Signs You May Be Struggling with Substance Use Disorder

Substance Use Disorder

Special thanks to today’s sponsor, Seasons in Malibu, and our guest author Dr. Nancy Irwin.

From comically-oversized wine glasses to supersized restaurant portions, we live in a culture that celebrates overindulgence.

Understanding of AddictionMost of us intuitively know when we’re overdoing it, even if we might not like to admit it. Yet, the line between moderate, safe consumption of a substance and problematic use can easily become blurred—especially with legal drugs like alcohol.

What begins as social drinking, for example, can evolve into regular, daily use that’s not safe or healthy.

Our Evolving Understanding of Addiction

But, isn’t it obvious when someone is addicted? The image many of us have of a “falling-down drunk” or “addict who has lost everything” represents the extreme picture of addiction, but it doesn’t represent the whole picture.

Today, those of us in the healthcare field—medical professionals, addiction specialists, and researchers—know that addiction occurs on a spectrum, from mild to severe.

A person who continues to use a drug, despite life-altering consequences like losing their job or home, getting multiple DUIs, or developing health issues, may need to abstain completely and may need help in the form of addiction treatment.

How Much Is Too Much?

What about those who fall outside this extreme? How do we determine who has a problem with drug or alcohol use and who doesn’t?

First things first—prescription drugs should only ever be used as directed by your doctor, especially opioids, which carry a high risk of addiction if misused. Misusing prescription drugs is, by definition, problem use.

Identifying problem alcohol use, on the other hand, can be trickier—it’s not always obvious how much is too much.

There’s a consensus among organizations that study human health and addiction, like the Centers for Disease Control and the National Institutes of Health, about what constitutes problem use. These organizations define risky or heavy drinking as:

  • More than 7 drinks per week or more than 3 drinks on any day for women
  • More than 14 drinks per week or more than 4 drinks on any day for men

Based on these limits, one in three Americans drinks excessively.

If you happen to fall into this category you might be thinking, what’s the harm in having a glass or two of wine at night after a stressful day at work? As it turns out…plenty.

Even one or two drinks a day can damage short- and long-term memory and cause structural changes in the brain. Remember that for women more than one drink per day is considered heavy use. In people with severe alcohol use disorder, alcohol can actually cause the brain to shrink, damaging its ability to send signals from one region to the another.

It’s easy to drink too much, especially since many of us have a skewed view of the size of a normal drink. It’s not all that surprising considering the enormous wine and beer glasses you encounter at many bars and restaurants.

A standard drink is defined as 5 ounces of wine, 12 ounces of beer (5% alcohol content), or 1.5 ounces of spirits. You can use this drink calculator to find out how many drinks actually make up that jumbo glass of vino and take this alcohol self-test to learn more about your drinking pattern.

Substance Use Disorders in Older Women: A Hidden Problem

The topic of substance abuse and dependence is rarely associated with seniors, yet 2.5 million older adults in the U.S. suffer with a drug or alcohol problem.

Older women (and men) may turn to drugs or alcohol to cope with major life changes like retirement, illness, downsizing to a smaller home, adult children “leaving the nest,” or loss of a spouse—all of which can bring on a slew of emotions.

Non-medical use of prescription drugs has risen dramatically among women aged 60-64, according to the 2009 National Survey on Drug Use and Health. Another report found that 6.3% of older women engaged in binge drinking, and 10.9% engaged in at-risk drinking (more than 7 drinks per week or 3 drinks on one occasion).

Seniors also fill 17 million tranquilizer prescriptions a year—some of the most abused drugs in the country, alongside opioid analgesics. An estimated 11% of older women misuse prescription medications.

While substance use disorders (SUD) have historically been much lower in seniors, Baby Boomers are unique in that they came of age in a period of more permissive attitudes toward drug and alcohol use. The prevalence of SUDs among Boomers remains high even as members of this generation age. And, the number of older adults with a substance use disorder is expected to nearly double in the coming years, from 2.8 million in 2002-2006 to 5.7 million in 2020.

It’s clear from these numbers we need to do a better job of opening the dialogue and addressing the problem of SUDs in seniors.

Signs You May Have a Problem

Substance Signs

Now for some good news. The U.S. has made considerable progress in recent years in recognizing substance use disorders as a legitimate health problem (not simply a lack of willpower) that warrants medical treatment. In fact, medical professionals today generally recognize addiction as a disease, with similar relapse rates to other diseases, like diabetes.

Doctors and many addiction specialists refer to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine whether a person has a substance use disorder and how severe it is.

The criteria for SUD include a wide variety of problems resulting from substance abuse. The more criteria you meet, the more severe the disorder. Here are signs you may have a problem:

  1. You take more of the substance than you intended to or use for a longer period of time than you intended.
  2. You’ve tried unsuccessfully to cut back.
  3. You have strong cravings and urges to use the substance.
  4. You spend a lot of time using and recovering from use of the substance.
  5. You’re failing to live up to responsibilities or obligations because of substance use.
  6. You’ve given up things you love, such as social or recreational activities because of your substance use.
  7. You have withdrawal symptoms when you stop taking the substance, even for a short period (e.g., a day or two).
  8. You continue to use, even though it’s causing relationship problems or problems at work.
  9. You drive, operate machinery, or do other risky activities (like swimming) while using the substance.
  10. You’ve developed a tolerance, meaning you need more of the substance than before to achieve the same effect.
  11. You continue to use the substance, even though you know it puts you in danger.


Other signs of a problem include borrowing or stealing money or items to pay for the drug, hiding your use from family or friends, and sleeping or eating too much or too little.

How to Tell If Someone You Love Has a Problem

If you’re concerned about whether someone you care about is drinking too much or taking recreational drugs too frequently, odds are they probably are. Here are some early signs someone may be developing a more serious problem:

  • She drinks to relieve stress.
  • He gets irritable when he can’t have a drink.
  • Her personality changes when she drinks.
  • He can put back a few drinks without any sign of intoxication.
  • She’ll switch to liquor or beer if wine isn’t available.
  • Drinking has negatively affected his life, like his relationships or his career.

Changes in personality or behavior, financial problems, changes in activities, disheveled appearance or lack of concern for personal hygiene, bloodshot eyes, shakes, tremors, or slurred speech are all signs of a more serious problem.

Getting Help for a Substance Use Disorder

Substance Help

People who have a milder form of SUD may be able to successfully cut back or quit on their own. Others will need professional help.

If you match five or more of the criteria from the DSM-5 (see above), you’ve tried to quit on your own, and you’re experiencing problems like trouble at work, relationship issues, or other problems because of substance use, treatment can help.

Consider getting an assessment from a psychiatrist who specializes in substance use disorders or a doctor certified by the American Society of Addiction Medicine. If he or she agrees that you need addiction treatment, your next step is finding the right treatment center. Research facilities carefully and choose one that offers care from mental health and addiction specialists.

Substance use disorders are common—an estimated 20 million adults in the U.S. has an SUD. The good news is that we’ve made tremendous strides in the science of addiction in recent years, and that means less stigma and better treatment for people with substance use disorders.

If you or someone you love has a substance use disorder, there is help, and there is hope.

About the Author

Dr. Nancy Irwin is a psychologist at Seasons in Malibu, a drug and alcohol addiction treatment center located in Malibu, California known for providing world-class dual diagnosis care. From alcoholism to cocaine addiction and prescription drug abuse, Seasons in Malibu treats a wide variety of addictions. As a leading therapist, Dr. Irwin works with the Seasons in Malibu team to create treatment programs that are individualized for each guest and his/her needs.