Today, 1 in 10 Americans are estimated to struggle with a substance abuse problem during their lifetime. But, when does substance use go from “recreational” or “following a prescription”, to “problematic”? This question is especially relevant in the United States, where substance abuse and intoxication is normalized and considered a normal social activity. 1 in 6 of us currently binge drinks at least 4 times per month, consuming excessive amounts of alcohol. The National Survey on Drug Abuse and Health shows that 9.4% of the population self-reports using drugs recreationally. Drugs like cannabis are increasingly legalized. And, some 4.38 billion prescriptions were filled by Americans in 2019 alone.

When does substance abuse become a problem? What are the early warning signs of substance abuse? If you or a loved one is developing a problem, when do you act? If you’re concerned, it’s probably always a good idea to discuss your concerns with your doctor. However, the following article covers some of the early warning signs of substance abuse and addiction.

Binging Substances

Binging is the act of taking a significantly large portion of a substance over a short period of time. For alcohol, binging is defined as consuming more than 4 units of alcohol in an hour. While it’s less defined for other substances, such as cannabis or opioids, any instance where you take a significant quantity of a substance, resulting in heavy intoxication, likely qualifies as binging.

Hiding Substance Use

Individuals who don’t have a problem rarely take the time to hide it, except when the substance is completely illegal. However, individuals using an illicit substance are putting themselves at risk by using it, so they should be considered here as well:

Hiding substance use typically occurs in situations where:

• You don’t think others will approve
• You’re using outside of socially acceptable norms
• You’re using in scenarios where it could endanger performance, work, or lives (e.g., at work, when driving, before operating machinery, etc.)
• Friends and family have expressed concerns over substance use
• You feel that substance use is problematic and don’t want others to reach the same conclusion

In most cases, if someone is hiding substance use, even if it’s a prescription, they likely have a problem.

More Substances are Needed for the Same Effect

Tolerance is the process of adjusting to a substance so that the original dose no longer has the same or any effect. This is one of the first signs of building a dependency, because it normally forces the individual to take more, resulting in increased exposure.

Tolerance means you’ve taken enough that you have adjusted to this dose. It is your new normal. If you can’ t back down and take less of a substance for a few days to revert to the previous dosing, you are likely heading for a substance abuse problem.

Higher exposure to a substance greatly increases the risk of substance use disorder, because exposure is the greatest common cause of drug and alcohol use disorders.

Quitting Has Failed

If someone has a drug or alcohol problem, they typically realize it fairly quickly. In most cases, they attempt to quit or to cut back and may even succeed for a bit. Eventually they relapse and start using again. This is more difficult for prescription users, who often cannot simply quit a substance, because they often need it to control symptoms.

However, the pattern includes recognizing a need to cut down or return to previous usage and either temporary success followed by failure or failure. Most people will have escalating and deescalating patterns of usage and may even quit for several months at a time but will always return to previous levels of usage.

Loss of Control

Someone with a substance use disorder loses control over how and when they use the substance. People who use so much that they black out, don’t remember things, or take more than intended after they start likely have a problem.

• “I’ll have one drink” turns into binge drinking
• Frequent blackouts
• Memory problems or missing days following drug binges
• Endangering themselves or others to use
• Using in situations where substance use has negative consequences, such as when it uses rent money, influences work performance, or results in reduced manual dexterity when driving.

Here, the you may actively realize you have a problem or actively plan to drink or use less, but always end up using more. Externally, this often looks like someone making promises and immediately breaking them, but the individual might not intend to do so.

Constantly Thinking About Using

People who use in a healthy way do not spend most of their time thinking about using or drinking. In fact, it likely largely never comes up until the activity is presented to them. Individuals who put a large amount of planning, time, or effort into ensuring that they can use a substance are doing so in a problematic way. This means spending a significant amount of time or energy acquiring drugs or alcohol, spending a significant amount of your income on drugs or alcohol, spending time fantasizing or planning for when you are able to drink or use, or thinking about when you’ll be able to drink or use.

In real life situations, that might work out to:

• Frequently taking detours from work to buy drugs or alcohol
• Frequently spending over your budget on drugs or alcohol
• Thinking about using or drinking when stressful events occur
• Doctor shopping, or acquiring a prescription from more than one doctor
• Buying your prescription outside of a pharmacy, or in higher quantities than your prescription allows
• Thinking about how and when you get to drink or use throughout the day
• Making changes to your diet or lifestyle to accommodate substance use (e.g., skipping meals to allow for alcohol consumption without weight gain, skipping plans to have time to use, giving up hobbies to afford drugs)

In any case where substance use becomes a major part of your life, you likely have a problem.

Physical Symptoms When Quitting

In any case where you have physical symptoms such as cold and flu symptoms, or excessive hangover when you quit, you’re likely developing a chemical dependency. This happens when the body adjusts to having the substance, and you must go through a detox process to readjust to the natural state without it. Physical dependence is the stage following tolerance, where your body adjusts secretion of neurotransmitters like dopamine and serotonin, and when the central nervous system adjusts to having the substance. Withdrawal symptoms are typically light for light dependencies but can be severe. For example, individuals who quit or suddenly reduce benzodiazepine intake can experience severe and dangerous withdrawal symptoms.

If you experience withdrawal symptoms when quitting a substance, talk to a professional. It might not be safe to quit without medical supervision.

Substance abuse is serious, and it can lead to substance use disorders and long-term ramifications for your physical and mental health. Addiction changes how people think, act, and live. It impacts mental health, reduces life satisfaction, prevents people from following through on goals or committing to relationships, and results in long-lasting harm to mental health. The sooner you get help for yourself or your loved one, the better.

If you or a loved one are struggling with substance abuse, please contact Christians Drug Rehab to learn more about our program. Our dedicated team can help you break the cycle of addiction and manage any co-occurring mental health condition that may accompany you or your loved one’s disorder.