Is It an Addiction? Signs to Look For
Only a clinician can diagnose a substance use disorder, but knowing what clinicians look for helps you see the pattern.
The National Institute on Drug Abuse explains the rule: “A person is diagnosed with a substance use disorder if they have two or more of the symptoms and behaviors related to their substance use listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.” For example, “they may use the drug more or for longer than intended, experience a strong desire to use the drug (craving), continue to use the drug even when knowing that it causes problems, or experience withdrawal symptoms when stopping drug use.” Addiction is the severe form.
For drinking, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) lists questions a person can ask about their own drinking in the past year. Among them:
- “Had times when you ended up drinking more, or longer, than you intended?”
- “More than once wanted to cut down or stop drinking, or tried to, but couldn’t?”
- “Continued to drink even though it was causing trouble with your family or friends?”
- “Given up or cut back on activities you found important, interesting, or pleasurable so you could drink?”
“Any of these symptoms may be cause for concern. The more symptoms, the more urgent the need for change.”
From the outside, you may also notice what the Substance Abuse and Mental Health Services Administration (SAMHSA) calls “Focusing only on getting and using alcohol or drugs” or trouble at work, lost friendships and forgotten commitments.
Before You Talk
Think of it as a health problem. The NIAAA’s Alcohol Treatment Navigator says “A person with alcohol use disorder (AUD) has a medical problem,” and it is “not a lack of willpower. There are lots of health professionals who can help. There are treatments that work.”
Choose your words. Labels push people away. The National Institute on Drug Abuse notes that “Feeling stigmatized can make people with SUD less willing to seek treatment,” and that “person with a substance use disorder” has a neutral tone and separates the person from his or her disorder (Words Matter).
Pick the moment. The Navigator says: “Choose the right time to talk. Thanksgiving dinner is probably not a good time for a thoughtful discussion about alcohol treatment. Neither is when your loved one is intoxicated.”
Prepare. It also advises: “Think about what you’re going to say before you say it. Maybe even do a role-play practice with someone else.”
How to Start the Conversation
Keep it kind. “try to adopt a nonjudgmental tone. Showing some empathy may lead to a more productive conversation,” the Navigator advises. And “Don’t gang up on the person or back him or her into a corner. You want your loved one to feel supported, not threatened.”
SAMHSA’s guide on how to talk to someone suggests open questions:
- “What are the good things about ___?”
- “What are the not-so-good things about ___?”
- “What do you think you will lose if you give up ___?”
- “How would you like things to be different?”
It also suggests that you:
- Name strengths. “It can be easy to tell them all the things they’re doing wrong, but it can close them off to asking for help.”
- Listen. “When it’s your turn to talk, repeat back what you heard them say.”
- Offer help. “If they want to get help, ask how you can support them. Also ask if you can follow up with them to check in.”
Be patient. “It may take many conversations before they get help.”
If they are open to it, ask how they would like to start. The Navigator suggests asking whether they would “rather talk one-on-one with a therapist, go to group counseling sessions, or make an appointment with a doctor,” then offering to “find a time when you can sit down and search together.”
What Not to Do
- Do not try to force it. “You can’t force someone to get care, so, the best thing you can do for a person is to be there for them and listen without judgment” (SAMHSA).
- Do not shield them from the results of their use. Covering for someone, paying their way out of trouble or drinking with them can keep the habit going. Our article on enabling explains what helps instead.
- Do not stage a group confrontation without knowing the evidence. Most families who prepare for one do not go through with it, and in a randomized trial a gentler approach, CRAFT, got more loved ones into treatment than the Johnson model, the best-known group confrontation. Our guide to addiction interventions in Ohio sets out the research.
- Do not push someone to stop drinking cold turkey on their own if they drink heavily. “Alcohol withdrawal is a potentially life-threatening process that can occur when someone who has been drinking heavily for a prolonged period of time suddenly stops drinking,” the NIAAA warns.
