In short
Drug use is suspected not from a single sign but from a combination of changes: sharp swings in mood and sleep, loss of interest in school, work and old friends, secrecy and lying, missing money and belongings, unusual pupils, odors, marks on the skin, and slurred or, on the contrary, rapid speech. No single sign proves drug use on its own — similar changes occur with depression, stress and illness. Only a doctor can give a definite answer: an addiction doctor (narcologist) will talk with the person, examine them and, with their consent, order tests. The most important thing for loved ones is to stay connected, avoid interrogations and see a doctor in good time.
Key points in one minute
- What matters most is not an isolated symptom but a lasting change in behavior, mood and social circle over recent weeks and months.
- Signs depend on the substance: stimulants speed people up and make them agitated, while opioids and sedatives slow them down and make them drowsy.
- Similar changes occur with depression, anxiety, bullying or illness, so conclusions should be drawn by a doctor, not a home test.
- Accusations, searches and threats more often destroy trust and push the person into hiding than help.
- Family members can consult an addiction doctor anonymously, even without the person who uses drugs being involved.
Which Signs May Point to Drug Use
Using psychoactive substances changes how the brain works, so behavior, mood and habits are usually the first things to change. Loved ones notice that the person has become different but can’t explain exactly how. It helps to ask yourself: what has changed over recent weeks and months, how long ago did it start, and how different is it from their usual character? Teenage mood swings and reactions to stress happen to everyone; what should raise concern are lasting changes in several areas of life at once.
Doctors divide the signs into behavioral, physical and social. Each of them on its own may have another explanation, but a combination of several, especially with a sudden onset, is a serious reason to talk and to consult a specialist. Below are the signs to pay attention to first, with brief explanations of why they matter and how to assess them correctly.
Changes in Behavior and Mood
Sharp, unexplained swings: euphoria and talkativeness give way to irritability, apathy or aggression. Sleep patterns are disrupted — sleepless nights and long daytime sleep. Secrecy and lying appear, along with reluctance to say where they were and with whom. The person loses interest in former hobbies, school or work and becomes indifferent to consequences.
Physical Signs
Pupils that are too small or too large and don’t change in response to light, red eyes, frequent sniffing, an unsteady gait, slowed or rapid speech. Sudden weight loss or, conversely, increased appetite, frequent colds, needle marks or cuts that the person hides under long sleeves even in hot weather, and unusual smells on their clothes.
Social and Household Signs
New friends they say nothing about, drifting away from old ones. Money, belongings or valuables disappearing from home, debts, requests for loans. Skipping classes, falling grades, conflicts at work. Things found at home: unfamiliar pills, small baggies, foil, burnt spoons, syringes, unusual smoking devices.
How the Signs Differ Depending on the Substance
Different groups of substances act on the brain in different ways, so states of intoxication look different too. Stimulants, including synthetic cathinones (“bath salts”), mephedrone and amphetamines, cause agitation, insomnia, rapid speech, dilated pupils and loss of appetite, and once the effect wears off — emptiness, irritability and long periods of sleep. Opioids, on the contrary, slow a person down: they constrict the pupils and cause drowsiness, “nodding off,” slowed speech and pallor.
Cannabinoids show up as red eyes, increased appetite, giggling or sluggishness, and impaired memory and concentration. Sedatives and sleeping pills look like alcohol intoxication without the smell of alcohol: unsteadiness, slurred speech, drowsiness. Hallucinogens and synthetic cannabinoids can cause fear, confusion and bizarre behavior. In practice, however, substances are often combined and synthetic mixtures are unpredictable, so it’s impossible to identify the substance accurately from outward signs.
| Substance group | Typical signs of intoxication | After the effect wears off |
|---|---|---|
| Stimulants (“bath salts,” mephedrone, amphetamines) | Agitation, rapid speech, dilated pupils, insomnia, no appetite | Emptiness, irritability, long sleep, low mood |
| Opioids | Drowsiness, pinpoint pupils, slowed speech, pallor | Aches, runny nose, yawning, anxiety, insomnia |
| Cannabinoids | Red eyes, increased appetite, giggling or sluggishness | Sluggishness, irritability, memory problems |
| Sedatives and sleeping pills | Unsteadiness, slurred speech, drowsiness without the smell of alcohol | Anxiety, insomnia, tremor; with long-term use, a risk of seizures |
| Hallucinogens and synthetic mixtures | Fear, confusion, strange behavior, visions | Anxiety, sleep problems, sometimes prolonged psychotic episodes |
What Signs of Drug Use Can Be Confused With
Many changes that look like drug use occur with other conditions. Adolescence itself comes with mood swings, a drive for independence and withdrawal. Depression causes apathy, sleep problems and loss of interest, while anxiety disorders cause irritability and withdrawal. Bullying at school, relationship problems and academic overload also change behavior. Small or large pupils, drowsiness and weight loss may be linked to medications or illnesses.
