The observation of acute substance intoxication, commonly referred to as being “high,” involves recognizing a cluster of physical and behavioral changes that deviate from a person’s normal state. These indicators are the body’s involuntary responses to mind-altering compounds. While these signs provide a strong indication of intoxication, they are general observations and not a formal medical diagnosis. Understanding these signs is primarily a matter of public health and safety, providing context for recognizing when an individual may require assistance or medical attention. The effects vary widely based on the specific substance, amount consumed, and the individual’s physiology.
Observable Physical Indicators
Physiological signs offer direct evidence of a disruption in the central nervous system’s regulation of bodily functions. Changes in the eyes are often immediately noticeable, particularly alterations in pupil size. Substances can cause either mydriasis (pupil dilation) or miosis (pinpoint pupil constriction).
The eyes may also appear bloodshot, watery, or glazed. Involuntary, jerky eye movements, known as nystagmus, frequently accompany intoxication, particularly with depressant substances. Motor control suffers, manifesting as poor coordination, unsteadiness, or an inability to maintain balance, often leading to a staggering gait.
A person may exhibit fine muscle tremors or fidgeting. Other observable changes include flushing or paleness of the skin, indicating changes in blood flow and body temperature regulation. Excessive sweating or chills are common as the body struggles to maintain its core temperature, and unusual odors on the breath or clothing may be present.
Altered Behavior and Cognitive Function
Intoxication affects the brain’s capacity for clear thought, communication, and emotional regulation. Speech patterns often become altered, presenting as slurred words, difficulty articulating thoughts, or an unusually rapid, pressured delivery. Conversely, some individuals might become unusually quiet or change their typical communication style.
Mood and emotional affect can swing dramatically, ranging from sudden euphoria and inappropriate giddiness to extreme irritability, aggression, or profound sadness. These shifts often appear inappropriate to the current social context. Cognitive functions are impaired, leading to poor judgment, difficulty tracking a conversation, and short-term memory lapses.
The ability to process information and make rational decisions is compromised, which may result in risky or uncharacteristic behavior. Social interactions can become strained as the intoxicated person may exhibit unusual withdrawal, excessive gregariousness, or acute paranoia.
Substance-Specific Symptom Differences
The general signs of intoxication are refined by the specific pharmacological class of the substance consumed.
Depressants (Opioids and Alcohol)
Depressant substances slow down the body’s functions. Opioid use is associated with extreme drowsiness, slowed or shallow breathing (respiratory depression), and pinpoint pupils (miosis). A person may repeatedly nod off or lapse into unresponsiveness, exhibiting a limp body and cold, clammy skin.
Stimulants (Cocaine and Amphetamines)
Stimulants increase neural activity and cause hyperactivity. Physical signs often include rapid heart rate (tachycardia), elevated blood pressure, and dilated pupils (mydriasis). Behaviorally, the person may exhibit extreme energy, agitation, repetitive behaviors, hyper-awareness, or paranoia. They may also display bruxism (teeth grinding) due to increased muscle tension.
Hallucinogens (LSD and Psilocybin)
Hallucinogens primarily affect perception and mood. Intoxication often involves distorted perceptions, visual illusions, and detachment from reality. Physical signs include dilated pupils and increased heart rate, similar to stimulants. The behavioral presentation is characterized by staring, irrational behavior, or intense psychological distress. The user may experience synesthesia (such as “seeing sounds”) and rapid shifts in emotional experience, from euphoria to fear and anxiety.
Distinguishing Intoxication from Other Conditions
Observing signs that resemble intoxication does not automatically confirm substance use, as various medical and mental health conditions can produce similar symptoms. A diabetic emergency, such as hypoglycemia (low blood sugar), can cause confusion, slurred speech, and loss of coordination that mimics impairment. High blood sugar (hyperglycemia) can also lead to fruity breath odor and altered mental status.
Neurological events, such as a stroke or seizure disorder, can result in sudden disorientation, speech difficulties, and impaired motor skills. Conditions like extreme fatigue, sleep deprivation, or the side effects of prescription medications can cause drowsiness, poor concentration, and an unsteady gait. Observation should be viewed as a signal that an individual is in distress, and a medical evaluation is often required to determine the true underlying cause.