5 Signs someone you love is struggling with substance misuse or addiction

Worried about someone’s relationship with alcohol, drugs, or prescribed medications? Here’s how to figure out if they have a problem with substance misuse or addiction — and what you can do to help.

Misuse of substances like alcohol and prescription or illegal drugs is more common than you might think. More than 59 million Americans — about 21% of us — used an illicit drug or misused a prescribed drug in the past year. And 30 million say they’ve had at least 1 day of binge drinking. (For men, that means having more than 5 alcoholic drinks in one sitting; for women, it’s 4 drinks.)

Sometimes the misuse is a one-time or occasional thing. But for more than 20 million Americans age 12 and older, misuse blooms into addiction. Both can have a major impact on physical and mental well-being.

Friends and family members tend to suffer too. And it’s not always easy to know how to help or whether it’s necessary. That’s why it’s important to know the difference between substance misuse and substance use disorder.

“Substance misuse is when a person uses drugs or alcohol in a way that’s harmful to themselves or others,” says Flora Sadri-Azarbayejani, D.O. Dr. Sadri-Azarbayejani is a specialist in addiction medicine at Psyclarity Health in Boston. This may include:

Substance use disorders happen when these habits have a negative impact on day-to-day functioning, such as how you perform at work. “Not everyone who misuses substances will develop a substance use disorder,” says Dr. Sadri-Azarbayejani. “But it does increase the risk.”

Need help spotting a potential problem in a loved one? Here are 5 common warning signs, plus expert advice on how to talk to them and help them get the care they need.

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We all get a little moody now and then. With substance misuse or abuse, the mood swings are more extreme than usual. The person may be happy one minute, then angry or depressed the next, says Heather Wilson, L.C.S.W. Wilson is the executive director at Epiphany Wellness in Blackwood, New Jersey.

They may also act differently, adds Wilson. For example, they might be more aggressive, paranoid, or impulsive. “This could be the effects of the substances they’re misusing, or the stress of trying to keep their use a secret,” says Dr. Sadri-Azarbayejani.

If the person is harder to get in touch with than usual, it may be a sign of a problem. “They may start canceling plans or stop returning phone calls or texts,” says Wilson. “This is often because they’re trying to hide or are ashamed of their substance use and don’t want to be around people they care about while they’re using.”

You may notice them missing work or school more than in the past. Or perhaps they’ve stopped cleaning their house or paying bills on time. “This can be a sign that something is taking over their life and they’re struggling to cope,” says Dr. Sadri-Azarbayejani.

The ongoing theme here is “different than usual.” If your messy brother Mike is still a mess, that’s likely just Mike being Mike. But if your stylish and buttoned-up sister stops caring about how she looks, that could be a red flag.

Some substances can also have physical side effects, says Wilson. Common signs include:

Driving under the influence. Having unprotected sex. Taking part in criminal activity. These can all be signs of substance misuse or abuse. “These behaviors are often a result of impaired judgment and can put the person in danger,” says Dr. Sadri-Azarbayejani. “That’s one reason why it’s so important to intervene if you see this happening and help them get the treatment they need.”

If you’re worried about someone you love, it’s important to reach out and see if they need help. Here are a few tips on how to start the conversation.

Pick a time when they’re sober and you’re both feeling calm. Then bring up your concerns and see if they are willing to talk. “Avoid accusatory language,” says Wilson. “Focus on expressing your concern for their well-being.”

It’s also important not to judge them or make assumptions about what’s going on, adds Dr. Sadri-Azarbayejani. Instead, stick to the facts. And try to be as specific as possible. For example, mention that they canceled plans on you 3 times in the past month.

Finally, use “I” phrases like “I’ve noticed” or “I’m worried.” They can’t dispute how you feel. On the other hand, using “you” language (e.g., “You never hang out anymore”) may feel like a personal attack.

Once you’ve started the conversation, be sure to listen to what your loved one has to say. “This can be a difficult thing to do. But it’s important to try to understand their perspective,” says Dr. Sadri-Azarbayejani.

As you listen, don’t interrupt or try to offer solutions right away. “Just let them know that you’re there for them and you’re willing to help in any way you can.” Even if your first attempt at talking doesn’t go well, try again later. If you’ve shown that you want to listen, there’s a better chance they’ll open up the next time.

Try to get a clear sense of what substances they’re taking and how often. “Asking questions can help you better understand the situation and figure out how to best help your loved one,” says Dr. Sadri-Azarbayejani. Just know that they may not be honest with their answers.

Don’t expect to solve their problems in your first chat. But do suggest ways you can be there for them in the future. That might include:

“Let them know that you want to help in any way you can,” says Dr. Sadri-Azarbayejani.

Many health plans offer a digital health management app like Wellframe as an added benefit. The app can connect you with your care advocate, who can help you find local resources. To find out if you have Wellframe, email your human resources department.

Just like your loved one doesn’t have to go it alone, neither do you. It can be helpful for you to talk to substance use experts. This could include speaking to:

Another trustworthy option: The U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) help line. Call 1-800-662-HELP.

Remember, you can’t force your loved one to go to therapy or change their behavior if they’re dealing with substance misuse or addiction. “The struggling person must admit they have a problem and be open to receiving help,” says Wilson. “The person must want to recover for themselves and not to please family or friends.” The good news? If they do want to stop using, with the help of their healthcare providers and loved ones like you, they can change their behavior and live a happy and healthy life.