (CM)	CM offers positive reinforcement to encourage healthy behaviors, providing tangible rewards for maintaining sobriety and meeting treatment goals.

While individual therapy is often a cornerstone of effective addiction treatment, group and family therapy are equally important to long-term recovery.

Group therapy serves as a powerful complement to individual therapeutic approaches, providing peer support and shared learning experiences. In group settings, people can practice new social skills, receive feedback from others in recovery, and develop a sense of community that supports long-term sobriety.

Similarly, family therapy plays an important role in addiction recovery by addressing relationship dynamics and healing family systems. This approach helps repair damaged relationships, improves communication patterns, and creates a supportive environment for recovery. Plus, family involvement can significantly enhance treatment outcomes by addressing intergenerational patterns of substance use and creating a stronger support network for the person in recovery.

Addiction and Mental Health

The intersection of mental health and substance use disorders presents a significant challenge in addiction treatment. According to the NSDUH, of the more than 58 million adults with a mental health disorder, roughly one-third (20.4 million people) also had a substance use disorder ^[1]. When these conditions occur concurrently, they’re called co-occurring disorders (also referred to as dual diagnosis). This dual diagnosis creates a complex web of symptoms and challenges that usually require specialized care.

In general, the relationship between drugs, alcohol, and mental health often creates a destructive cycle. Mental health conditions like depression, anxiety, and PTSD may lead people to self-medicate with substances, while prolonged substance use can trigger or worsen mental health symptoms. This reciprocal relationship makes it crucial to address both conditions simultaneously rather than treating them in isolation ^[7].

Research consistently shows that integrated treatment approaches yield better outcomes than addressing either condition separately. These comprehensive programs combine mental health services with addiction treatment, including medication management, trauma-informed therapy, and specialized counseling ^[7].

Healing from Substance Abuse

Recovery from substance use disorders is a transformative journey that requires courage, commitment, and comprehensive support. While the path to healing may present challenges, countless people have successfully rebuilt their lives and found lasting recovery through evidence-based treatment approaches and dedicated support systems.

The journey toward healing often begins with professional treatment that addresses both the physical and psychological aspects of addiction. Through a combination of medication-assisted treatment, therapy, and support groups, people can develop the tools and coping strategies necessary for long-term recovery. While the path to recovery is different for everyone, what remains consistent is the importance of ongoing support and self-compassion throughout the healing journey.

If you recognize the symptoms of alcohol and drug abuse in yourself or someone you know, help is available 24/7 through the National Helpline at 988. This confidential, free service can connect people with local treatment options and support resources. Taking the first step toward recovery can feel overwhelming, but with proper support and treatment, healing is possible.