When someone you care about starts acting differently than their normal, it’s natural to worry. Understanding how to tell if someone is high is about recognizing when someone you know needs support, not about argument or accusation. At The Freedom Center, we believe addiction awareness starts with education and compassion. This guide will help you identify drug use symptoms while empowering you to respond with care.
It is essential to understand that you CAN’T tell, for certain, if someone is “high.” You may see physical signs which are consistent with drug use, or notice behaviors that are different from an individual’s characteristic behaviors, or suspect illicit use of drugs, but you can’t tell for certain without their admission of drug use or a drug test.
There are numerous physical and mental medical conditions that can be mistaken for the illicit use of drugs. Some of these include migraine headaches, stroke, and other neurological conditions. Depression, anxiety, psychosis, schizophrenia, and other mental health disorders may cause abnormal physical signs and uncharacteristic behaviors. Head trauma could be a problem. Metabolic disorders can show signs and symptoms characteristic of drug use. The most immediately threatening situations are associated with diabetes, such as very high blood sugar or diabetic coma, or an insulin reaction, often with dangerously low blood sugar. These situations call for emergency medical attention. Medication reactions can also mimic illicit use of drugs.
It is never useful to engage in heated arguments or accusations with someone showing signs and symptoms of illicit or inappropriate use of drugs, or a condition which can appear similar. These situations call for medical evaluation. If your suspicion for illicit drug use is great, remember that you can’t engage in rational dialogue with someone whose thinking is irrational. You also want to avoid triggering behaviors that may escalate to harm you or the person of concern.
What Does It Mean to Be “High”?
Being “high” refers to an altered state of consciousness caused by psychoactive substances that change brain chemistry, leading to euphoria, sedation, or hallucinations. These substances act on neurotransmitters, chemicals in the brain that regulate mood, perception, movement, and judgment. They may also affect the brain’s reward circuit, flooding it with dopamine and creating feelings of pleasure that reinforce drug‑taking behavior [1].
Intoxication can result from prescription medications or illicit drugs. Someone might become high from legally prescribed painkillers taken in excess, anxiety medications, ADHD stimulants, or street drugs like heroin or cocaine. This reality is important because it means substance misuse can happen even when drugs are obtained legitimately. The source doesn’t change the fact that someone needs help.
Why People Get High
People use substances for complex reasons that deserve our understanding and compassion. In adolescence, experimentation may result from curiosity or peer pressure [2]. Others use substances as a coping mechanism for overwhelming stress, unresolved trauma, chronic pain that seems unbearable, or mental health challenges like depression and anxiety that haven’t been properly addressed.
Social and emotional factors also play significant roles. The desire to fit in with peers, pressure from social circles, or attempts to escape difficult life circumstances can all contribute to substance use. For some, what starts as occasional recreational use gradually becomes physical or psychological dependence, where the body and mind begin to rely on the drug to feel normal. Recognizing these underlying motivations reminds us that substance use isn’t about weakness or poor character. It’s often a sign that someone is struggling with challenges they don’t know how to manage in healthier ways.
Understanding Intoxication vs. Addiction
Understanding intoxication versus addiction is crucial for proper addiction awareness. Intoxication is temporary, while addiction involves compulsive use despite consequences. Repeated drug exposure changes the brain’s reward, stress, and self‑control circuits. Tolerance develops, so more of the drug is needed to achieve the same effect, cravings drive continued use[1][2], and withdrawal occurs when stopping. What begins as a choice can transform into a medical condition requiring professional treatment.
Common Signs of Drug Use
Physical Symptoms
Drug intoxication often manifests in the body first. Some of the most recognizable signs include:
- Bloodshot or red eyes. For example, cannabis lowers blood pressure and dilates blood vessels in the eyes, producing the classic red or bloodshot appearance. Dry mouth and impaired motor skills often accompany this symptom [3].
- Changes in pupil size. Stimulants like cocaine and methamphetamine cause pupil dilation by increasing norepinephrine and dopamine levels. Hallucinogens also trigger extreme pupil dilation and can distort time perception [4]. By contrast, opioids produce pinpoint pupils, especially during an overdose, when respiratory depression (slow, shallow breathing that can lead to insufficient oxygen or excess carbon dioxide in the blood) and unconsciousness may also occur [5].
- Impaired coordination and slurred speech. Depressants such as benzodiazepines and barbiturates slow the central nervous system, leading to drowsiness, slurred speech, poor coordination, and even respiratory depression [4]. Alcohol intoxication shows similar effects.
- Unusual odors. The smell of cannabis smoke or chemicals from inhalants on the breath, clothing, or hair can be a giveaway. Inhalant use is sometimes accompanied by chemical stains on the face or hands, or empty aerosol cans hidden nearby [5].
Behavioral Symptoms
Substance use doesn’t only affect the body; it alters actions and relationships, too. Mood may swing from euphoria to paranoia or anxiety within a short time. People who are high might withdraw from family or friends, become secretive about their whereabouts, abandon hobbies, and neglect responsibilities. Reckless behavior, poor judgment, and impulsive decisions are also common [6].
Psychological Symptoms
Drugs change how the brain processes thoughts and emotions. Users may experience memory problems, confusion, or difficulty concentrating. Long‑term use is linked to depression, apathy, and sometimes hallucinations or grandiose beliefs. The National Institute on Drug Abuse notes that drug use and mental illness frequently co‑exist and that substance use can trigger or worsen mental health conditions such as anxiety and depression [6].
