Is someone you love abusing heroin? Don’t be embarrassed if you don’t know the answer to that question.

Few people who abuse drugs broadcast that fact to friends and family members. And many drug abusers are adept at hiding their use.

You don’t have to be a super sleuth to uncover the truth. And thankfully, you don’t have to run urine tests or blood tests to spot signs of heroin use.

Measurable physical and mental health changes come with abuse. And using heroin isn’t easy. It requires a lot of gear, and when you find that equipment, you have a sure sign of abuse unfolding.

Here’s what to look for.

Heroin’s Physical Changes

Heroin is sedating, so people who use it often seem sluggish or sleepy. Someone who appears peppy one moment and then knocked out the next could be using heroin. The distinctive head nodding, drooling, and drowsy symptoms often spark addiction concerns in families.

But people who abuse heroin aren’t high and sedated all the time. They may only shoot up a few times per day, and the nods wear off quickly. There are other physical symptoms you can watch for, and they tend to last longer.

For example, the person you love may be trying to get better. They may stop taking the drug for days or even weeks at a time. It’s a smart move, but the body dislikes it. Withdrawal symptoms set in, and according to the National Institute on Drug Abuse, they can persist for up to a week.

You might notice the following:

• Nausea
• Frequent bathroom trips for diarrhea
• Goosebumps
• Twitching, jerking arms and legs
• Restlessness
• Soreness or grunts of pain

If the symptoms are severe, they can prompt the person to head out for more drugs. When that happens, you’ll see an immediate resolution in withdrawal discomfort.

Damage Caused by Needles

Most people who abuse heroin do so with a needle, and if you look closely at the person’s skin, you’ll see tiny speckles. Each one represents a needle’s pinprick.

Don’t limit your search to the arms. As researchers point out, long-term heroin abuse dissolves veins and arteries. They close up to keep the person from injecting any more. Long-term users resort to unusual injection spots, like between the toes or in the hand.

Drugs aren’t the only things that move into the body with a needle. Tiny specks of bacteria make the trip too, and when they do, they can cause infections. You might notice:

• Swelling. It can be confined to the area around the injection, or the whole arm, leg, or foot can grow huge and puffy.
• Redness. The area gets irritated and appears red.
• A distinct scent. Pockets of puss smell just awful. If the abscess bursts, the distinctive odor of death gets bigger.
• Fever. In severe cases, an abscess makes the whole body’s temperature rise. The person can complain of feeling hot, cold, or both.

Abscesses are very common among heroin users. In one study from 2000, researchers found that 32 percent of injecting drug users had them. Many had tried to cure their own by cutting or pinching them.

Heroin’s Emotional Changes

We think of heroin as a central nervous system drug. It makes us sleepy and doped-up, and it slows our breathing. But make no mistake: Heroin can also cause big changes within the brain. When it does, it can alter the way a person both thinks and feels.

Research from the National Institute on Drug Abuse suggests that white matter in the brain shrinks with repeated heroin use. Those dead brain cells once tackled impulse control and decision-making. Without them, the person can seem wild, out of control, and adolescent. You may wonder why they make the choices they do, and despite your coaching, they may persist in poor decision-making.

Health Direct also reports that regular heroin users face a higher risk of:

• Confusion
• Mood swings
• Depression
• Anxiety

Brain changes sparked by the drug are to blame, combined with chronic stress. Using drugs and worrying about the future each day is taxing. The person can feel trapped, worried, and confused. Mental health problems blossom in this environment.

The person you love can also seem both paranoid and secretive. Drug users are desperate to keep their problems private, and they must go through mental gymnastics to make that happen. Someone who seemed open and honest can now seem angry and closed off. The drugs are to blame.

Heroin Gear to Look For

Maybe you’ve seen some — but not all — of the changes we described. What’s the one thing you could hold up as proof that drug use is happening? Paraphernalia could be the answer.

To use heroin, the person needs a set of gear, including:

• A heat source. Heroin must be cooked before it can slide into a needle. Candles, matches, or burners could do the trick.
• Spoons. Powdered heroin blends with water in the bowl, and it can be held over the flame. It might be blackened from previous cooks.
• Cotton balls. The needle sucks up liquid through this material.
• Needles. This is an easy one. To push the drug into the body, the person you love needs a sharp needle. Experienced drug users have many.
• A tourniquet. It’s easier to inject drugs into a large, puffy vein. Tying off an arm or leg with a tie, belt, or rubber hose makes that possible.

Most users keep all their gear in one place, so they’ll have everything they need when it’s time to shoot up.

What Should You Do?

Confronting someone you love isn’t easy. Take a deep breath and remind yourself that you’re saving a life. Without your intervention, an addiction can be fatal.

When you have the evidence you need, start a conversation about what you’ve seen and how treatment helps. You might find that your talk holds the answers the person you love has been looking for.