Addiction is identified by a pattern of behavior over twelve months, not by a physical tell. Clinicians work from eleven specific criteria, and meeting two of them in a year is the threshold for a substance use disorder diagnosis. Bloodshot eyes and a changed sleep schedule are not on that list.
That gap between what people watch for and what actually counts is why families spend months unsure. This page covers the eleven criteria in plain language, what tolerance and withdrawal do and do not prove, the behavioral signs a family member can genuinely observe, how the picture differs by substance, and what an overdose looks like. If any of this feels familiar, a comprehensive assessment is a useful early step. Minnesota’s Direct Access system lets a person choose a substance use disorder treatment provider without first obtaining a county or tribal referral.
What the Signs of Addiction Actually Are
The eleven criteria below come from the Diagnostic and Statistical Manual, fifth edition, as measured in the 2025 National Survey on Drug Use and Health [1]. They apply to alcohol and to drugs, and they are the same list a counselor works through during an assessment. A substance use disorder is a diagnosable mental and behavioral health condition, not simply a habit or a moral failing. National surveys generally report substance use disorders separately from other mental illnesses, even though both fall within behavioral health care. Substance use disorders involve changes in brain function and behavior that can make controlling use increasingly difficult. They are not a moral failing or simply a matter of willpower; biological, psychological, social, and environmental factors all contribute.
Read them as a set of questions about the past year. The list is the same whether the addictive substance is alcohol, a prescription, or something bought on the street, so clinicians talk about substance use disorders instead of treating drug addiction and alcohol addiction as two separate things. Our post on the symptoms of co-occurring disorders covers the mental health side of the same conversation, which often runs alongside.
The Eleven Criteria in Plain Language
In the past twelve months, has the person:
- Used more of the substance, or used it for longer, than they meant to
- Wanted to cut down or stop, or tried to, without managing it
- Spent a great deal of time getting the substance, using it, or recovering from it
- Had cravings, meaning a strong urge to use
- Failed to meet obligations at work, school or home because of use
- Kept using despite social or interpersonal problems it caused or made worse
- Gave up or cut back activities that mattered to them in order to use
- Used in situations where doing so was physically hazardous
- Kept using despite knowing it was causing or worsening a physical or psychological problem
- Needed markedly more to get the same effect, or found the same amount doing markedly less, which is tolerance
- Experienced withdrawal symptoms when cutting back, or used to avoid them
Two Criteria Is the Threshold
A person is classified as having a substance use disorder if they meet two or more of the applicable criteria in a twelve-month period [1]. Severity follows the count: two to three is mild, four to five moderate, six or more severe. A diagnosis does not require a dramatic consequence such as losing a job, relationship, or home. Some criteria involve consequences, while others capture loss of control, craving, time spent using, tolerance, or withdrawal, which means a disorder can be recognized before someone’s life visibly falls apart.
Two is lower than almost anyone expects, and that matters more than the rest of this page. Someone holding a job, paying rent, and seeing friends can meet the definition of a mild substance use disorder while nobody around them has used the word addiction. Waiting for a visible collapse means waiting past the point where the problem was easiest to treat.
Why Physical Signs Are the Weakest Evidence
Physical signs are what circulates online as warning signs, and they are the least diagnostic thing on offer. Bloodshot eyes, sleep changes, weight changes, and changes in hygiene are highly nonspecific. Slurred speech or impaired coordination can suggest intoxication or another medical problem, but neither identifies a substance use disorder by itself.
Physical symptoms tell you that something is wrong. Two on the list are more specific, because they say something about how a substance is getting into the body: track marks on the arms suggest injection, and frequent nosebleeds suggest something is being insufflated. Even those are indications rather than proof, and neither belongs in a confrontation.
Drug paraphernalia or unexpected medication use can add context, but neither diagnoses a substance use disorder. Unless there is an immediate safety concern, concrete observations and a direct conversation are generally more useful than trying to diagnose someone from objects alone.