How Different Substances Affect Behavior
Cannabis
- Signs: Red eyes, dry mouth, slowed reactions, increased appetite, giggling, clumsiness, lethargy, euphoria, impaired memory, sometimes paranoia.
- Onset: Smoking leads to a faster onset of symptoms, while edibles have less predictable symptoms that can come on more slowly [3].
Stimulants (Cocaine, Meth, Adderall)
- Signs: Dilated pupils, increased energy, rapid speech, elevated heart rate, restlessness, hyperactivity, aggression, euphoria, paranoia, and insomnia [4].
Depressants (Alcohol, Benzodiazepines)
- Signs: Slurred speech, impaired coordination, reduced inhibitions, drowsiness, confusion, mood swings, and memory blackouts [4].
- Danger signs: Slow breathing, inability to wake, blue lips require an immediate 911 call.
Opioids (Heroin, Fentanyl, Painkillers)
- Signs: Pinpoint pupils, slowed breathing, drowsiness, nodding off, decreased coordination [7].
- Signs of overdose: Blue lips, unresponsiveness, slowed or stopped breathing. Call 911 and use naloxone (Narcan) if available.
Hallucinogens (LSD, Psilocybin)
- Signs: Extremely dilated pupils, sweating, hallucinations, confusion, paranoia, unpredictable emotions [4]. Hallucinogens can also cause psychosis, which is a loss of contact with reality.
Dissociatives (Ketamine, dextromethorphan or DXM)
- Signs: Dissociatives can cause confusion, detachment from reality, memory loss, and inability to move or speak. Like hallucinogens, dissociatives can also cause psychosis.
Inhalants & Synthetic Drugs
- Inhalants: Brief euphoria, dizziness, chemical odor. Can cause sudden death [5].
- K2/Spice: Extreme anxiety, paranoia, hallucinations, violent behavior.
- Bath Salts: Agitation, paranoia, violent behavior, high body temperature.
Special Considerations
Adolescents
Teen drug use symptoms overlap with typical development. Watch for patterns like academic decline, abandoning interests, extreme secretiveness, finding paraphernalia, dramatic personality shifts, damaged or disrupted relationships, frequent lying, smoke smell, excessive eye drops, or mints.
Paraphernalia & Hiding Spots
Common hiding places can include makeup containers, markers, dresser drawers, video game cases, and air vents. Paraphernalia includes needles, burnt spoons, baggies, pipes, rolling papers, straws, eye drops, razor blades, and elastic bands.
Mental Health Impacts
Long-term use causes or worsens depression, anxiety [6], memory problems, and can trigger psychotic episodes.
How to Respond
If someone is unconscious, struggling to breathe, having seizures, or showing blue lips, call 911 immediately. For opioid overdose, use naloxone, then call emergency services.
If you’re trying to approach someone about getting help, timing and approach matter enormously. Wait until they’re completely sober to have this conversation. Attempting to talk while someone is intoxicated rarely leads to productive outcomes and can escalate into conflict. Choose a private, comfortable setting where you won’t be interrupted and where they feel safe.
Use “I” statements to express concern without sounding accusatory: “I’ve noticed some changes lately and I’m worried about you” works far better than “You’re obviously using drugs.” This approach opens dialogue rather than putting them on the defensive. Listen actively and attentively, even if what you hear is difficult or uncomfortable. Ask open-ended questions that invite them to share their experience: “What’s been going on?” or “How have you been feeling?” Do not ask, “What’s wrong with you?”
Most importantly, avoid judgment and blame. Shame pushes people deeper into isolation and substance use rather than encouraging them toward recovery. Remember that addiction is a disease that affects the brain, not a moral failing or lack of willpower. Your goal is to maintain a connection and create a safe space where they might eventually feel comfortable accepting help.
Research treatment options before speaking with the person of concern. You can call a treatment center for guidance about approaching the individual of concern. Mention therapists, outpatient/inpatient programs, support groups, and helplines like SAMHSA’s (1-800-662-HELP). At The Freedom Center in Buckeystown and Gaithersburg, Maryland, we offer comprehensive care through both inpatient and outpatient programs. Never demand or conduct a drug test without consent. This is a violation of trust, likely with adverse consequences. Focus on communication rather than surveillance.
Recovery Is Possible
Long-term drug use damages cardiovascular, respiratory, liver, and cognitive health, or the abilty to think, learn, and remember. Professional treatment varies but can include medical detox (using medication and other interventions to safely withdraw from a substance), cognitive-behavioral therapy (CBT, a type of psychotherapy that focuses on identifying and changing unhelpful thoughts and behaviors), residential programs, outpatient care, medication-assisted treatment, and support groups.
At The Freedom Center, we treat the whole person, addressing substance use and underlying factors like trauma and mental health conditions. Recovery is possible. Millions have overcome substance misuse and addiction and rebuilt meaningful lives. The path may not be linear, but with support and compassion, long-term sobriety is achievable.
If you recognize these signs in someone you know, reach out. Start a conversation. Offer support without judgment. Remember: asking for help shows courage, not weakness. Recovery is possible, hope is real, and compassionate support can lead to successful outcomes.
