You cannot reliably tell whether someone is misusing pills from their face, mood or one isolated behavior. Changes in alertness, coordination, daily responsibilities or medication use may justify a conversation and clinical assessment, but they do not establish addiction. Unresponsiveness, breathing problems or seizures require emergency help immediately.
Substance use disorder involves a problematic pattern of use, such as impaired control and continuing despite harm. Prescription medicines can be misused by taking a different dose or route than prescribed, using another person’s medication or taking a medicine to get high. Alcohol, nicotine and cannabis are also substances, but they are not all prescription medicines or pills.
Problems can begin with recreational experimentation or misuse of a prescribed medicine. Risk varies with the substance, dose, duration, combinations and the person’s circumstances. Taking a medicine correctly for pain, anxiety or another condition does not by itself mean someone has an addiction.
Tolerance means that the same amount has less effect over time. Physical dependence means the body has adapted and withdrawal symptoms may occur when the substance is reduced or stopped. Either can develop during prescribed treatment without addiction. If stopping is difficult, seek professional advice rather than imposing an abrupt withdrawal.
Emergency signs: act before assessing addiction
Call your local emergency number if someone is unconscious, cannot be awakened, is breathing slowly or abnormally, or has a seizure after taking a substance. Give naloxone if an opioid overdose is suspected and it is available, without delaying emergency care. Follow the dispatcher’s instructions: begin CPR if the person is unresponsive and not breathing normally; if unresponsive but breathing normally, place them on their side and monitor breathing. Stay until help arrives.
Early changes that may prompt a conversation
Changes may have many explanations, including illness, stress, a prescribed medicine’s side effects or ordinary adolescent development. A new friendship, smoking or wanting privacy is not proof of pill misuse. Pay attention to a pattern of sudden or substantial changes and ask calmly about what is happening.
- Different social contacts or withdrawing from usual relationships and interests.
- Changes in mood, routines, communication or openness with family.
- Smoking materials or a substance found among belongings, which warrants a conversation rather than a diagnosis.
- Unexpected spending or unexplained missing money.
- New secrecy or inconsistent explanations, while respecting that privacy alone is normal.
Use, physical dependence and addiction are different
The amount used or the presence of withdrawal alone does not determine a substance use disorder. A clinician assesses impaired control, harm and the effects on the person’s life.
- Physical dependence can occur with prescribed treatment and does not prove addiction; addiction can also occur without physical dependence.
- Tolerance may lead someone to seek a larger dose but is neither required nor sufficient to establish addiction.
- Any harmful use can deserve support, even when diagnostic criteria for addiction are not met.
- Mental health difficulties vary between individuals and cannot be ranked simply by calling someone a user or an addict.
- Withdrawal depends on the substance, dose and duration. Its presence does not establish addiction, and its absence does not rule it out.
Patterns that can suggest problematic pill use
Taking a prescribed medicine every day may be entirely appropriate. The following patterns warrant assessment in context; no single item is a home diagnostic test.
- Strong cravings or feeling unable to control use.
- Taking more than intended, more often than prescribed, or using a medicine for a nonmedical effect.
- Increasing the dose without discussing it with the prescriber.
- Spending excessive time obtaining, using or recovering from the substance.
- Seeking a continuing supply or spending money needed for other essentials.
- Missing responsibilities or important activities because of use.
- Continuing despite recognized physical, psychological or relationship harm.
- Taking risks, such as impaired driving, or acting outside one’s usual values to obtain a substance.
- Repeated unsuccessful attempts to reduce or stop use.
- Withdrawal symptoms when reducing use, which also require evaluation for physical dependence during legitimate treatment.
Changes at home, school or work
- Attendance, performance or activity can change for many reasons; a marked decline deserves a supportive conversation.
- Low energy, weight changes, red eyes or poor concentration may be associated with illness, sleep problems, medication effects or substance use.
- Reduced self-care can signal distress but does not identify a particular drug or addiction.
- Unusual secrecy, altered relationships or financial difficulties may be relevant when considered with other evidence.
For a teenager, avoid treating ordinary mood changes or a need for independence as a diagnosis. Discuss specific observations, listen and arrange a professional assessment when concerns persist.
Possible effects of different substances
Effects vary and overlap. A symptom list cannot identify an unknown pill or establish addiction. Some symptoms also occur with correctly prescribed medication. Do not delay emergency help to work out which substance was involved.
