The muscles controlling the eyes are involuntary, which means they reveal what a person may be actively trying to hide. A glassy, watery look paired with drooping eyelids or bloodshot whites is a classic indicator of alcohol, marijuana, or sedative use — the eyes are, in effect, a dashboard for the nervous system.
Stimulants like cocaine or methamphetamine force the pupils to dilate so wide they consume most of the colored iris; opioids like heroin or fentanyl do the opposite, shrinking pupils to pinpoints even in a dim room. Unlike bloodshot eyes, which can be explained away by allergies or a late night, extreme pupil changes cannot be faked.
Use the Checklist and Rating Scale to document specific, repeated behaviors. Make it a habit to get close — hugs, family dinners, any well-lit situation where you can observe their eyes directly — and do not hesitate to comment on what you notice, since this is something the person using has no control over and will often try to avoid. Also note how frequently they reach for eye drops, and whether they are pulling back from physical closeness, because that withdrawal is itself a warning sign.
They say the eyes are the windows to the soul, but when it comes to substance abuse, they are more like a dashboard for the nervous system. Because the muscles controlling our eyes are involuntary, they easily give away what a loved one might be trying to hide. One of the most common signs is a “glassy” or watery look. This glazed-over appearance, often paired with heavy, drooping eyelids or bloodshot whites, is a classic sign of alcohol, marijuana, or sedative use, showing they are mentally drifting away.
But the real clues lie in the pupils. When someone is using stimulants like cocaine, meth, or ADHD medications, or hallucinogens like LSD, their body goes into overdrive. This forces their pupils to dilate, stretching so wide they swallow up the colored part of the eye entirely.
Conversely, opioids like heroin, fentanyl, or prescription painkillers do the exact opposite. They cause the pupils to shrink into tiny “pinpoints”—remaining like microscopic dots even in a dimly lit room.
While bloodshot eyes can easily be blamed on a late night or allergies, extreme pupil changes cannot be faked or explained away. If you notice your loved one’s eyes constantly looking unusually wide or shrunk to tiny points, their body is signaling a deep physical reaction to a chemical habit. Pay attention; their eyes may be telling you the truth they cannot say out loud.
Make it a habit to get up close to a loved one to be able to examine the nature of their eyes. You can do this with hugs and kisses and sit down events – family dinner is always a good place – where the lighting is good and you can get a good look at them. Do not hesitate to comment on the nature of the their eyes. This is one thing that the using person has no control over and they will attempt to avoid close contact. By drawing attention to the fact that they are pushing away signs of affection, it too becomes a warning sign that something is wrong. Also monitor the amount of eye drops they use to clear their eyes and remove the bloodshot nature of them.
This sign is for awareness and education only. It is useful as a screening tool, not a diagnostic tool. It is not a substitute for professional assessment or treatment. If you are concerned about someone you love, speaking with a qualified addiction counselor or psychologist is always the right next step.
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