Many people begin to use alcohol or illicit drugs as a result of peer influences, out of curiosity, or in an attempt to cope with everyday life stressors. Still others begin to develop addictive behaviors in conjunction with previous experiences with medications legitimately prescribed for a medical condition—drugs such as opioids for pain management (e.g., Vicodin, OxyContin), benzodiazepines for anxiety management (e.g., Xanax, Ativan), and hypnotics such as Ambien for sleep management—all substances with a pronounced potential for dependence and abuse. A small proportion of these people who have used drugs for medicinal purposes may go on to abuse them for their pleasurable psychoactive effects, to deal with stress, or for other maladaptive reasons.
Of course, not everyone who uses drugs or alcohol will develop a substance use disorder (a clinical designation that encompasses both the notions of substance abuse and addiction).1 There is no conclusive and reliable method that can allow anyone to predict who will develop a substance use disorder and who will not, though certain factors may increase your propensity toward addiction.
However, despite what you may read on the internet, see or hear in the media, or are otherwise predisposed to believe, a substance use disorder is a very treatable condition. Many people who get themselves into treatment go on to live a clean, productive, and drug- or alcohol-free lives.
Risk Factors for Addiction
Researchers have identified a number of specific risk factors that can make you more vulnerable to developing a substance use disorder. It’s important to note that these factors are not causal in nature, meaning that having these factors does not automatically result in addiction, however their presence does raise the probability that you may.
Some of the most commonly cited risk factors that you may develop an addiction include:1,2
- Having a first-degree (immediate) relative diagnosed with a substance use disorder. It’s also true that having any relative who has a history of drug or alcohol addiction increases your risk, but the risk is markedly higher with an affected first-degree relative.
- Being diagnosed with a psychological or psychiatric disorder such as anxiety, major depression, or a personality disorder. Your risk increases dramatically with the existence of any other form of mental illness—often because you may self-medicate for your disorder with a substance.
- A history of childhood trauma, sexual abuse, physical abuse, or another traumatic event.
- The earlier you begin to use drugs or alcohol, the stronger your potential of developing an addiction. This specific risk factor also includes using tobacco at an early age.
- A history of childhood aggressiveness.
- A history of poor parental supervision when you were a child.
- Accessibility to drugs and alcohol.
- The type of drug you use (e.g., you are far more likely to develop an addiction by using heroin than drinking alcohol) or how you take it (smoking, snorting, or injecting drugs is more likely to lead to an addiction than taking a pill orally).
- Being male.
- Having poor social skills.
- Being in a lower social economic status.
Common Physical Warning Signs of Addiction
Substance use disorders are defined and diagnosed by the aspects of your use of drugs or alcohol, the effects your use produces, and your inability to control that use despite experiencing a number of detrimental effects as a result.
According to the American Society of Addiction Medicine, some of the most common physical warning signs of an addiction include:3
- Changes in your behavior such as suddenly becoming unreliable; not being as involved as you once were with friends or family; not fulfilling important personal obligations; and isolating yourself from people who you normally enjoy spending time with.
- Physical changes such as losing weight; sores on your face, arms, or legs; issues with your dental health; nosebleeds; or a general overall disheveled appearance.
- A lack of attention to your appearance or personal hygiene.
- Red, bloodshot, or glassy eyes.
- Being congested all the time.
- Your basic lifestyle patterns are altered, such as sleeping and eating patterns.
- Sudden intermittent complaints of feeling ill or having flulike symptoms.
- Needing more of the substance to achieve the same effect that was once achieved at lower doses (a warning sign of tolerance).
- Experiencing depression, anxiety, or severe cravings after attempts to quit your drug of choice (warning signs of withdrawal symptoms). You frequently begin using your drug of choice to alleviate these symptoms.
Common Emotional and Social Warning Signs of Addiction
Substance use disorders represent both a combination of both physical and psychological or emotional issues that relate to abusing drugs or alcohol. Some of the psychological and emotional signs and symptoms associated with substance use disorders include:1, 2, 3
- Mood swings that can include depression, irritability, and aggressive behavior.
- Significant cravings for the drug of choice.
- Turning to substance use as a coping method for stress or difficult emotions.