Finding Treatment
Treatment comes in levels. The NIAAA’s Navigator lists four, as defined by the American Society of Addiction Medicine:
| Level | What it is |
|---|---|
| Outpatient | “Regular office visits for counseling, medication support, or both.” |
| Intensive outpatient or partial hospitalization | “Coordinated outpatient care for complex needs.” |
| Residential | “Low or high intensity programs in 24-hour treatment settings.” |
| Intensive inpatient | “Medically-directed 24-hour services; may manage withdrawal.” |
The Navigator says: “A complete assessment of a person’s alcohol problems and complications provides guidance.” Outpatient care has a practical upside: “Many outpatient options allow people to maintain their regular routines and their privacy, too, if desired.”
How to judge a program. The Navigator’s quality checklist includes warnings:
- “Steer clear of a provider who only asks about a person’s alcohol and drug use.”
- “Steer clear of anyone promising a ‘cure’ for AUD in a certain period of time. Each person has different needs, and there are no quick solutions.”
- “Steer clear of any program, physician, or therapist who rejects medications out-of-hand.”
It also looks for a “Current license and accreditation by an independent review board.” SAMHSA’s own checklist for finding quality treatment adds that “Family members can be included in the treatment process as desired by the person in care.”
Where to search. FindTreatment.gov is SAMHSA’s “confidential and anonymous resource for persons seeking treatment for mental and substance use disorders,” where you can “Find state-licensed treatment near you.”
Treat both at once. Mental health conditions often come with substance use. “When someone has a substance use disorder and a co-occurring disorder or health condition, it is usually better to treat these health issues at the same time rather than separately” (NIDA).
Paying for Treatment in Ohio
“Most health insurance covers some alcohol or drug treatment. Insurers may call this ‘behavioral health’ coverage” (NIAAA).
Federal parity rules set terms for plans that cover this care. SAMHSA’s page on insurance coverage explains that plans that cover mental health, drug and alcohol treatment “must pay for them at a comparable level to what they pay for medical and surgical care. Limits on getting these benefits must also be comparable.”
Call the number on the insurance card and ask “If they cover the type of treatment you want and at what rate,” and “If they have case managers (like a nurse or social worker) who can work with you for free.”
Ohio Medicaid covers substance use treatment. The Ohio Department of Medicaid lists, among its behavioral health services:
- “Counseling and psychotherapy (both individually and in a family or group setting)”
- “Medications to assist with the treatment of mental illness or substance use disorder”
- “Intensive outpatient treatment, residential treatment, and withdrawal management for individuals with substance use disorder”
If They Say No
The Navigator suggests: “Maybe your loved one just needs a break from the discussion. Give him or her some time to think more about it.” And “If your loved one will talk but just doesn’t like the choices you’ve offered, you can ask again what kinds of help he or she might be willing to try.”
SAMHSA adds: “If they don’t want to talk, let them know that you’ll be there when they’re ready.”
Meanwhile, look after yourself. SAMHSA’s page on taking care of yourself suggests saying plainly what you will and will not do, for example: “I can pick up the mail and check on your apartment while you’re in treatment, but I don’t have the money right now to help you pay for treatment.” Free family programs such as Al-Anon, Nar-Anon and SMART Recovery Family and Friends are covered in our article on enabling.
If the person’s drinking or drug use has become dangerous, Ohio’s Casey’s Law lets a spouse, relative or guardian ask a probate court to order treatment. Our guide to Casey’s Law in Ohio explains how.
Keep Naloxone and Know the Signs of an Overdose
If opioids are involved, including fentanyl, heroin or prescription painkillers, keep naloxone at home. The CDC says:
- “Naloxone is easy to use and small to carry.”
- “Naloxone won’t harm someone if they’re overdosing on drugs other than opioids, so it’s always best to use it if you think someone is overdosing.”
- “Naloxone is available in all 50 states over the counter.”
