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Substance Abuse on the Rise: Know the Signs

By Fahad Alam, MD January 17, 2023 Posted in: Mental Health, Wellness

No one thinks it will happen to them, but substance abuse upends families every day. A recent report(1) from the National Institute on Drug Use showed some concerning trends among young adults (age 18-30):

  • Daily, past-month and past-year marijuana use reached the highest levels recorded since 1988.
  • Reports of past-year hallucinogen use started to increase dramatically in 2020 after being stable for the past few decades.
  • Binge drinking (5 or more drinks in a row) rebounded in 2021 after experiencing an historic low in 2020.
  • High-intensity drinking (10 or more drinks in a sitting) reached its highest recorded level since 2005.

Of the 5.1 million young adults in the US with a substance use disorder, 87% did not get treatment according to SAMHSA, the Substance Abuse and Mental Health Services. Being aware of and watching for these signs of substance abuse is a first step toward getting people help:

Signs of Substance Abuse

Physical Signs

  • Large or small pupils, bloodshot eyes
  • Sudden weight loss or gain
  • Insomnia/sleep pattern changes
  • Poor coordination/rapid or slurred speech
  • Unusual body odors/unkempt appearance

Behavioral Signs

  • Mood swings, personality changes, outbursts
  • Secretive behavior
  • Problems at school/work or neglecting home responsibilities
  • New friend groups or social activities
  • Risk-taking when using – driving recklessly, having unprotected sex
  • Legal problems – DUIs, disorderly conduct arrests

How to Start a Conversation about Substance Abuse

Maybe you’ve noticed these signs and you’re concerned about your loved one. How do you start a conversation? Try these steps from SAMHSA(2):

  1. Identify an appropriate time and place. Consider a private setting with limited distractions, such as at home or on a walk.
  2. Express concerns and be direct. Ask how they are feeling and describe the reasons for your concern.
  3. Acknowledge their feelings and listen. Listen openly, actively and without judgment.
  4. Offer to help. Provide reassurance that mental and/or substance use disorders are treatable. Help them locate and connect to treatment services.
  5. Be patient. Recognize that helping your loved one doesn’t happen overnight. Continue reaching out with offers to listen and help.

A primary care provider can be a helpful resource if you’re concerned about or a loved one’s – or your own – substance use or abuse. It’s important to know that health care providers will listen without judgment and guide you to essential resources.




Fahad Alam, MD
Fahad Alam, MD

Fahad Alam, MD, is an internal medicine doctor at CHI Health.

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