What are the symptoms of substance abuse?

Quick Answer
Substance abuse is characterized by the overuse of alcohol or drugs that leads to compulsive urges to consume the substance of choice. Substance abuse affects the user’s quality of life and the ability to make good decisions. In addition to negative behavioral symptoms, substance abuse generates harmful physical symptoms—unseen physiological damage to internal organs and visible deterioration in the user’s appearance.
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Risk Factors

Experimentation with alcohol and drugs is the most prominent risk to becoming a substance abuser. Whether the reward of the high is physical pleasure, the temporary removal of a traumatic memory from the mind, or simply acceptance by a peer group, experimenting with substances is always risky. Symptoms of the substance use and its effects begin to appear immediately.

Many neuroscientists and mental health professionals assert that some persons are more susceptible than others to becoming addicted to alcohol or drugs because of genetic, biological, or environmental tendencies or exposure. Risk factors include a family history of substance abuse, mental disorders, childhood trauma, and early experimentation with substances. For persons with or without these risk factors, experimentation with certain substances could lead to addiction.

The earlier a substance abuser recognizes the symptoms of substance abuse and acknowledges the dangers of continued use, the earlier he or she can advance toward treatment and recovery. At any point between a substance abuser’s experimentation and addiction, signs of dependency increasingly become apparent. Friends and family members may recognize the symptoms and then intervene to break a substance abuser’s destructive patterns. Not confronting a person suspected of substance abuse will likely allow the problem to worsen.

Though a substance abuser is likely to admit to using a substance, he or she is less likely to admit to abusing that substance, which makes the process of intervention difficult. Still, the more proficient a loved one or friend is in recognizing the symptoms of substance abuse, the more confident he or she can be in intervening.

Physical Symptoms

The most profound physiological symptoms of substance abuse stem from how substances radically alter the biochemical processes of the brain. Alcohol and drugs affect how the brain’s nerve receptors receive, process, and send information by overtaking the brain’s neurotransmitters and overstimulating its pleasure center.

This effect on the brain is manifested in a substance abuser’s mood. He or she will seem cheerful or “normal” when feeling the initial effects, or the high, of the substance. Once the high wears off, he or she will be noticeably agitated or depressed. A substance abuser also requires increasingly larger and more frequent dosing of the substance of choice to achieve the same effects after physical dependence develops.

Without increasing dosage and frequency, the abuser will experience disruptive withdrawal symptoms. Other common physical warning signs of substance abuse include bloodshot and glassy eyes, sudden weight loss or weight gain, change in appetite, deteriorating personal appearance and hygiene, odor of alcohol or smoke emanating from the person’s breath or clothing, tremors, lack of coordination, and changes in speech patterns, such as slurring.

Though all substances can generate short-term or long-term effects on the body, different substances affect the body differently and manifest different symptoms. Alcohol, for example, increases dopamine in the brain, and when abused it impedes the natural production and transmission of dopamine. As the brain’s organic ability to generate pleasure chemicals is impeded by chronic alcohol consumption, the alcoholic develops a tolerance for alcohol and has difficulty functioning in daily life without it. Physical signs of alcoholism include the odor of alcohol on the breath and skin, bloodshot eyes, redness in the face, a bloated stomach, slurred speech, and a lack of coordination and focus.

Marijuana’s main active chemical, delta-9-tetrahydrocannabinol (THC), impacts sites in the brain known as cannabinoid receptors. A marijuana user will have bloodshot and glassy eyes, impaired coordination, difficulty with thinking, and memory loss. Because THC weakens the immune system, a chronic marijuana smoker frequently contracts respiratory infections.

Cocaine stimulates the nervous system by increasing the level of dopamine in the brain, and it adversely affects the ability of the brain to transmit dopamine organically. A cocaine user is hyperactive and talkative when high and appears fatigued and melancholy later, when the high has worn off. Chronic cocaine snorting causes a chronic cough, frequent nose bleeds, and even permanent damage to the nasal cavity, including a loss of the sense of smell and loss of appetite. Those who smoke crack cocaine or methamphetamine (meth) experience blemishes on the skin, weight loss from decreased appetite, and rotting teeth. Stimulants such as cocaine, crack cocaine, and meth also will manifest physical signs of dilated pupils, dry mouth, unusual sleeping and eating patterns, and increased heart rate and blood pressure.

Nonstimulant drugs generate different symptoms. Abusers of heroin, for example, exhibit weight loss; tremors and twitching; track marks on the arms, legs, or feet; paleness; sweating; and reduced heart rate and respiration. Abusers of narcotic depressants, including prescription painkillers, appear drunk and exhibit poor judgment, clumsiness, sleepiness, and an inability to concentrate.

Behavioral Symptoms

Substance abuse inflicts long-term changes to the brain; the neuroadaptations the brain produces to control the release of dopamine and regulate emotions remain with the addict even after treatment and abstinence. Substance addiction also alters the prefrontal cortex of the user, causing the reduction in neuron activity in this part of the brain.

These changes to the brain also lead to the release of the neurotransmitter glutamate, which impairs the addict’s decision-making ability. Glutamate facilitates impulsiveness and intense focus on achieving the immediate reward of pleasure. Consequently, addicts often engage in reckless behavior, and rehabilitated addicts are prone to relapse when faced with substance-related stimuli. In the amygdala, the part of the brain involved in memory formation, emotional memories associated with being high are enhanced, thereby making it difficult for the addict to resist stimuli that trigger these memories.

Because substance abuse radically affects the physiology of the brain, abuse also profoundly affects behavior. The need to consume the substance of choice increasingly dominates a substance abuser’s sense of judgment and daily actions.

Substance abuse may be attributed to several disruptive and harmful behavioral patterns, such as family disintegration, loss of employment, domestic violence, and child abuse. Common behavioral symptoms include the inability to refrain from consuming the substance, an obsession with achieving the next high, an abandonment of important responsibilities and interpersonal relationships, and a disregard for the obvious harm the substance is causing to the body.

Consistent with the effect that substance abuse has on the brain, a substance abuser is more likely to drop out of school or quit a job, may change peer groups often, may experience conflicts with the law, and may experience mood swings, recklessness, laziness, and paranoia.

The classic behavioral symptom of persons with a substance abuse problem is that they sever important relationships by betraying those closest to them. Because the quest for the next high is so prominent in their mind, substance abusers will lie, cheat, and steal from strangers and loved ones alike to get the next fix.


Fisher, Gary L., and Nancy A. Roget, eds. Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery. 2 vols. Thousand Oaks: Sage, 2009. Print.

Hoffman, John, and Susan Froemke, eds. Addiction: Why Can’t They Just Stop? New York: Rodale, 2007. Print.

Lawford, Christopher Kennedy. Moments of Clarity: Voices from the Front Lines of Addiction and Recovery. New York: Morrow, 2009. Print.

“The Science of Drug Abuse and Addiction: The Basics.” National Institute on Drug Abuse. Natl. Insts. of Health, Sept. 2014. Web. 6 Nov. 2015.

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