- “Because you can’t use naloxone on yourself, let others know you have it in case you experience an opioid overdose.”
Getting it in Ohio. Under section 3715.502, a pharmacist can dispense it without a prescription to “A family member, friend, or other individual in a position to assist an individual who there is reason to believe is at risk of experiencing an opioid-related overdose.” The Ohio Department of Health’s Project DAWN says “Anyone in Ohio can obtain free ORM and overdose response education through Project DAWN locations.” ORM stands for overdose reversal medication.
Signs of an overdose, from the CDC: “Unconsciousness or inability to awaken,” “Discolored skin (especially in nails or lips),” and “Small, constricted ‘pinpoint pupils’ that don’t react to light.”
What to do. The CDC’s first step is to give an overdose reversal medication such as naloxone, if you have it, and call 911. Then “Try to keep the person awake and breathing,” “Lay the person on their side to prevent choking,” and “Stay with the person until emergency assistance arrives.”
Ohio’s Good Samaritan law gives some protection to a person who calls for help in good faith during an overdose, and to the person who overdosed, against minor drug possession charges. It has conditions: the person must get a screening and a treatment referral within thirty days, and “No person shall be granted an immunity under division (B)(2)(b) of this section more than two times” (section 2925.11). Call 911 regardless.
After a break, the risk is higher. “If a person uses as much of the drug as they did before quitting, they can more easily overdose because their bodies are no longer used to their previous level of drug exposure” (NIDA).
When the Person Is a Teenager
Teens need care built for them. The National Institute on Drug Abuse says “Adolescents who have drug use problems need treatment programs tailored to their needs,” and that many approaches “involve family members or other caregivers in the treatment process.” For drinking, the NIAAA notes that “there are no alcohol treatment medications that have been approved for use by adolescents,” and that counseling for teens “often places much greater emphasis on family therapy.”
In Ohio, section 3719.012 lets a minor “give consent for the diagnosis or treatment by a physician licensed to practice in this state of any condition which it is reasonable to believe is caused by a drug of abuse, beer, or intoxicating liquor.”
During and After Treatment
Expect it to take time. “Remember that the total length of treatment is likely to be measured in months, not weeks or days. And, there may be some bumps along the way,” the Navigator’s page on managing expectations says. Its advice for families: “Ask your loved one how you can be most helpful,” and “Get involved if you’re comfortable and if it’s appropriate, such as when the treatment provider offers family therapy or a family program.”
Setbacks happen. “Relapse is common as people work to overcome alcohol problems,” and it “can be seen as a temporary set-back to full recovery and not a complete failure.” When it happens, “their healthcare provider should adjust their treatment plan accordingly” (Understanding Relapse).
Where Leora Behavioral Health Fits
Leora Behavioral Health is an outpatient provider in Columbus and Dayton. It does not provide overnight or emergency care.
A family member can call admissions on someone else’s behalf to ask how an assessment works and what the person should bring, and both facilities welcome walk-ins. The first visit is an assessment, which recommends a level of care.
Leora runs partial hospitalization, Monday to Friday, 9:00 am to 4:15 pm; intensive outpatient, three hours a day, three to five days a week; and outpatient care, one to two days a week. It also offers ambulatory detox for mild to moderate withdrawal and medication assisted treatment. Family therapy is one of Leora’s services, with the consent of the person in treatment.
Leora accepts every Ohio Medicaid plan and every commercial carrier, and admissions can check coverage when you call. Leora’s page for families has more.
If Someone Is in Danger Right Now
“If you or someone you know is in danger or having a medical emergency, call 911 or go to your nearest emergency room” (SAMHSA).
For a mental health or substance use crisis, call or text 988. The Ohio Department of Behavioral Health says “Ohioans who are experiencing a mental health or addiction crisis, and their family members, can call, text, or chat the 988 Suicide & Crisis Lifeline to reach a trained specialist who can offer help and support.”
