Substance abuse is a growing problem in the U.S. Prior to the 1990s, poisoning was a rare cause of death in America, but has skyrocketed to become one of the most common causes of preventable injury and death. Opioid abuse constitutes much of the problem, but use of drugs in other categories is also on the rise. Some organizations, such as the CDC, have even labeled opioid addiction an epidemic. 

Whether it’s prescription painkillers, alcohol, or some other addictive substance, it’s not always easy to tell whether someone is addicted. Healthcare professionals who need to make a diagnosis have the luxury of turning to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, to determine whether someone has a substance abuse disorder. 

The first line of defense and best chance at prevention, however, almost always lies within a person’s immediate environment — their loved ones. It’s therefore helpful to be familiar with the criteria the DSM has set forth. 

According to the DSM guidelines, any person who experiences two to three of the following criteria within a 12-month span has a mild substance abuse disorder. Meeting four to five of the criteria can be classified as a moderate disorder, while six to 11 is a severe disorder:

1. Withdrawal syndrome

The first of the signs of substance abuse or dependence is someone experiencing withdrawal symptoms when trying to go off the drug. Each drug has its own set of symptoms that occur when the individual’s body and mind become used to the drug. Common withdrawal symptoms include mood disorders such as anxiety or depression, as well as physical symptoms such as shivering, constipation, headaches, insomnia, loss of appetite, cravings, and more. In most cases, the person will feel compelled to take more drugs in order to alleviate the symptoms. 

2. Neglecting responsibilities

As the use of a substance becomes a habit, the user’s responsibilities will lose importance to them. Frequent substance abuse often results in the individual forgetting about or ignoring responsibilities and obligations such as work, school, or their duties around the home. 

3. Cravings 

Craving a drug or alcohol is often a sign that substance abuse has taken hold over a person’s life. They have a strong urge or desire to use the substance — a compulsion often so strong it feels impossible to ignore.

4. Uncontrollable use

If a person decides they will only take a limited amount of the substance — or only for a limited amount of time — but find themselves unable to control their use once they start, it can be a sign of a larger problem. 

5. Time spent

In addition to time spent under the influence of drugs or alcohol, an individual with a substance use disorder will often spend a great deal of time and effort to obtain more of the substance, as well as in coping with the negative effects it has on them. 

6. Not being able to stop

Someone with a substance abuse disorder often wants nothing more than to change their behavior, but find they can’t. They’ve usually gone through repeated failed attempts to gain control over their substance use. They may try to slow down their use, but even that is typically unsuccessful. 

7. Relationship troubles don’t discourage use

Due to the effects substance abuse has on an individual’s priorities, behavior, and mood, problems often manifest in an addict’s personal relationships. These can be the result of friends and family being let down too often, or because the addict’s behavior pushes those close to them away. Even when it becomes clear to the substance abuser that their recurrent drug use is causing trouble in their relationships, they fail to change their behavior.

8. Development of tolerance

Tolerance is a sign that substance abuse has begun to dramatically affect brain function and structure. A drug tolerance can be defined as experiencing a diminished effect from a drug over time, or the need to increase the quantity of a substance to get the same effect it usually has. 

9. Hazardous use

Someone who has become addicted to a substance often doesn’t allow circumstances to deter them, even when a situation becomes dangerous. For example, driving under the influence is illegal, and dangerous both to the person driving and those around them — but alarmingly common. When these situations occur frequently, it’s almost always a sign of a substance abuse disorder. 

10. Physical and psychological issues don’t deter use

Regardless of the specific substance being abused, both physical and mental problems can become apparent — or exacerbated — by the continued abuse of the substance. It often becomes clear to the abuser that these problems are caused by (or worsened by) the abuse of drugs or alcohol, but even this awareness fails to change their behavior.

11. Previously important activities are given up

These important activities can range from hobbies and social activities to career-related opportunities that once held great significance to the abuser, such as attending events or making time for friends. The addict may greatly reduce the time they spend doing these activities or drop them altogether.

Bottom line

Knowing a problem exists is the first step in managing or treating it. Looking at each of the above criteria as individual red flags, and understanding the danger they signify, is crucial in introducing appropriate interventions before the problem grows worse. Thanks to modern science, we know addiction can happen to anyone, and fortunately the stigma around it is slowly being dismantled. Being educated about the risks can help prevent it from ruining your life or that of someone you love.