Warning signs: what shows up first

Behavioral signs

• Secrecy that wasn't there before — locked doors, guarded phone, vague answers about where they've been, new friends they won't introduce.
• Dropping things they cared about — quitting the team, skipping family events, abandoning hobbies, grades or job performance sliding.
• Money problems — always broke despite income, borrowing constantly, selling possessions, money or valuables missing from the house.
• Mood swings out of proportion — irritability, defensiveness when substances come up, bursts of unusual energy or long stretches of apathy.
• Broken routines — sleeping at odd hours, disappearing at predictable times, missing obligations with elaborate excuses.

Physical signs

• Eyes — pupils unusually large or pinpoint-small, bloodshot eyes, heavy lids at odd times.
• Weight and appetite changes — rapid loss (stimulants) or gain, skipped meals, sudden junk-food binges.
• Sleep extremes — up for days, or sleeping most of the day.
• Grooming decline — someone who used to care about appearance stops caring.
• Physical tells — track marks or long sleeves in summer, frequent nosebleeds or sniffling, burned fingers or lips, sores or scratching, smell of smoke or chemicals, slurred or rapid-fire speech.

Around the house

• Missing prescription pills — especially painkillers, ADHD meds, or anxiety meds
• Missing alcohol, watered-down bottles
• Unfamiliar items: tiny baggies, foil with burn marks, glass pipes, straws cut short, spoons with residue, pill bottles with someone else's name, small rubber ties
• Eye drops, breath products, incense, or air freshener used constantly to cover tells

Signs that mean act now

Fentanyl has made "experimenting" far more dangerous than it used to be — a single counterfeit pill can be lethal. If opioids might be involved, get naloxone (Narcan) from any pharmacy and keep it at home. See the substance facts guide for what to know substance by substance.

What to do with what you've noticed

1. Write it down. Dates, what you saw, how often. A written pattern beats a vague feeling — for the conversation, and for a professional later.
2. Don't launch an ambush. Read talking about it first — how you raise it matters as much as what you say.
3. Line up the next step. Know what you'd suggest if they say "okay, maybe" — a doctor's appointment, the SAMHSA line, a program from drughelp.co.