Symptoms and Signs of Substance Abuse

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 9/29/2021

Doctor's Notes on Substance Abuse

Substance abuse, or drug abuse, is when people take illegal drugs or they misuse legal drugs such as alcohol, tobacco, or prescription medications. Abused substances often produce some form of intoxication that alters judgment, perception, attention, or physical control. 

Signs and symptoms of substance abuse may include

  • giving up past activities a person used to enjoy,
  • hanging out with new friends,
  • declining grades,
  • aggressiveness,
  • irritability,
  • significant changes in mood or behavior,
  • forgetfulness,
  • disappearing money or valuables,
  • feeling rundown,
  • hopelessness, depression,
  • suicidal thoughts or actions,
  • selfishness,
  • use of room deodorizers and incense,
  • presence of drug paraphernalia (such as baggies, small boxes, pipes, and rolling paper),
  • physical problems with unclear cause (for example, red eyes and slurred speech),
  • getting drunk or high on drugs on a regular basis,
  • lying (especially about how much alcohol or other drugs are being used),
  • avoiding friends or family in order to get drunk or high,
  • planning drinking in advance,
  • hiding alcohol,
  • drinking or using other drugs alone,
  • having to drink more to get the same high,
  • believing that in order to have fun you need to drink or use other drugs,
  • frequent hangovers,
  • pressuring others to drink or use other drugs,
  • taking risks (including sexual risks),
  • having “blackouts,” forgetting what happened the night before,
  • constantly talking about drinking or using other drugs,
  • the trouble with the law, drinking, and driving, and
  • suspension or other problems at school or in the workplace for alcohol- or drug-related incidents.

Many substances can also bring on withdrawal symptoms when the drug is stopped or reduced that can range from mild anxiety to seizures and hallucinations. Drug overdose may also cause death.

What Is the Treatment for Substance Abuse?

Substance abuse requires a comprehensive treatment plan, including the active participation of the patient. Slowly decreasing the use of substances (tapering) and eventually stopping use, or drug substitution to either a less addictive medication or another drug class are mainstays of treatment. High-risk patients with long-term addiction or substance abuse may do better with inpatient residential rehab treatment or intensive inpatient addiction services. 

Because substance abuse and addiction are chronic diseases, people can’t simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using completely and recover their lives.

Substance abuse treatment must help the person do the following:

  • Stop using the addicting substances
  • Stay clean and clear of the substance
  • Be productive in the family, at work, and in society 

Strategies for treatment of substance abuse may include:

  • Behavioral counseling
  • Tapering of amount and dose until abstinence
    • Lower and lower dose with less frequency until the medication is no longer needed
  • Antiseizure medication substitution
  • Psychotherapy
    • Used with tapering the dose or drug substitution, is shown to be more effective than either approach separately
  • Evaluation and treatment for co-occurring mental health issues such as depression and anxiety
  • Maintenance therapy
    • Some patients cannot get off certain drugs and need to be on low-dose chronic medication therapy supervised by their healthcare provider

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.