Signs of Substance Use

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Overview

The following are some obvious signs that a person may be drinking alcohol, using tobacco, or using other substances. This is not a complete list. If you suspect use of a particular substance, get more information on signs of use for that substance.

Alcohol

  • Alcoholic beverages missing from the home storage cabinet
  • Odor of mouthwash (used to cover up alcohol) on the breath
  • Hangover symptoms (such as nausea, vomiting, or headache), if recently used

Tobacco

  • A distinctive smell on the breath and clothing
  • Tobacco products in the person's possession

Marijuana

  • Sweet smell on clothing; bloodshot eyes, if recently used, and frequent use of eyedrops to reduce the redness
  • Careless grooming, increased fatigue, and changes in eating and sleeping patterns, if using regularly
  • Drug paraphernalia (such as pipes) in the person's possession

Club drugs such as ecstasy (MDMA)

  • Skin rash similar to acne
  • Small bottles with liquid or powder in the person's possession

Stimulants such as cocaine or methylphenidate (Ritalin)

  • Long periods of time without sleep
  • Persistent runny nose and nosebleeds, or injection marks on arms or other parts of the body
  • Drug paraphernalia, such as syringes, spoons with smoke stains, small pieces of glass, and razor blades

Hallucinogens such as LSD

  • Trance-like appearance with dilated pupils, if recently used
  • Possession of small squares of blotter paper (sometimes stamped with cartoon characters) or other forms of the drug

Opioids such as heroin or hydrocodone (Norco)

  • Very small pupils and a drowsy or relaxed look, if recently used
  • Extra pill bottles around the house or in the trash
  • "Doctor shopping" (getting multiple opioid prescriptions from different doctors)
  • Possession of injecting supplies (an outfit or rig), which may consist of a spoon or bottle cap, syringe, tourniquet, cotton, and matches

Inhalants

  • Chemical breath, red eyes, or stains on clothing or face, if recently used
  • Soaked rags or empty aerosol containers in the trash

Anabolic steroids

  • An unpleasant breath odor
  • Mood changes, including increased aggression
  • Changes in physical appearance that aren't caused by expected patterns of growth and development
  • Possession of medicines or syringes

Credits

Current as of: November 15, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.