Signs Someone You Love May Have a Substance Use Problem

You’d be far from the only family in this spot. In 2025, about 44.6 million people in the U.S. aged 12 and older had a substance use disorder, and only about 1 in 6 of those who needed treatment got it.¹

Is this a phase, or something serious?

The difference is control and harm, not how often they use. NIAAA describes alcohol use disorder as an impaired ability to stop or control drinking despite social, work or health consequences.² Clinicians work from 11 criteria, the same for alcohol and drugs, looking back over the past 12 months. Two or three point to a mild disorder, four or five to a moderate one, and six or more to a severe one.²⁶ Most people with a substance use disorder have the mild form; about 1 in 5 have a severe one.¹

A phase usually means occasional use that stays the same and stops when it causes trouble. A problem tends to grow, the promises don’t hold, and the consequences change nothing.

What do families usually notice first?

For teens, SAMHSA’s warning signs include flare-ups of temper and defensiveness, slipping grades or attendance, broken family rules, new friends they’d rather you didn’t meet, a “nothing matters” attitude, alcohol in their room or on their breath, and memory lapses, bloodshot eyes or slurred speech. A problem is more likely when several show up at once, appear suddenly, or are extreme.³

In adults the changes look similar: slipping at work, secrecy, an unexplained need for money, sudden mood swings, and using even when it strains relationships.⁴ Missing cash, valuables or medication deserve attention too.

Plenty of these can also come from ordinary stress or, in teens, growing pains.³

Which signs do clinicians ask about?

The list below adapts NIAAA’s questions for alcohol use disorder into things a family can actually see.² Tick what you’ve noticed in the past year and bring the printout to a doctor’s visit.

Two or more ticks is reason enough to get a professional opinion. If they get shaky or sick when they cut back, especially from alcohol or sedatives, read when withdrawal is dangerous before anyone pushes them to quit cold turkey.

How much drinking is too much?

There’s no single cutoff. NIAAA defines binge drinking as about five or more drinks for a man, or four or more for a woman, in roughly two hours. Heavy drinking is five or more on any day or 15 or more a week for men, and four or more on any day or eight or more a week for women. Both raise the risk of alcohol use disorder over time, even if it only happens on weekends.⁵

These numbers measure risk, not diagnosis. Someone who drinks less can still have a problem if they can’t stop once they start.

What can I do if I’m seeing these signs?

You don’t need proof or a diagnosis to act.

1. Write down what you’ve seen, with dates. “You missed work three Mondays in a row” lands better than “you’re an alcoholic.”
2. Wait for a calm moment when they’re sober and you’re not angry, then offer one concrete step, like a visit to their primary care doctor. SAMHSA promotes screening in primary care precisely to catch problems before they get worse.⁹
3. If you’re stuck, the SAMHSA National Helpline at 1-800-662-4357 is free, confidential, open 24/7, and can point you to local services.¹⁰
4. Get support for yourself, whether or not they accept help.

For the conversation itself, see how to raise it without a fight. If you’re wondering why someone can promise to stop and still keep using, read addiction explained in plain English.

What should I ask a doctor or counselor?

These questions help you leave a screening with a plan. If your loved one is an adult, the clinician may not be able to share details with you unless they sign a release; see privacy rules and consent forms.