What Tolerance and Withdrawal Do Not Prove
Tolerance and withdrawal are criteria ten and eleven, and they are the two things people most often mistake for the whole diagnosis. On their own, they are physical adaptations, which is not the same thing as addiction.
Prescribed Medication Taken as Directed
This is the distinction that spares a lot of unnecessary fear. For prescription opioids, tranquilizers, stimulants, and sedatives used but not misused, only the first nine criteria apply. Tolerance and withdrawal are excluded, because both can occur as normal physiological adaptations when these medications are used appropriately under medical supervision [1].
So a person taking a prescribed opioid for chronic pain who needs a higher dose over time, or who would feel unwell stopping abruptly, has not thereby met a criterion for addiction. What would count is the other nine: using more than prescribed, failing obligations, giving up activities, continuing despite harm. Those describe a person’s life narrowing. A body adapting to a medication it was given is a different thing. If you are the one worrying about your own prescription, that difference is the thing to hold onto.
Where Hallucinogens and Inhalants Differ
For hallucinogens and inhalants, only the first ten criteria apply, because the withdrawal criterion does not apply to them. A person can have a serious problem with either and never experience withdrawal, so its absence proves nothing.
One measurement gap is worth knowing if you are reading national figures. The survey’s questions about illegally made fentanyl come after the disorder questions, so the headline substance use disorder totals do not capture disorders arising solely from illegally made fentanyl. The real number is higher than the published one.
Behavioral Signs a Family Member Can Observe
Behavior is where the useful evidence is, because the criteria are behavioral. You are not looking for a symptom; you are looking for a pattern that persists and that costs the person something.
Changes in Time and Money
Changes in how a person spends time can be one of the more visible warning signs. Spending increasing amounts of time obtaining, using, or recovering from a substance maps to criterion three, while giving up important activities maps to criterion seven. Neither has to appear first.
Money follows. Unpaid bills, borrowing, cash withdrawals that do not match anything, items that go missing. Financial strain is not proof either, and legal trouble tends to show up late, so the quieter version is the one to notice. A general increase in risky behavior may be concerning, but criterion eight is more specific: it refers to repeatedly using a substance in physically hazardous situations, such as driving while impaired.
The Emotional Signs People Miss
Emotional changes are easier to see than substance use and harder to interpret. Low mood, hopelessness, anxiety, irritability, and changes in self-esteem can occur alongside substance use disorders, but they can also reflect withdrawal, sleep disruption, stress, or a separate mental health condition. They are important to notice, but they are not diagnostic on their own.
A noticeable increase in irritability can occur during withdrawal, but it can also come from poor sleep, anxiety, depression, pain, or many other causes. A repeated cluster of symptoms that appears when substance use stops or decreases and improves after use resumes is more suggestive of withdrawal and deserves clinical assessment.
Changes in People and Places
Social circles turn over: new people the family has not met, old friendships dropped without explanation, withdrawal from anyone likely to comment, and a preference for gatherings where the substance will be present. Mood swings, sudden shifts in temper, and irritability often come with it, though anxiety and other mental health conditions produce those too, and relationships strain either way.
Loved ones may notice changes in relationships, routines, or behavior before they know what is causing them. Those observations can be valuable, but they still need context.
Secrecy is the through-line. Vagueness about whereabouts, phone conversations taken in another room, defensiveness out of proportion to the question asked.
What to Do with What You Have Noticed
If there is no immediate safety issue, write down concrete examples before raising the concern: what changed, when it happened, how often it happened, and whether it seemed connected to substance use. Specific observations can give a clinician more useful context than a general statement that someone has ‘changed.’
Then pick a sober moment and open non-judgmentally. Name what you have seen and leave your conclusions out of it. Ask questions instead of making statements, and expect this to take more than one conversation. A compassionate conversation goes further than a confrontation, and the difference is not softness; it is that the person can respond to an observation and can only defend against a verdict.
How the Signs Differ by Substance
Most substance use disorders are assessed with the same core DSM criteria, but not every criterion applies to every substance or circumstance. What also changes by substance is how intoxication, withdrawal, and other warning signs look from the outside.