That’s why it’s important not to jump to conclusions or put labels on people. If you are wrong and accuse someone of using drugs when in fact they are going through depression or bullying, you risk losing their trust at the hardest moment. And if you are right, accusations also tend to lead to denial and secrecy. That is why the best first step is a calm conversation about what you’ve noticed and a consultation with a specialist who can help you work it out.
How to Talk to a Loved One If You Suspect Drug Use
- Calm yourself down firstDon’t start the conversation right after a discovery or an argument. Give yourself time and discuss the situation with another adult or a specialist.
- Choose the right momentTalk when the person is sober and not tired, and when there is time for a calm conversation without other people around.
- Describe facts and feelingsSay exactly what you’ve noticed and how you feel, avoiding labels like “drug addict” and accusations.
- ListenAsk open questions and let them speak. Don’t interrupt or argue with every word.
- Offer helpSay that you’re ready to see a doctor or psychologist together, and suggest a specific option, such as an online consultation.
- Stay connectedIf the conversation doesn’t go well, don’t cut off the relationship. Come back to the topic later and keep showing your support.
Can You Check With a Drug Test?
Pharmacy rapid urine tests detect only a limited range of substances, and only for a certain time after use. Many new synthetic substances aren’t detected by them, and false-positive results are possible with some medications. A negative test doesn’t rule out drug use, and a positive one doesn’t mean addiction. In addition, forcing a teenager or adult to take a test without their consent is usually experienced as humiliating and damages the relationship.
More reliable testing is carried out in a medical setting: the doctor assesses the person’s condition, asks questions and, if needed, orders laboratory tests with confirmation of the result. But the main goal of an addiction doctor is not to “catch” someone, but to understand whether there is occasional use, misuse or established addiction, and to choose the appropriate help. That requires a conversation and voluntary participation.
How to Tell Whether Addiction Has Already Developed
Not every case of drug use means addiction, but without help, occasional use often turns into regular use. The international classifications ICD-10 and DSM-5 describe addiction through a set of signs that appear over an extended period. If you recognize three or more of the points below in your loved one, you should see an addiction doctor as soon as possible.
- Strong cravings, an obsessive urge to use, thoughts constantly returning to the substance
- Loss of control: the person uses more or for longer than they planned
- Growing tolerance: ever larger amounts are needed for the same effect
- Withdrawal: without the substance, they feel unwell, anxious and achy
- Giving up former interests, school, work and friends for the sake of using
- Continuing to use despite obvious harm to health, relationships or studies
- Unsuccessful attempts to stop or cut down on their own
What to Do If You Suspect Drug Use
First, don’t panic and don’t act while overwhelmed by strong emotions. Prepare for the conversation: choose a calm time when the person is sober and neither of you is in a hurry. Talk about yourself and your feelings instead of making accusations: “I’ve noticed you’re sleeping very little and often get angry, and I’m worried.” Ask open questions and listen, even if you don’t like the answers. It’s important to show that you’re on their side and ready to help, not to punish.
Don’t secretly search their room, don’t threaten, shame or lecture — this only strengthens their defenses. Agree on a united position among the adults in the family. See an addiction doctor or psychologist for a family consultation: the specialist will help assess the situation, prepare for the conversation and choose next steps. Take care of yourself too: the loved ones of people with addiction often experience severe stress and need support.
How Narcology 24 Can Help
At Narcology 24, relatives can get an anonymous consultation with an addiction doctor or psychologist, including online — even if the person themselves is still refusing help. The specialist will help you figure out how well-founded your suspicions are, how to start the conversation and how to motivate the person toward treatment without pressure. If the person is ready, the doctor will examine them, order laboratory tests if needed, assess their condition and offer a treatment plan.
