Quentin's family worries that he has a substance abuse issue. What would MOST likely lead them to believe he is experiencing this critical health issue?

They have noticed he is no longer exercising and is gaining weight
They have found empty beer bottles hidden in his closet
They have seen him have multiple romantic relationships
They have heard him complain that he has no friends and feels alone.

The most likely factor that would lead Quentin's family to believe he has a substance abuse issue is if they have found empty beer bottles hidden in his closet. This indicates potential alcohol consumption and suggests he may have a problem with alcohol abuse. The other mentioned indicators such as lack of exercise, weight gain, multiple romantic relationships, feeling lonely, and having no friends may be possible signs of other issues, but they do not directly suggest substance abuse.