Health Department

The Tennessee Department of Mental Health and Substance Abuse Services outlines the following as possible warning signs of substance abuse. The presence of these signs does not mean that substance use is present or the only cause of concern.

Physical Signs:

• Bloodshot eyes and pupils larger/smaller than usual
• Sudden changes in appetite, sleep patterns or physical appearance
• Unusual smells on breath, body or clothing
• Impaired coordination

Behavioral Signs:

• Drop in attendance and performance at work or school
• Engaging in secretive or suspicious behaviors
• Sudden changes in friends, favorite hangouts or hobbies

Psychological Signs: 

• Unexplained change in personality or attitude
• Sudden mood swings with irritability, spacing out or angry outbursts
• Appears fearful, anxious or paranoid without reason

It’s not easy talking to a loved one about potential substance misuse, but your support is key in getting them the help they need. Starting the conversation, while potentially uncomfortable, will be the first step to getting help.

How to Prepare:

1. Identify an appropriate time and place. Consider a private, calm setting with limited distractions, such as at home or during a walk in the park.
2. Express concerns and be direct. Ask how your loved one is feeling and describe the reasons for your concern.
3. Acknowledge their feelings and actively listen. Calmly and actively listen to your loved one’s responses. Make sure your body language, facial expression and tone are without judgment. Your loved one will most likely feel vulnerable.
4. Offer to help. Provide reassurance that substance misuse is treatable, and recovery is possible. Help them locate and connect to treatment services that work best for them.
5. Be patient. Recognize that helping your loved one does not happen overnight. Continue to support them by offering to listen and help.

What to Say:

• “I’ve been worried about you. Can we talk? If not, who would you feel comfortable talking to?”
• “It seems like you’re going through something. How can I best support you?”
• “I care about you and am here to listen. Do you want to talk about what’s been going on?”
• “I noticed that you haven’t seemed like yourself recently. How would you like me to help you?”

Remember that Substance Misuse is Treatable. People can, and do recover from substance misuse every day. Having a reliable support system can make all the difference in getting to and staying in recovery.

Talk to Your Loved One. Find a time and place to talk with your loved one and express your concern. Emphasize that you’re there to help. Create a judgement-free and loving environment, so that they feel safe enough to open up.

Be Open and Compassionate. If applicable, discuss your family history of substance misuse. It may help your loved one feel less alone. Also, exercise patience as you help your loved one locate resources and treatment services.

Seek Support. If you or your loved one needs help, call 1-800-662-Help (4357) for free and confidential information and treatment referrals.

It is important to understand the challenges that come from helping a loved one with substance misuse can be stressful and emotionally draining. Caregivers should take steps to prioritize their own health.

Taking time for yourself can make you a more effective and patient caregiver. Finding small ways to lower your stress and boost your mood can give you the strength and stamina needed to support your loved one. Here are seven tips for self-care.

• Be active. Find an activity that you enjoy: walking, dancing, gardening or something else. Even short periods of exercise can lower stress.
• Eat well. Try to maintain a well-balanced diet with healthy foods. Make sure to drink plenty of water every day.
• Prioritize sleep. You should aim for seven to nine hours of sleep a night. A lack of sleep can negatively impact stress levels, cognitive function, emotional regulation and eating habits. If you struggle to fall asleep, develop a relaxing bedtime routine to make the process easier.
• Make time to relax. Carve out time each week to do something you enjoy that also has nothing to do with your other responsibilities. It can be as simple as watching a movie, reading a magazine or working on a hobby.
• Take a break if you need it. Ask another family member, friend or sponsor (if applicable) to step in if a particular situation is too much for you to handle. Recognizing your limitations and asking for assistance is an effective way to manage both yours and your loved one’s struggles.
• Be kind to yourself. You don’t have to pretend to be cheerful or collected all the time. Feelings of frustration, sadness and guilt are normal and understandable. Consider expressing your feelings by writing in a journal or talking with someone you trust.
• Reach out for support. Talk to a trusted family member or friend or seek counseling from a mental health professional. Consider joining an online or in-person support group for caregivers like Al-Anon.

For more information, visit samhsa.gov/families.

Al-Anon is a worldwide fellowship that offers a program of recovery for families and friends of alcoholics, whether or not the alcoholic recognizes the existence of a drinking problem or seeks help.

Alateen is part of the Al-Anon fellowship and designed for relatives and friends of alcoholics who are teenagers. Members do not give direction or advice. They share personal experiences and stories that other members may learn from and apply to their own lives.

To locate an Al-Anon meeting near you, visit the Knoxville Al-Anon Website.

If you suspect that your loved one is using drugs, especially if they live with you, you may want to make a safety plan should a medical or psychiatric emergency occur. If you are able, you should communicate this plan to your loved one. Some common elements of these plans are included below.

Overdose Prevention:

• Do you have naloxone (Narcan) with you in case of an overdose?
• Is it kept in a place you or your loved one can easily get to?
• Is the location where it is kept safe from extreme hot or cold temperatures?

Acute Withdrawal:

• Withdrawal from some drugs, especially alcohol and benzodiazepines (such as Xanax, Valium and Ativan) is extremely dangerous when done suddenly.
• Symptoms can include tremors, psychosis, intense sweating, nausea, seizures and elevated heart rate.
• These are signs of an emergency, and it is appropriate to call 911.

Acute Intoxication:

• Some symptoms of drug use are especially concerning and are a sign that your loved one’s physical or mental health is at immediate risk. They are listed below.
  • Loss of consciousness
  • Sudden disorganized speech or inability to speak
  • Hallucinations
  • Intense agitation or aggression, paranoia and thoughts of self-harm
• If your loved one is displaying any of these signs, consider calling 911.