Signs of Addiction by Substance: When to Ask for Help
You may have noticed changes in your own drinking or drug use, or be worried about someone close to you. Start with the substance involved to read about warning signs and where to get help.
Updated Sep 14, 2026
In this article
If you are worried about your own use or someone else's, this page points you to the warning signs that matter for each substance, the quizzes that can help you think it through, and the guide to read next. The quizzes here are optional and educational; they cannot tell you whether it is safe to stop on your own. Only a clinician can assess that.
How to use this page
Skim the general signs first. Then jump to the substance you are worried about and follow one link. You do not need to read everything. If anything in the emergency section applies right now, stop reading and call.
Signs that show up with almost any substance
Clinicians diagnose a substance use disorder by looking at patterns rather than amounts, and the criteria NIAAA and NIDA describe are similar across substances (NIAAA, NIDA): using more or longer than intended, wanting to cut down and not managing to, spending a lot of time using or recovering, craving, problems at work or home, giving up things you cared about, using in risky situations, continuing despite harm, needing more for the same effect, and withdrawal when you stop. NIAAA describes severity in terms of how many of these apply within a year (source). See what a substance use disorder is.
Sober Nation guide
A practical starting roadmap
The right level of support depends on the substance, recent use, health, and safety—not on willpower.
Today
Make it safer
Tell one trusted person, remove immediate risks, and ask a clinician whether withdrawal needs medical supervision.
First week
Build support
Arrange appointments, transportation, medication access, meals, sleep, and a plan for high-risk times.
First month
Treat the pattern
Continue care, learn trigger responses, strengthen connection, and adjust the plan using what you learn.
Keep in mind: Call 911 for immediate physical danger. Call or text 988 for suicidal thoughts or a mental-health crisis in the United States.
Alcohol
Watch for morning shakiness, drinking to steady yourself, blackouts, and hiding how much. NIAAA warns that stopping suddenly after prolonged heavy drinking can be dangerous, including seizures, so plan any quit with a clinician (source). Read signs of alcohol use disorder, try the alcohol quiz, then see how to quit drinking.
Opioids, heroin, and painkillers
Watch for nodding off, running out of prescriptions early, and feeling ill when a dose is missed. The emergency sign is slow or stopped breathing; naloxone reverses opioid overdose (SAMHSA). Read signs of opioid use or signs of heroin use, try the opioid or heroin quiz, and see how to quit painkillers. If the drug is prescribed, changes go through the prescriber; dependence on a prescription is not the same as a use disorder.
Stimulants: cocaine, meth, and Adderall
Watch for long stretches without sleep followed by crashes, weight loss, paranoia, and money disappearing. The ASAM/AAAP guideline lists heart emergencies and dangerous overheating among the life-threatening complications of stimulant intoxication (source). Read signs of methamphetamine use, try the cocaine or meth quiz, and see how to quit cocaine or quitting Adderall.
Benzodiazepines like Xanax
Watch for taking more than prescribed and combining with alcohol or opioids. The FDA warns that physical dependence can develop within days to weeks even at prescribed doses, and that stopping abruptly can cause life-threatening seizures, so never stop without a prescriber's plan (source). Read what benzodiazepines are, try the benzodiazepine quiz, and see how to quit Xanax.
Cannabis and MDMA
For cannabis, watch for daily use, irritability and insomnia when you stop, and recurring vomiting; NIDA lists irritability, anxiety, sleep problems, and appetite changes among withdrawal symptoms (source). See quitting marijuana. For MDMA, watch for worsening days after use, memory problems, and using more often; NIDA notes that testing has found other drugs in pills sold as ecstasy or Molly (source). See stopping ecstasy or MDMA.
When it's an emergency, and what to do next
Call 911 for unresponsiveness, slow or stopped breathing, seizure, chest pain, or dangerously high body temperature; our signs of overdose page has more detail. Call or text 988, the Suicide and Crisis Lifeline, for thoughts of suicide or a mental health crisis. For everything else, the next step is the same regardless of substance: one honest conversation with a clinician, or one call to a treatment program. If you are reading on behalf of someone else, start with how to support a loved one. If it is you, getting sober walks through the first decisions.
Sources
- NIAAA: Treatment for Alcohol Problems
- NIDA: Cannabis (Marijuana)
- NIDA: MDMA (Ecstasy/Molly)
- SAMHSA: Treatment Options for Substance Use Disorder
- ASAM/AAAP Clinical Practice Guideline on Stimulant Use Disorder
- FDA Drug Safety Communication on benzodiazepines
- 988 Suicide and Crisis Lifeline
Physical signs you might notice, and how severity is measured
Behavior is easier to hide than the body is. A 2013 Sober Nation post on physical symptoms put it this way: drugs and alcohol affect people's thoughts and behavior in many different ways, but their bodies are affected relatively the same. Common physical signs, none of which proves anything on its own:
- Pupils larger or smaller than normal; red, glassy, or watery eyes
- Itching or picking at skin; a persistent stuffy nose, cough, or dry mouth
- Unusual weight loss or gain, or a much bigger or smaller appetite
- Sleeping far more than usual, or insomnia and bursts of energy at odd hours
- Deterioration in hygiene, twitching or shaking, nausea or vomiting
- Unexplained injuries: bruises from falls, burns on fingers or clothing
Many of the same signs appear during withdrawal, when a person may seem to have a bad cold or stomach flu that keeps coming back. All of them have other causes too, so look at the whole picture: several emotional, behavioral, and physical changes together with no other explanation. If you decide to raise it, do so privately and without accusation. Being wrong and having an awkward conversation is better than staying silent about something that can be fatal.
Clinicians group the criteria above into four kinds of problem: impaired control (using more or longer than intended, wanting to cut down and not managing it), social problems (neglecting work, home, or things you used to enjoy), risky use (using in situations where it is dangerous or despite harm), and physical dependence (tolerance and withdrawal). NIAAA describes severity by count: two to three criteria in a year is mild, four to five moderate, six or more severe. The count guides the level of care, from regular outpatient counseling to intensive outpatient or residential treatment, and a trained professional can help make that call. If the person is 12-step averse and does not need residential care, groups such as SMART Recovery offer a science-based, non-spiritual approach that discourages labels like "addict."