Cannabis
Cannabis may affect memory, attention, coordination and reaction time. Other possible effects include altered perception, a feeling of euphoria, anxiety, dry mouth, red eyes, increased appetite or a faster heart rate. Smoking may leave an odor, but appearance or smell does not diagnose a substance use disorder. Avoid presenting changes in schoolwork, friendships or cognition as an inevitable permanent loss of intelligence.
Sedatives, benzodiazepines, barbiturates and sleeping medicines
Examples include alprazolam (Xanax), diazepam (Valium), phenobarbital, zolpidem and zaleplon. Possible effects include drowsiness, dizziness, slurred speech, reduced coordination, falls, impaired concentration or memory, and changes in behavior. Some can lower blood pressure or dangerously slow breathing, especially in risky combinations. Slow or abnormal breathing needs emergency care.
Related reading: Xanax side effects.
Amphetamines and cocaine
Stimulant misuse may involve seeking energy, performance or appetite suppression. Possible effects include increased alertness, rapid speech, enlarged pupils, agitation, anxiety, suspiciousness, sweating, nausea and changes in heart rate, blood pressure or temperature. Confusion, hallucinations, chest pain or severe overheating require urgent assessment. Nasal or dental problems can be associated with some routes of use but do not prove the substance involved.
Sleep disruption and low mood after use can occur. Serious depression or thoughts of self-harm need prompt support; seek emergency help if there is immediate danger.
Opioids
Opioids include medicines such as morphine and codeine, as well as substances such as heroin. They can reduce pain and cause sedation, nausea, constipation, small pupils, impaired attention or coordination and slurred speech. Some effects may occur during prescribed treatment. Unresponsiveness or slow breathing is an emergency, not merely a sign to watch for when assessing addiction.
Nasal irritation or injection marks may relate to a route of use but are not a diagnosis. Combining opioids with alcohol, benzodiazepines or other sedating medicines increases overdose risk. Tell clinicians about all substances taken.
Substances used at parties
MDMA/ecstasy, ketamine and GHB do not belong to one identical drug class. Effects depend on the substance and may include altered perception, sweating, shaking, teeth clenching, changes in muscle tone, poor coordination, impaired judgment or memory, and altered heart rate or blood pressure. Unknown ingredients add uncertainty. Loss of consciousness, seizures or severe overheating require emergency help.
Hallucinogens and dissociative drugs
LSD can markedly alter perception, emotions and the sense of reality. PCP can cause detachment from the body, confusion, impaired movement, involuntary eye movements, reduced pain awareness or agitation. Persistent perceptual symptoms can occur in some people after hallucinogen use, but permanent untreatable damage is not an inevitable outcome. Seek assessment for continuing symptoms, and emergency care for seizures, collapse or dangerous confusion.
Tramadol
Tramadol is an opioid pain medicine. It can cause nausea, vomiting, dizziness, sleepiness, constipation and reduced alertness. These effects do not establish misuse or addiction. Some people experience serious effects such as seizures, breathing problems or severe confusion; seek urgent help. Do not explain every mood, memory or visual symptom as damage to a specific “brain center.” Discuss symptoms, cravings or difficulty reducing the medicine with the prescriber.
Possible complications of harmful use
The risks depend on the substance, dose, combinations and method of use. Unknown or counterfeit pills may contain unexpected ingredients. A serious adverse event can happen on a first use; prior experience and a familiar-looking tablet do not establish safety.
- Overdose can cause impaired breathing, unconsciousness, seizures, coma or death.
- Some substances can cause severe overheating, dehydration or disturbances in body salts.
- Impaired judgment or coordination can lead to accidents and can make someone vulnerable to unwanted contact or assault; responsibility for assault lies with the perpetrator.
- Sharing injection equipment can transmit infections such as HIV.
- Mental health problems, family conflict, financial difficulties or difficulties at work and school may occur. They are not inevitable, and addiction does not make someone inherently criminal or violent.
- Suicidal thoughts require urgent support and emergency care when there is immediate danger.
Support and treatment at THE BALANCE
If you are concerned, speak with a healthcare professional or an addiction service. Assessments should consider prescribed treatment, physical dependence, mental health and the person’s own account. Do not force someone to stop a dependence-forming medicine abruptly; the prescriber should help plan any changes.
THE BALANCE can discuss an individual assessment and appropriate treatment options in a private setting. A plan may include medical care, psychological treatment and ongoing support, depending on need. No treatment can promise a guaranteed cure. Contact THE BALANCE to discuss suitability.
