Families and friends are being urged to look beyond dramatic physical symptoms when recognising addiction, particularly opioid addiction, as fentanyl raises the risk of fatal overdose. An addiction physician says compulsive drug use, worsening relationships and changes in daily life can be more revealing than sweating or vomiting, while LGBTQ+ people may face added stigma and barriers to welcoming care.

Addiction doesn't always look dramatic

Sweating, vomiting and obvious intoxication are often treated as telltale signs of addiction. But according to addiction physician Dr Yngvild Olsen, the more meaningful clues may be quieter: a person keeps using despite damage to their health, education, work or relationships.

That distinction matters because addiction is defined by compulsive behaviour, not simply by how someone looks in a difficult moment. A person may appear calm, polished or functional while their drug use is steadily taking over their life.

Olsen's work in addiction medicine has included treatment, research and public health leadership. Her experience has also reinforced a hopeful point: recovery is possible, and treatment can help people rebuild routines, relationships and confidence.

Why fentanyl has changed the risks

The opioid crisis has shifted over time, moving from heroin to prescription painkillers, then back to heroin and increasingly towards illicit fentanyl. According to the Washington Blade's account of Olsen's interview, fentanyl's extreme potency means that a very small amount can cause a fatal overdose.

The danger isn't limited to people who knowingly seek fentanyl. Illicit drugs can be mixed or contaminated with powerful synthetic opioids, making every unregulated supply unpredictable. That uncertainty is one reason public health advice increasingly stresses overdose prevention and rapid access to help.

Other synthetic opioids are also appearing, but fentanyl remains a major driver of overdose deaths. The practical message is stark: assumptions about what a drug contains can be dangerously unreliable.

Addiction is a disease, not a character flaw

Olsen describes addiction as a complex disease shaped by genetics, environment and experiences such as childhood trauma. That framing challenges the familiar but damaging idea that someone could simply stop if they tried hard enough.

Shame can keep people away from treatment, particularly when they already feel judged by family, employers or healthcare professionals. Research and clinical experience have shown that medications such as methadone and buprenorphine can support recovery for people with opioid use disorder, alongside services tailored to their circumstances.

The wider picture is important, too. Addiction treatment isn't a single appointment or a stern conversation. It may involve medication, mental health support, housing assistance, primary care and trusted relationships, all working together.

LGBTQ+ people may face extra barriers

LGBTQ+ people can experience overlapping forms of stigma, discrimination and stress, which may increase vulnerability to substance use and make recovery harder. Olsen told the Washington Blade that these pressures can be particularly significant for transgender people and others who struggle to find services that feel safe and respectful.

A welcoming clinic isn't a minor extra. If a patient expects misgendering, hostility or a lack of understanding, they may delay seeking help until a crisis arrives. Inclusive language, confidential care and staff training can make the difference between someone returning for support and disappearing from treatment.

Washington, DC's policy discussions have also highlighted the importance of sustained funding for LGBTQ+ services. That broader investment matters because specialist support can't be built on goodwill alone.

How to approach someone you're worried about

A calm, specific conversation is usually more useful than an accusation. Mention changes you've noticed, such as missed commitments, shifts in mood or behaviour, money problems or health concerns, and explain why you're worried.

Try to avoid labels and ultimatums where possible. Someone may deny having a problem at first, but that doesn't mean the conversation has failed. Keeping the door open and returning to the subject after another worrying incident can be more effective than trying to force an immediate admission.

It also helps to mention that treatment works and that people can feel better. If there may be an overdose, seek emergency help immediately and use naloxone if it's available and you know how to administer it.

Recognising the quieter signs can be the first step towards safer, kinder support.

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