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Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Symptoms of substance misuse

by Melissa Walsh, Kelly Owen, Esq

Category: Health issues and physiology

Definition: Substance misuse is characterized by an overuse of alcohol or drugs that leads to compulsive urges to consume the substance of choice. Substance misuse affects the user’s quality of life and ability to make good decisions. In addition to negative behavioral symptoms, substance misuse generates harmful physical symptoms, including unseen physiological damage to internal organs and visible deterioration in the user’s appearance.

Risk Factors

Experimentation with alcohol and drugs is the most prominent risk to developing substance use disorder. Whether the reward of the high is physical pleasure, the temporary removal of a traumatic memory from the mind, or simply acceptance by a peer group; experimenting with substances is always risky. Symptoms of the substance use and its effects begin to appear immediately. Many neuroscientists and mental health professionals assert that some persons are more susceptible than others to becoming addicted to alcohol or drugs because of genetic, biological, or environmental tendencies or exposure. Risk factors include a family history of substance misuse, mental disorders, childhood trauma, and early experimentation with substances. For persons with or without these risk factors, experimentation with certain substances could lead to addiction.

The earlier someone misusing substances recognizes the symptoms of substance misuse and acknowledges the dangers of continued use, the earlier he or she can advance toward treatment and recovery. At any point between a substance user experimentation and addiction, signs of dependency increasingly become apparent. Friends and family members may recognize the symptoms and then intervene to break his or her destructive patterns. Not confronting a person suspected of substance misuse will likely allow the problem to worsen.

Though one with a substance use disorder is likely to admit to using a substance, he or she is less likely to admit to misusing that substance, which makes the process of intervention difficult. Recognizing the symptoms of substance misuse can instill confidence in family and friends in preparation of their approaching the substance user with the problem.

Physical Symptoms

The most profound physiological symptoms of substance misuse stem from how substances radically alter the biochemical processes of the brain. Alcohol and drugs affect how the brain’s nerve receptors receive, process, and send information by overtaking the brain’s neurotransmitters and overstimulating its pleasure center.

This effect on the brain is manifested in the user’s mood. He or she will seem cheerful or “normal” when feeling the initial effects, or the high, of the substance. Once the high wears off, he or she will be noticeably agitated or depressed. A substance misuser also requires increasingly larger and more frequent dosing of the substance of choice to achieve the same effects after physical dependence develops.

Without increasing dosage and frequency, the individual will experience disruptive withdrawal symptoms. Other common physical warning signs of substance misuse include bloodshot and glassy eyes, sudden weight loss or weight gain, change in appetite, deteriorating personal appearance and hygiene, odor of alcohol or smoke emanating from the person’s breath or clothing, tremors, lack of coordination, and changes in speech patterns, such as slurring.

Though all substances can generate short-term or long-term effects on the body, different substances affect the body differently and manifest different symptoms. Alcohol, for example, increases dopamine in the brain, and when misused it impedes the natural production and transmission of dopamine. As the brain’s organic ability to generate pleasure chemicals is impeded by chronic alcohol consumption, the alcoholic develops a tolerance for alcohol and has difficulty functioning in daily life without it. Physical signs of alcoholism include the odor of alcohol on the breath and skin, bloodshot eyes, redness in the face, a bloated stomach, slurred speech, and a lack of coordination and focus.

Marijuana’s main active chemical, delta-9-tetrahydrocannabinol (THC), impacts sites in the brain known as cannabinoid receptors. A marijuana user will have bloodshot and glassy eyes, impaired coordination, difficulty with thinking, and memory loss. Because THC weakens the immune system, a chronic marijuana smoker frequently contracts respiratory infections.

Cocaine stimulates the nervous system by increasing the level of dopamine in the brain, and it adversely affects the ability of the brain to transmit dopamine organically. A cocaine user is hyperactive and talkative when high and appears fatigued and melancholy later, when the high has worn off. Chronic cocaine snorting causes a chronic cough, frequent nose bleeds, and even permanent damage to the nasal cavity, including a loss of the sense of smell and loss of appetite. Those who smoke crack cocaine or methamphetamine (meth) experience blemishes on the skin, weight loss from decreased appetite, and rotting teeth. Stimulants such as cocaine, crack cocaine, and meth also will manifest physical signs of dilated pupils, dry mouth, unusual sleeping and eating patterns, and increased heart rate and blood pressure.

