Substance Misuse: Signs and Risks

Millions of people are drinking too much or misusing drugs. And many don’t get help.

But asking for help is a normal part of life, and people should never feel like they have to handle things on their own, says the Substance Abuse and Mental Health Services Administration. 

Help is available for you or someone in your life. It’s important not to wait to get help. Misusing alcohol and other drugs can trigger serious health problems. Cancer, stroke and health problems of the heart, lungs and liver are a few. Anxiety, depression and schizophrenia are among the mental health issues linked to substance misuse.

It's a big problem. A national study in 2020  found that more than 13 percent of Americans 12 and older have misused drugs in the past 30 days. And among people ages 12 or older, 28.3 million people had alcohol use disorder in the past year. Use was highest among young adults ages 18 to 25.

How do you know if there’s a problem? Look for these warning signs:

Behavioral Changes:

• Getting into trouble
• Changes in appetite
• New sleep patterns
• Irritability or anger outbursts
• Lack of motivation
• Fearful or anxious with no reason

Physical Changes:

• Bloodshot eyes and abnormally sized pupils
• Weight loss or gain
• Deterioration of physical appearance
• Unusual smells on breath, body or clothing
• Shaking or slurred speech

Social Changes:

• Changes in friends, hangouts and hobbies
• Legal trouble
• Money issues
• Relationship problems

Risk Factors

Anyone can be at risk for addiction, but some people have a higher risk. People with a family history of addiction are more likely to misuse drugs and alcohol. Substance misuse has a genetic link.

People with mental health issues like anxiety or depression also have a greater risk. Many use drugs to cope.

Certain situations can also play a role in driving drug and alcohol use, such as:

• Peer pressure. Many people, especially young people, can be pressured by friends or family members to use drugs.
• Lack of family ties. Poor relationships with parents can make young people feel lonely and trigger drug misuse.
• Early use. Using drugs at an early age can change the brain. These changes can make some people more likely to keep using drugs.
• Taking highly addictive drugs. Some painkillers like opioids  and benzodiazepines can contribute to the misuse of drugs. There are other, less risky options to safely manage pain.

Getting Help

What should you do if you think you may have a problem? Talk with your primary care doctor or a mental health professional. There are doctors who work in addiction medicine and addiction psychiatry. There are also licensed alcohol and drug counselors.

If you need help finding a health care provider, call the number on your member ID card. We are here to help.

In case of emergency (overdose, trouble breathing, seizures or any other bad reaction from drug use), go to the nearest ER or call 911.

Sources: USA Addiction Statistics,  Addiction Guide, 2023; SAMHSA Releases 2020 National Survey on Drug Use and Health,  Substance Abuse and Mental Health Services Administration, 2021; Mental Illness and Substance Use in Young Adults,  SAMHSA,2022; Addiction and Health,  National Institute of Drug Abuse, 2020; Drug Misuse and Addiction,  National Institute on Drug Abuse, 2020; Opioid Addiction,  Family Doctor, 2023

Originally published 1/2/2019; Revised 2022, 2023, 2024