What are the symptoms of a substance use disorder (SUD)?

It is important to recognize the signs and symptoms of a substance use disorder (SUD). The National Council on Alcoholism and Drug Dependence (NCADD) provides the following warning signs:

  • Loss of control: Drinking or drug use more than people want to, for longer than intended or despite telling themselves that they wouldn’t do it this time.
  • Neglecting other activities: Spending less time hanging out with family and friends, exercising, pursuing hobbies or other interests. A drop in attendance and performance at work or school.
  • Risk taking: Taking serious risks to obtain one’s drug of choice.
  • Relationship issues: Acting out against the people closest to them, particularly if someone is attempting to address their substance problems. Complaints from co-workers, supervisors, teachers or classmates.
  • Secrecy: Going out of their way to hide drugs or alcohol, or to conceal their activities when drinking or using drugs. Unexplained injuries or accidents.
  • Changing appearance: Serious changes or deterioration in hygiene or physical appearance, such as lack of showering, slovenly appearance or unclean clothes.
  • Family history: A family history of addiction can dramatically increase one's predisposition to substance use disorder (SUD).
  • Tolerance: Over time, a person's body adapts to a substance to the point that the person needs more and more of it in order to have the same reaction.
  • Withdrawal: As the effect of the alcohol or drugs wears off, the person may experience symptoms such as anxiety, trembling, sweating, nausea and vomiting, insomnia, depression, irritability, fatigue, loss of appetite and headaches.
  • Continued use despite negative consequences: Even though it is causing problems, a person continues to misuse alcohol and drugs.

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Serious addiction to drugs or alcohol impacts every part of our life. Addiction causes our social relationships to deteriorate, because when you're addicted, drugs and alcohol come before any interest in people. Suddenly, ethical, honest and kind people will lie, steal, cheat or whatever it takes to hide their addiction the best they can. Addiction impacts us physically all kinds of ways, causing brain shrinkage that deteriorates our ability to think clearly. Brain injury from addiction leads to poor job performance because addicts may start to using or thinking about drugs during working, making it harder to concentrate.

Put simply: Addiction hits organ systems all throughout the body.

Drinking alcohol regularly becomes substance abuse when you can no longer control it. In other words, your drinking begins to disrupt your life and makes it harder for you to stay close to family and friends, do your job and pay your bills. Here are some questions to ponder: Do you feel annoyed people complain about your use? Do you drink first thing in the morning? Have you ever felt embarrassed or guilty about your drinking? Do you ever feel the need to cut back on your drinking? If you can answer "yes" to one or more of these questions, you should consider getting help.

Fredrick Wade
Addiction Medicine Specialist

The following are symptoms, hallmarks of abuse or dependence, and or traits by which the onset or actual diagnosis of abuse or dependence may be arrived at.  

  • Tolerance
  • Use despite knowledge of potential negative consequences
  • Unsuccessful attempts to cut down
  • Diminished social activities given up to allow more time for the pursuit of the use and abuse of the substance of choice.
  • Withdrawal


The following are the most common behaviors that indicate an individual is having a problem with substance abuse. However, each individual may experience symptoms differently. Symptoms may include:

  • getting high on drugs or getting intoxicated (drunk) on a regular basis
  • lying, especially about how much they are using or drinking
  • avoiding friends and family members
  • giving up activities they used to enjoy such as sports or spending time with non-using friends
  • talking a lot about using drugs or alcohol
  • believing they need to use or drink in order to have fun
  • pressuring others to use or drink
  • getting in trouble with the law
  • taking risks, such as sexual risks or driving under the influence of a substance
  • work performance suffers due to substance abuse before, after, or during working or business hours
  • missing work due to substance use
  • depressed, hopeless, or suicidal feelings

The symptoms of substance abuse may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.

Dr. Howard J. Shaffer, PhD
Addiction Medicine Specialist
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), people who are dependent on substances exhibit at least three of the following symptoms or behaviors during the same 12-month period:
  • Greater tolerance: using higher doses of the substance to reach the same level of intoxication, or being able to use more than others without becoming intoxicated.
  • Withdrawal symptoms: experiencing certain physical symptoms when use of the substance is stopped or cut back, such as anxiety, sweating, trembling, trouble sleeping, nausea, or vomiting.
  • Ongoing desire to quit using: attempting to cut down or quit, without success.
  • Loss of control over quantity or involvement: using greater amounts, or using over a longer period than intended.
  • Greater focus on the substance: spending a lot of time thinking about using, making plans to use, using, and recovering from the effects of the substance.
  • Less focus on other things: spending less time doing other things -- engaging in sports, being with family and friends, and pursuing hobbies.
  • Ignoring problems: continuing to use despite recognizing that it's causing problems, such as interfering with relationships or worsening health.
An ongoing (real or perceived) need for the substance and physical withdrawal symptoms may indicate a more severe level of dependence.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.