Addiction doesn’t just affect the addict themselves, it also affects everyone around them. If you’re concerned about a friend or loved one, and suspect that they may be abusing a substance, it can be difficult to know what to look for.

Opioids and other “pain pills” are one of the most common addictions in the world. Due to an overabundance of supply and an often unconcerned attitude towards them (they’re prescribed by doctors, how bad can they be?), even people who may otherwise not ever have a propensity for addiction may find themselves addicted to them.

If you’re concerned that a loved one may be addicted to opioids, here are a few things to look for.

Underlying Risk Factors

Before ever considering changes in the person’s behavior, it’s helpful to look at the underlying risk factors that may play into their chances of becoming addicted to painkillers. While the answers to these questions by no means provide a definitive “yes” or “no” as to whether the person is addicted or not, it can give us some insight into how susceptible they may be.

Here are a few questions to ask about their background:

• Do they have a personal history of substance abuse or addiction, or does it run in their family? Opioids very often “take the place” of another addiction (or are used concurrently). Those who are naturally predisposed to other addictions are likely more at risk for opioid addiction as well.
• Are they younger? While opioid addiction is not limited to a certain age range, statistics show that teenagers and those in their early 20s are at the highest risk for developing an opioid addiction.
• Do they have a history of high anxiety or depression? Opioids are often used by addicts to “calm the nerves” or “even out” someone’s mood.
• Are they heavy smokers or tobacco users? Studies have shown that nicotine and opioids have similar effects on the brain’s pleasure centers, and if someone already addicted to nicotine is introduced to opioids, that similarity can create cravings.
• Are they currently experiencing any higher than normal stress? Recently losing a job, going through a divorce, or even something as simple as moving to a new town can cause someone to seek out an outlet for that stress.
• Are they regularly around opioids? This doesn’t even necessarily mean that their friends or family members abuse painkillers – this extends to professionals that are around them all the time. Doctors, nurses, social workers – all of these fields have a higher-than-average rate of opioid dependency.

These are just a few of the risk factors that may come into play when determining if someone may be addicted to pain pills. Though they are by no mean surefire indicators, they can help when you’re painting the overall picture of a person’s susceptibility.

Changes in Behavior

So what changes should you look for when trying to tell if a loved one is abusing painkillers? Here are a few red flags to look for.

• Are they exhibiting increasingly erratic behavior? Are they doing things “out of character,” or putting themselves (and others) in dangerous situations that they normally wouldn’t? Addiction can override the self-preservation instincts and even the protective instincts of parents and friends.
• Are they taking more than the prescribed medication to “get ahead of the pain?” While staying on top of pain medication is important when recovering from surgeries and trauma, taking higher or more frequent doses of medication is a strong indicator of forming habits.
• Do they make jokes about how the pills make them feel good? Of course simply joking about painkillers doesn’t mean a person is addicted, but frequently talking about how the pills make them feel and turning it into a joke is a common deflection of concerns about actual dependency, both to others and themselves.
• Do they have mood swings? Addiction tends to make emotions erratic, especially when access to the substance is limited. Addicts tend to go from very high to very low and back again rapidly.
• Have their sleep patterns changed drastically? Are they sleeping much more than normal, or on the other hand are they staying up far more than they used to? Addiction to opioids changes a person’s physiology and can have differing effects on different people.
• Do they “lose” their prescriptions often? While most doctors will not give a refill prescription to someone that claims they’ve lost their pills, addicts very regularly will go to another doctor to get another prescription and play it off to those that ask by saying they lost their pills.

Of course a person may exhibit none of these behaviors or risk signs and may still be addicted, or conversely may exhibit multiple of these signs and not have any dependency at all. Being aware of these things to look for, however, can help when you’re trying to tell if someone is addicted to pain pills.