- Beginning to think that your substance use is normal for you even if it results in a number of negative consequences such as financial issues, legal issues, problems with relationships, and problems at work.
- Becoming defensive and aggressive when someone tries to discuss your substance use with you.
- Displaying periods of uncharacteristic hyperactivity, overexcitement, or cheerfulness, or agitation and irritability.
- Displaying periods of lethargy, lack of motivation, or being highly distractible (e.g., spaced out).
- Having periods where you are anxious, fearful, or suspicious or paranoid with no discernible reason for this behavior.
Red Flags for Friends and Family
There are a number of red flags that may indicate that a loved one has a substance use disorder. It is important to understand that only a licensed trained mental health professional can formally diagnose a substance use disorder in anyone. However, concerned family members or friends can certainly refer to some of these signs and symptoms and try to help their loved one get a professional assessment and enter formal treatment if needed.
Red flags family and friends can look for include: 1,3
- Several of the physical signs listed above may signal that your loved one is developing or has developed a substance use disorder.
- Seemingly sudden and radical changes in their mood or personality in conjunction with known use of drugs or alcohol.
- Changes in their health that seem puzzling, such as those mentioned above.
- Sudden and possibly radical declines in your loved one’s performance at work, in school, or in other aspects of their daily lives may suggest that they have an addiction.
- Financial or legal issues or uncharacteristic dishonesty.
- Relationship issues such as becoming isolated, no longer associating with close friends or family, developing new and seemingly dodgy friends, frequent instances of major problems with coworkers and peers that were never issues previously.
Formal symptoms of a substance use disorder include:1
- Continuing to use the substance despite experiencing significant detrimental effects in their work, relationships, education, health, or other areas of their life.
- Frequently using more of the drug than they had originally intended to use or using it longer than they had originally intended to use it.
- Spending a significant amount of time recovering from using their drug of choice or spending significant amounts of time trying to get that drug.
- Frequent cravings for their drug of choice.
- A failure to address important obligations as a result of their substance use.
- Continuing to use a substance in situations where it may be physically dangerous to do so, such as driving while intoxicated, using the substance at work, using it while watching small children, and mixing it with other drugs or alcohol.
- Even though they have stated that they wish to cut down or stop using their substance of choice, they are unable to do so.
- The development of tolerance.
- The development of withdrawal symptoms.
One of the most enduring myths regarding addiction is that you must hit rock-bottom before you are ready to begin changing your behavior and getting involved in a recovery program. In truth, the only thing required to begin a recovery program is the willingness and motivation to take the first step.
Addiction treatment approaches will vary depending on your specific case and the type of substance(s) you use. However, in general, competent professional treatment should consist of:3,4
- A thorough physical and psychological assessment to identify all problem areas.
- Initial withdrawal management (otherwise known as detox) that can be performed on an inpatient or outpatient basis if you have developed physical dependence to a drug (meaning you have both physical tolerance and withdrawal to the drug).
- Targeted addiction therapy to assist you in identifying the specific reasons that drove your substance abuse; developing coping skills; and learning relapse-prevention skills.
- Diagnosis of and treatment of any other psychological, psychiatric, or physical conditions concurrently with the substance use disorder treatment (i.e., dual diagnosis treatment). For some forms of substance abuse, medications may also assist you in recovery. Treatment medications, when appropriate, can be administered by an addiction medicine physician or psychiatrist, and will be most beneficial in conjunction with behavioral therapeutic approaches.
- Strong social support in the form of family members (this can also occur with family therapy), friends, and other people who are also recovery. This may include participation in 12-step groups such as Alcoholics Anonymous or Narcotics Anonymous.
- Careful planning for and then adherence to a long-term aftercare program that allows you to develop a lifestyle that is consistent with recovery.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2014). Drugs, brains, and behavior: The science of addiction.
- Ries, R. K., Fiellin, D. A., Miller, S. C. & Saitz, R. (2014). The ASAM Principles of Addiction Medicine. New York: Lippincott Williams & Wilkins.
- Miller, W. R., Forcehimes, A. A. & Zweben, A. (2011). Treating Addiction: A Guide for Professionals. New York: Guilford Press.