Despite the immense stigma surrounding substance abuse, drug use is an all too common issue for both Americans and Canadians. In the US, the National Institute on Drug Abuse found that 24.6 million Americans aged 12 and older had used an illicit drug within the past month during 2013. According to the National Institute on Alcohol Abuse and Alcoholism, approximately 10 percent of Americans meet the criteria for a drug use disorder at some point during their lives. The US surgeon general even went as far to say that one in seven Americans struggles with substance addiction. And while drug use is reportedly on the decline in Canada, substance abuse is still rampant enough that it costs local taxpayers nearly $23 billion per year.

While we think we may know a lot about drug use, the truth is that addiction isn’t so easy to pin down and categorize. Substance abuse isn’t a condition that falls neatly into any one category. Addiction is classified as a disease, to be sure, but there’s also some level of choice involved that can perpetuate that disease. What’s more, there’s a substantial amount of denial involved in active addiction—not only on the part of the person abusing the substance, but also involving that person’s loved ones. Some people believe that the signs of drug addiction are obvious, but the shame and secrecy surrounding this disease mean that individuals will go to great lengths to conceal their struggle (or the struggle of others).

Understanding the common signs of hidden addiction can allow you to seek out the resources you need to be a supportive person in the life of your loved one.

That means it’s important for you to look past what you think you know about substance abuse and learn a bit more about the subtle signs—many of which are often normalized or downplayed—of addiction. Here are some indicators that your loved one could be fighting a hidden battle with addiction just below the surface or that you should be paying closer attention to “casual” drug use that may quickly spiral out of control.

Major attitude changes

The idea that drugs or alcohol can change a person is absolutely true (and in more ways than one). But a person struggling with substance abuse will likely also be struggling to keep their secret at any cost. This can culminate in strange or suspicious behaviors, as well as noticeable deviations from this person’s normal mood or attitude. For example, if your spouse or sibling begins to show signs of paranoia or starts to isolate themselves from you, you might want to take note. Mood swings, emotional defensiveness, lost interest, sudden unreliability, or increased lethargy can also accompany addictive behaviors. While these changes alone do not always point to a substance abuse problem, they can certainly be part of the puzzle. Coupled with other signs, they may make a lot of sense.

Putting on a show

When we attempt to hide something from the world, we may go too far in the other direction in an attempt to convince others. We’ve all done this; we pretend that nothing is wrong and end up overcompensating with words, inflections, or other actions. Someone who is doing everything possible to hide a substance abuse problem may wear a “mask” in order to project a successful or well-adapted image. For example, people with hidden substance abuse issues might embrace an over-the-top lifestyle to prove their success (both to themselves and others).

They might purchase expensive items, brag to anyone who will listen, or spend hours in the gym. They might even be outwardly judgmental of people who use drugs in order to deflect suspicion off of themselves. While some people are natural braggarts, it’s important to pay attention if your loved one has started exhibiting these behaviors more recently—especially if you get the impression that these behaviors aren’t authentic or don’t match up with the other information you know about this person.

Missing or hidden items

Drug addiction does not stay a secret for long. In many cases, your loved one’s problem may be hiding in plain sight—as may their drug of choice. People who struggle with addiction will usually do their part to ensure their addiction can always be taken care of. That may mean hiding extra bottles of alcohol or prescription medications in the car, under the sink, in the closet, or under the bed. Although others may not think to find these substances in such areas, these hiding spots allow the addicted person to continue the cycle without being found out.

But just as you may find hidden additions to your loved one’s home, you may also find that other things are missing. Addiction is notoriously expensive, particularly because an addicted individual will always need more and more of a particular substance to achieve the desired effect. Rather than ask a loved one repeatedly for financial help, an addicted individual may resort to selling possessions or even stealing from others in order to fund their condition. If you notice that your friend’s house is noticeably barren or that you’re missing money, jewelry, or other valuables, it’s entirely possible that a drug addiction may be the main factor.

It’s not always easy to know whether someone you care about is struggling with addiction, nor is convincing this person that he or she needs help. While a Toronto drug rehab facility can provide the treatment tools your loved one needs to begin the recovery process, you may not even know for sure whether this person truly has a substance abuse issue. Ultimately, it’s up to the individual to acknowledge his or her disease and whether or not to accept help. However, understanding the common signs of hidden addiction can allow you to seek out the resources you need to be a supportive person in the life of your loved one.