In cases of poisoning or a severe condition, a doctor can come to your home around the clock, and inpatient care is offered if needed. Treatment for drug addiction includes detox, work with a psychiatrist for co-occurring disorders, addiction psychotherapy and rehab, as well as support for the family. Voluntary treatment is confidential: under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System,” this information is protected by medical confidentiality.
When to see a doctor
- You’ve noticed a combination of several signs that have lasted longer than two weeks
- Money or valuables are disappearing from home, or debts have appeared without explanation
- You’ve found unfamiliar pills, baggies, syringes or smoking devices
- School or work performance has dropped sharply, and the person has stopped seeing old friends
- Your loved one has developed strange ideas, suspiciousness, fear or visions
- The person has admitted using drugs, is asking for help or wants to stop
- You feel you can’t cope and need support yourself
When urgent help is needed
Call 103 or 112 if the person is unconscious or can’t be woken, is breathing slowly or with a rattling sound, or has seizures, a very high temperature, chest pain, or severe agitation with aggression or visions. Do not leave them alone. If a teenager or young person has thoughts of suicide, call 150.
How Narcology 24 can help
Round-the-clock home visits, inpatient care and detox, coding, rehab and online consultations with an addiction doctor or psychiatrist. Confidential, with no registry entry.
- Drug addiction treatmentfrom 12 000 ₸ · Online 24/7
- Assessment and tests for addictionfrom 10 000 ₸ · Online 24/7
- Addiction in teenagersfrom 12 000 ₸ · Online 24/7
Questions and answers
How can I tell if my child is using drugs?
Look for a combination of changes: sharp swings in mood and sleep, falling grades, new friends and secrecy, missing money, loss of interest in former activities, unusual pupils, odors and marks on the skin. No single sign proves anything on its own. It’s better to talk calmly and seek a consultation with an addiction doctor or psychologist so you can work it out together.
What do a person’s pupils look like when they’re on drugs?
It depends on the substance. Stimulants, cannabinoids and hallucinogens often dilate the pupils, while opioids constrict them sharply. It’s significant if the pupils don’t react to changes in lighting. However, pupil size also changes with medications, lighting and emotions, so this sign alone doesn’t prove drug use and should be assessed together with others.
Are pharmacy drug tests reliable?
Only partly. Rapid tests detect a limited range of substances and only for a certain time after use. Many synthetic substances aren’t detected by them, and false-positive results are possible because of medications. A negative test doesn’t rule out drug use. More reliable testing is done in a medical setting, with confirmation of the result.
What should I do if I find drugs on my teenager?
Don’t make a scene right away. Calm down and discuss the situation with another adult and, if possible, a specialist. Then talk calmly with your teenager, describe what you found and why you’re worried. Suggest seeing a doctor or psychologist together. Threats and punishments usually just mean that the drug use continues in secret.
Can I consult an addiction doctor without the person being present?
Yes. A family consultation can be held without the person who uses drugs. The specialist will help you assess the situation, prepare for a conversation, choose a way to motivate them toward treatment and suggest how to support yourself. At Narcology 24, you can get such a consultation anonymously, including online.
Will I be placed on a registry if I see an addiction doctor?
Seeking care voluntarily at a private clinic, including anonymously, does not lead to being placed on the state addiction registry. Under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System,” information about the visit and diagnosis is protected by medical confidentiality and is not passed on to a school, university or employer without the patient’s consent, except in cases expressly provided for by law.
Can a person be forced into treatment for drug addiction?
As a general rule, addiction treatment is voluntary. Involuntary medical care is possible only in the cases and in the manner provided for by the legislation of the Republic of Kazakhstan, by court decision. In practice, motivational work is far more effective: specialists help the family approach the conversation so that the person agrees to treatment on their own. You can start with a consultation for loved ones.
Sources and methodology
- ICD-10, World Health Organization
- DSM-5, American Psychiatric Association
- UNODC/WHO International Standards for the Treatment of Drug Use Disorders
- Clinical protocols for diagnosis and treatment, Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
This article was prepared by the Narcology 24 medical editorial team and reviewed by a doctor. It is for reference only and does not replace a specialist consultation. Editorial policy
Medically reviewed by
Nurlan Isayev, MDAddiction psychiatrist · experience 10 yearsSynthetic stimulant and cannabis addiction, addiction in teenagers, gambling addiction and online follow-up.