Alcohol
Alcohol addiction is the most common and the easiest to normalize, because the substance is legal and social. All eleven criteria apply to alcohol use. The signs that tend to show first are drinking faster than the room, drinking before an event, irritation at any comment about it, and morning drinking, which is criterion eleven appearing as a routine.
Alcohol is also the substance where stopping abruptly carries real medical danger, and unsupervised withdrawal can be life-threatening, so a person drinking heavily every day needs medical advice before quitting, not encouragement to white-knuckle it. Our explainer on clinically managed and medically monitored withdrawal management covers what supervised withdrawal involves, and our guide on the alcohol withdrawal timeline covers this substance in depth.
Opioids
Some opioid use disorders begin after exposure to prescription opioids, while others begin with nonmedical or illicit opioid use. However, a history of receiving a legitimate prescription does not by itself establish misuse or opioid use disorder. Signs the line has moved include running out early, seeking prescriptions from more than one source, and a level of alertness about the supply that the pain itself does not explain.
Pinpoint pupils, drowsiness in the middle of a conversation, and nodding off are the physical signs. Opioids carry the highest overdose risk of any category discussed here, which is why this page includes a section on overdose.
Stimulants and Other Substances
Stimulants, which the diagnostic categories group together as cocaine, methamphetamine, and prescription stimulants, look almost opposite: long stretches without sleep, then a crash, appetite loss, rapid speech, and a level of activity that does not match what actually gets finished.
Cannabis and prescription sedatives are the two most often dismissed. All eleven criteria apply to cannabis, and daily cannabis use that a person has tried and failed to reduce meets criterion two, whatever anyone thinks about the substance. For sedatives and tranquilizers, the criteria depend on whether the medication is being misused, per the distinction above.
How Common Substance Use Disorder Is
In 2025, 15.3 percent of people aged 12 or older, or 44.6 million people, had a substance use disorder in the past year, down from 16.7 percent and 46.8 million in 2021 [2]. Among adults, 7.0 percent, or 18.5 million people, had both any mental illness and a substance use disorder in the same year.
The number that should change how a family acts is a different one. Among people aged 12 or older with a past-year substance use disorder in 2025, 86.4 percent received no substance use treatment or other services at all, which is 38.5 million people. Most people who meet the criteria are not in treatment, and the gap is widest among young adults aged 18 to 25, at 90.6 percent.
The treatment gap has several causes. Among adults with an SUD who did not receive treatment in 2025, most did not believe they needed treatment. Among those who did feel they needed help, common barriers included wanting to handle the problem on their own, not being ready to cut back or start treatment, lack of time, stigma, uncertainty about where to go, and cost. Our overview of what is a co-occurring disorder covers why an untreated mental health condition is one of the reasons treatment does not stick.
Signs of an Overdose and What to Do
This section is the reason to read the rest. Recognizing addiction is a conversation that can happen next week; recognizing an overdose is a decision measured in minutes.
What an Opioid Overdose Looks Like
Overdose signs vary by substance. For opioid overdose specifically, the Centers for Disease Control and Prevention lists four key signs. The person is unconscious or cannot be awakened. Breathing is slow, shallow, or difficult, including choking, gurgling, or snoring sounds from someone who cannot be roused. The skin, lips, or nails may become discolored, and the pupils may become very small and constricted [3].
CDC’s instructions are to give naloxone if it is available and call 911, then keep the person awake and breathing, lay them on their side so they do not choke, and stay with them until help arrives. Snoring from someone you cannot wake is the sign people most often misread as sleep.
Naloxone and Minnesota’s Good Samaritan Law
Naloxone is worth keeping wherever an opioid is kept, prescribed or not. Two facts remove most of the reasons people hesitate. Naloxone reverses an opioid overdose; it comes as a nasal spray or an injection, and the CDC states plainly that it will not harm someone if you give it to them and they are not overdosing on an opioid [4]. Giving it when you are unsure is the safer error.
