Guide to Recognizing and Getting Help for Substance Abuse

Drug-related overdoses have increased at an alarming rate in the past few decades. In fact, the Center for Disease Control estimates that over 100 Americans die a day from drug-related overdose, the majority of which result from opioids.

If you think you or a friend or loved one is struggling with addiction, it’s important to recognize the signs and get the help needed to overcome this potentially fatal problem.

How Does Addiction Work?

Substance addiction occurs through a complex interaction of many different factors, responses, and patterns of behavior. While it has been a subject of great research and scrutiny, scientists haven’t yet fully tackled all the aspects that go into a substance use disorder.

What they have discovered, though, is that an addiction is chemically fueled by three aspects: pleasure, memory, and tolerance.

The pleasure aspect of substance addiction comes into play through the release of the chemical dopamine. When it comes to any sort of pleasurable activity, whether it’s riding a bike, eating a nice meal, or figuring out a puzzle, dopamine is responsible for activating the areas of the brain responsible for perceiving that activity as enjoyable. This dopamine is released from an area called the nucleus accumbens, nicknamed the pleasure center, and spreads across the brain to create a feeling of reward.

Certain drugs, however, act as a way to bypass the typical requirements for dopamine release and instead hack directly into the pleasure center to release dopamine. Beyond being able to skip the work usually involved in triggering the reward sensation, some drugs can also release two to ten times as much dopamine compared to natural processes. In this way, the brain will experience a more powerful reward than might be possible without it, making such a drug highly addictive.

The memory aspect of substance abuse is a recent addition to the scientific understanding of addiction. Researchers discovered that dopamine also plays a role in the learning processes related to rewards, not just the rewards themselves. As such, using an addictive substance over time can overload the areas of the brain responsible for motivation so that cravings for the drug are stronger and less controllable than many other desires.

What’s more, the chemical malfunction can strongly link drug use to certain situations. This interplay leads to the development of “triggers,” any sort of environmental cue (from bars and parties to cigarette smoke or even certain people) that signal intense cravings for the drug.

Tolerance is another aspect of addiction and, as with the other factors, also has to do with how the brain processes dopamine. As a drug user continually floods his or her brain with this pleasure chemical, the body begins to account for the dopamine overload by decreasing its release rate. As a result, the same amount of a drug that created such a high the first time will be less pleasurable after repeated use.

Due to the interweaving of the memory aspect of addiction, an addict will be chemically driven to achieve that same high to the point of putting a potentially fatal amount of a toxic substance into their body.

The complex entanglement of these three factors of addiction are the main driving forces behind how easily someone can develop a substance abuse problem. Now that you know a bit about the mechanisms behind addiction, let’s take a look at some of the warning signs to help you identify if you or a loved one has a problem.

Identifying a Substance Abuse Problem in Yourself

One of the most difficult things a substance abuser has to do on the road to recovery is to first admit they have a problem. Part of this difficulty comes from the fact that their brains have already become so altered to seek out the drug that they are incapable of using objective reasoning when it comes to their problem.

This is called a “cognitive bias” — a way of thinking that impedes rationality. As such, many addicts will subconsciously come up with justifications for their substance abuse like “I just use it to unwind after a hard day” or “at least I’m not using as much as my friends.” These types of justifications keep a substance abuser from admitting they have a problem and, ultimately, keep them from having to give up the drug.

Here is a list of criteria provided by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5), that can be used to determine if you have a substance use disorder. In general, meeting two to three of these criteria correlates with a mild substance use disorder, four to five indicates moderate, and six to seven mean a severe substance use disorder.

  • Taking the substance in larger amounts and for longer than intended
  • Wanting to cut down or quit but not being able to do it
  • Spending a lot of time obtaining the substance
  • Craving or feeling a strong desire to use the substance
  • Repeatedly being unable to carry out major obligations at work, school, or home due to substance use
  • Continuing use despite persistent or recurring social or interpersonal problems caused or made worse by substance use
  • Stopping or reducing important social, occupational, or recreational activities due to substance use
  • Recurrent use of substances in physically hazardous situations
  • Consistent use of substances despite acknowledgment of persistent or recurrent physical or psychological difficulties from using substances
  • Experiencing tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount
  • Experiencing withdrawal or using the substance to avoid withdrawal

Withdrawal is the body’s natural response to no longer being under the influence of a particular substance. As the chemistry of your brain was once supplemented by the drug, the sudden absence of this drug causes the brain to overreact, usually resulting in a variety of symptoms like anxiety, cold sweats, nausea, and insomnia.

