I just watched the beginning of the stream, it's very obvious he's high on something he's not used to, he was over sharing, talking fast, bragging about how much tolerance he has to Xanax, and just had a different demeanor than the usual 'life is hell'.
I think Ralph has finally graduated to heroin, during the start of the stream he still was high on the initial rush but you see it diminish throughout the night.
If true, it will become super obvious in the coming weeks, he's probably too much of a coward to shoot up so he' would be snorting/smoking, making it fairly obvious when he starts doing it more often during the show/taking breaks to do it. I saw him sort of pick/check his nose a couple of times, which is the typical 'can people see I snorted something?' check.
I may be wrong, but I'm 99% sure he is/was on something and with his history, heroin would make the most sense.