Under Minn. Stat. 604A.05, known as Steve’s Law, a person acting in good faith who seeks medical help for someone experiencing a drug-related overdose cannot be charged or prosecuted for possession, sharing, or use of a controlled substance. The protection applies provided they give a name and contact information, stay on the scene until help arrives, and cooperate with authorities [5]. The person who overdosed is likewise protected from prosecution for possession or paraphernalia, and neither probation nor supervised release can be revoked over such an incident.
Common Questions About the Signs of Addiction
What Are the Early Signs of Addiction?
There is no fixed order in which substance use disorder criteria appear. Early changes may include using more than intended, unsuccessful efforts to cut down, craving, increasing time spent using, hazardous use, or relationship and responsibility problems. What appears first varies by person and substance.
How Do You Know if You Have an Addiction?
Two or more applicable criteria within twelve months can meet DSM criteria for a substance use disorder, but self-counting is a starting point rather than a formal diagnosis. A qualified clinician can review the pattern, determine which criteria actually apply, and assess whether another medical or mental health condition better explains what is happening.
A comprehensive assessment is how you get an answer, and our explainer on the rule 25 assessment and what replaced it covers how to arrange one.
What Are the Signs of an Addictive Personality?
There is no addictive personality diagnosis, which is worth saying plainly because the phrase is everywhere. It is not in the Diagnostic and Statistical Manual, and no clinician assesses for it.
What does exist is a set of risk factors: family history, early exposure, trauma, and untreated mental health conditions including anxiety. A supportive environment does not immunize anyone, and a difficult one does not condemn them. Those raise the odds without deciding anything, and treating what is underneath is more useful than accepting a label. Our practical guidance on managing anxiety is the more useful read if that history is part of the picture.
What Are the Seven Stages of Addiction?
There is no clinical seven-stage model. Various stage frameworks circulate, from experimentation through to dependence, and they are teaching tools rather than diagnostic instruments.
The diagnostic reality is a count out of eleven and a severity band, which is less dramatic and considerably more useful. Lasting recovery does not run through stages either; it runs through treatment, support groups where those help, and time. Anyone telling you which of seven stages you are in is telling you a story, not giving you a diagnosis.
Getting an Assessment in Minnesota
If two or more of the eleven criteria fit, the reasonable next step is professional assistance, and it starts with an assessment. Seeking professional help early is the single thing that most changes how hard the next year is. Minnesota does not require a county referral first.
An assessment is not a commitment to a particular program. It produces a level of care recommendation, and you are entitled to a second opinion on it from another qualified assessor. Our post on emotional sobriety covers the stretch of recovery that comes after treatment.
NorthStar Regional completes comprehensive assessments and provides substance use disorder and mental health treatment across the Twin Cities metro. Our team helps review your benefits before anyone commits to a program, and they can be reached through our contact page.
Sources
- Substance Abuse and Mental Health Services Administration. 2025 National Survey on Drug Use and Health: Methodological Summary and Definitions. Section 3.4.8.2, Substance Use Disorder for Drugs and Alcohol. https://www.samhsa.gov/data/sites/default/files/reports/rpt57377/2025-nsduh-method-summary-defs/2025-nsduh-method-summary-defs.htm
- Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2025 National Survey on Drug Use and Health. Released July 2026. https://www.samhsa.gov/data/sites/default/files/reports/rpt57150/2025-nsduh-annual-national-html/2025-nsduh-annual-national.htm
- Centers for Disease Control and Prevention. What to Do If You Think Someone Is Overdosing. Last reviewed April 2, 2024. https://www.cdc.gov/stop-overdose/response/
- Centers for Disease Control and Prevention. 5 Things to Know About Naloxone. Last updated May 2, 2024. https://www.cdc.gov/overdose-prevention/reversing-overdose/about-naloxone.html
- Minnesota Statutes 604A.05, Good Samaritan Overdose Medical Assistance (Steve’s Law). Subdivision 1, amended 2024. https://www.revisor.mn.gov/statutes/cite/604A.05