Not all substances produce the same withdrawal effects. Here are a few resources provided by MedlinePlus, a government organization that’s part of the U.S. National Library of Medicine. If you think you may have a substance abuse problem, recognizing the withdrawal symptoms outlined below may be key to moving towards getting the help you need.

Identifying a Substance Abuse Problem in Others

While recognizing substance abuse in yourself can be hard, seeing it in others can be just as challenging.

On the one hand, if your friend or loved one comes to you for help and admits they may have a substance abuse problem, you can use the above-mentioned DSM 5 test to evaluate their situation. Although you can ask them the questions directly, it’s worth noting that some people may not be entirely truthful with you or may be unwilling to answer the questions. Sometimes just pointing these individuals to the test can be enough to help them realize their abuse problems and start looking for the help they need.

Other people may not be as forthcoming with their problem or may be ignoring it entirely. In this case, you may have to rely on identifying certain signals of abuse. Here is a list of some possible changes you may have noticed that could point to substance abuse.

  • Changes in physical health: decreased motivation or energy, frequent sickness
  • Problems at their job or school: frequently calling in or missing work, sudden apathetic disposition, decreased performance
  • Sudden behavioral shifts: avoiding contact with friends and family, secrecy about their activities, unusual mood changes
  • Neglected physical appearance: decrease in hygiene, grooming, or clothing style
  • Money problems: frequently asks for money, may be stealing money or items from you or others to support their habit

If you notice a sudden shift in any of these behaviors, it’s possible your friend or loved one is struggling with a substance abuse problem. The next step is getting them the help they need.

Getting Help for a Substance Abuse Problem

As mentioned above, if you have a substance abuse problem, one of the biggest hurdles is simply admitting it. Once you get to that point, it’s only a matter of finding a proper treatment facility or program.

While some drugs like nicotine and tobacco might allow abusers to quit on their own, other more serious substances and addictions require the help of qualified professionals. Trying to quit certain substances “cold turkey,” for instance, may actually lead to a variety of health problems like seizures, coma, and even death. A treatment center gives substance abusers access to the expertise of a medically certified staff so that your safety will never be compromised.

Such centers will also typically provide supplemental services like counseling, stress management, talk and group therapy, and ongoing support to reduce the likelihood of relapse. While no treatment plan works the same for every patient, the incorporation of these services has been proven more effective than drug-based therapy alone.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is one of the best resources for finding a treatment facility near you. It can also provide answers to condition-specific questions and treatment advice as well. Their national helpline is available 24/7, 365 days a year and is absolutely free.

  • SAMHSA National Helpline: 1-800-662-HELP (4357)

Persuading someone you care about to seek out help can be particularly challenging, especially if they do not think they have a problem. Displaying anger or harsh judgement may cause them to overreact or ignore you entirely. In that same vein, abrupt interventions popularized by modern television have shown no difference in the likelihood of beginning treatment. What’s more, they could backfire and result in aggression or violence.

Instead, let an addicted friend or loved one know that you care about their well-being and because of the reasons above, you think they might have a problem and should seek help. If they refuse to check in to a treatment center, try to get them to agree to see a qualified physician. Oftentimes, an unbiased medical opinion can be all it takes to make your friend or loved one realize they have a problem.

The American Society of Addiction Medicine has a Find a Physician feature that can help you get in touch with a qualified physician near you for this purpose.

If you have any questions regarding substance use disorders or need advice on how to handle it for yourself or someone else, feel free to visit the National Institute on Drug Abuse or SAMHSA for more information or call the SAMHSA national helpline at 1-800-662-HELP (4357) any time, day or night.

You can also use search terms like “substance abuse advice,” “substance abuse counseling,” “substance abuse recovery”, or “drug addiction help” in your area in search engines for more information.


Dealing with a substance abuse problem can be one of the hardest things a person will ever do. The idea of living life without the crutch of a particular substance might seem like a daunting task. But with the help of friends, family members, and the qualified expertise of professionals at a treatment center, you or your loved one can move on to a happy and sober life.

DISCLAIMER: This guide is provided only for informational purposes and is not intended to be a substitute for legal or other professional advice. This guide does not contain nor is it intended to provide legal or other professional advice for any specific situation and readers should not take action or refrain from taking action, based only on the information provided in this guide. Goldberg & Osborne has attempted to provide accurate and current information in this guide, but cannot and does not guarantee that the information is accurate, complete, or up to date. This guide may contain links and/or search terms that will lead to external websites as a convenience to the reader, but Goldberg & Osborne is not responsible for the content or operation of any website other than its own website. The presence of a link or a search term does not imply and is not an endorsement by Goldberg & Osborne of the website provider or the information contained on any linked website or on any website contained in search results from a search term provided in the guide.