Non-stimulant drugs generate different symptoms. Users of heroin, for example, exhibit weight loss; tremors and twitching; track marks on the arms, legs, or feet; paleness; sweating; and reduced heart rate and respiration. Users of narcotic depressants, including prescription painkillers, appear drunk and exhibit poor judgment, clumsiness, sleepiness, and an inability to concentrate.

Regardless the substance chosen, the real danger lies in the increased continuous use that’s required to achieve the level of their previous high. As the individual builds physical tolerance, increased amounts and mixing substances are required, effecting brain, heart, and organ function, and sadly often leading to death by overdose.

Behavioral Symptoms

Substance misuse inflicts long-term changes to the brain; the neuroadaptations the brain produces to control the release of dopamine and regulate emotions remain with the addict even after treatment and abstinence. Substance addiction also alters the prefrontal cortex of the user, causing the reduction in neuron activity in this part of the brain.

These changes to the brain also lead to the release of the neurotransmitter glutamate, which impairs the addict’s decision-making ability. Glutamate facilitates impulsiveness and intense focus on achieving the immediate reward of pleasure. Consequently, addicts often engage in reckless behavior, and rehabilitated addicts are prone to relapse when faced with substance-related stimuli. In the amygdala, the part of the brain involved in memory formation, emotional memories associated with being high are enhanced, thereby making it difficult for the addict to resist stimuli that trigger these memories.

Because substance misuse radically affects the physiology of the brain, misuse also profoundly affects behavior. The need to consume the substance of choice increasingly dominates judgment and daily actions. Other previously healthy habits and priorities are abandoned and replaced by the addiction.

Substance misuse may be attributed to several disruptive and harmful behavioral patterns, such as family disintegration, loss of employment, domestic violence, financial problems and child abuse. Common behavioral symptoms include the inability to refrain from consuming the substance, an obsession with achieving the next high, an abandonment of important responsibilities and interpersonal relationships, and a disregard for the obvious harm the substance is causing to the body.

Consistent with the effect that substance misuse has on the brain, a user is more likely to drop out of school or quit a job, may change peer groups often, may experience conflicts with the law, and may experience mood swings, inability to focus, decreased rationale thinking, recklessness, laziness, depression and paranoia.

The classic behavioral symptom of persons with a substance misuse problem is that they sever important relationships by betraying those closest to them. Because the quest for the next high is so prominent in their mind, people with substance use disorder will lie, cheat, and steal from strangers and loved ones alike to get the next fix.

For Further Information

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author.

Fisher, Gary L., and Nancy A. Roget, eds. Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery. 2 vols. Thousand Oaks: Sage, 2009. Print.

Hoffman, John, and Susan Froemke, eds. Addiction: Why Can’t They Just Stop? New York: Rodale, 2007. Print.

Lawford, Christopher Kennedy. Moments of Clarity: Voices from the Front Lines of Addiction and Recovery. New York: Morrow, 2009. Print.

“The Science of Drug Abuse and Addiction: The Basics.” National Institute on Drug Abuse. Natl. Insts. of Health, Sept. 2014. Web. 6 Nov. 2015.

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2014). “Monitoring the Future national survey results on drug use: 1975-2013: Overview, key findings on adolescent drug use.” Ann Arbor: Institute for Social Research, The University of Michigan.

Zeller, S.L., Nordstrom, K.D., & Wilson, M.P. The Diagnosis and Management of Agitation. Cambridge University Press. 2017. Print.

Citation Types

Type

Format

MLA 9th

Walsh, Melissa, and Kelly Owen. "Symptoms Of Substance Misuse." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0306.

APA 7th

Walsh, M., & Owen, K. (2018). Symptoms of substance misuse. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Walsh, Melissa and Owen, Kelly. "Symptoms Of Substance Misuse." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

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