Polysubstance Use and Dependence

One of the most common but unrecognized types of substance abuse is polysubstance abuse. Such an intimidating term causes people to think it must be a rare condition; however, polysubstance abuse is widespread and directly responsible for thousands of deaths yearly.

Abusing multiple substances at a time has become so common that most people don’t even realize what they are doing. If you have ever had a couple of drinks while taking prescribed painkillers or taken a bump of coke to enhance the effects of MDMA, you have engaged in polysubstance abuse.

Taking Xanax at night to counteract the morning Adderall you took is polysubstance abuse, despite both being prescription medications.

While many people experiment with drugs, it can quickly become a complex problem and habit with unforeseen short and long-term effects, including addiction and overdoses.

Cases of substance abuse involving multiple substances are about reaching a feeling or specific mental and physical state, not necessarily about using a particular drug. Because polysubstance abuse is more behavior centered, it requires an in-depth, careful, and informed treatment approach to overcome.

What Is Polysubstance Use?

Polysubstance abuse is taking more than one type of drug together, simultaneously, or within a short period, sequentially. According to the Centers for Disease Control and Prevention (CDC), most polysubstance abuse is intentional but can happen unintentionally and include illicit and prescription drugs and alcohol.

Polysubstance users are generally addicted to a specific feeling or high rather than a particular drug. For instance, people who love to feel sedated may prefer benzodiazepines but happily mix alcohol and prescription opioids to achieve a similar feeling if that’s the only option. Or people who enjoy cocaine while they drink may substitute a crushed-up Adderall in a pinch.

But how can someone unintentionally abuse more than one substance at a time? Generally speaking, they are taking drugs cut with something they don’t realize.

Fentanyl has become one of the primary drugs used to cut drugs like heroin, cocaine, and even MDMA because of its potent effects and addictive properties. People were taking different drugs than they intended increases the risk of not receiving proper medical treatment in case of an emergency or accidental overdose, not to mention potentially complicated and confusing withdrawal symptoms.

Medical and addiction treatment professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM), universally reviewed and agreed-on criteria for diagnosing and treating various medical and mental health conditions to assess patients and determine the best course of action. The most recent edition, DSM-5, eliminated polysubstance abuse and polysubstance addiction as official diagnoses. Instead, substance use disorder, ranked from mild, moderate, to severe based on met criteria, refers to dependence and addiction regardless of whether it involves more than one substance.

Despite no longer being an officially recognized diagnosis, professionals still use the previous criteria for polysubstance abuse to help patients understand the specifics of their behaviors and condition. Many agencies also use the term to discuss statistics involving user habits, side effects, emergency department visits, and overdose deaths.

Polysubstance Use Facts

Each year in the United States, almost 20 million people meet the criteria for having a substance use disorder. Between treatment, criminal charges, healthcare, public health campaigns, and emergency responses, addiction in America costs $740 billion annually, with polysubstance abuse contributing to a significant portion of those numbers.

The following are some more facts about polysubstance use in the United States:

• 250 people die of drug overdoses every day, and over half involve more than one substance
• 15 million Americans are diagnosed with alcohol use disorder yearly, and the majority of them admit to regularly using other substances with alcohol
• 80% of polysubstance overdoses involved opioids
• Deaths involving combinations of cocaine and opioids have doubled between 2010 to 2015
• Up to 80% of heroin users admitted to using cocaine as well
• Up to 98% of cocaine users said admitted to drinking alcohol simultaneously
• Stimulant users are the most common polysubstance abusers
• Almost 50% of people with diagnosed mental illnesses also struggle with substance use disorders

Only recently have treatment outcomes for polysubstance addiction begun to improve with the evolution of comprehensive, evidence-based treatment plans that address all aspects of co-occurring disorders.

Polysubstance Abuse and Dependence

Polysubstance abuse does not always lead to dependence, much like there is a difference between dependence and addiction. Abuse can be an occasional occurrence or an intermittent thing; dependence demands consistency to avoid withdrawal symptoms.

According to the National Institute on Drug Abuse (NIDA), substance abuse means taking drugs with no medical purpose, taking prescription drugs in ways other than prescribed, or mixing substances to achieve heightened effects. A person with a valid prescription for a cough syrup containing DXM that combines it with alcohol is engaging in polysubstance abuse; however, abusing DXM one time will not make them physically dependent on the mixture.

Polysubstance use is about achieving a feeling; the drug combination is a means to an end. A person who cannot sleep without mixing whatever drugs and alcohol available to sedate themselves is polysubstance dependent. If a person is addicted exclusively to a cocktail of sleeping pills and benzodiazepines, they have a sedative use disorder, not polysubstance dependence.

Before being removed from the DSM-5, the criteria for diagnosis of polysubstance dependence were:

• Tolerance
• Experiencing withdrawal symptoms
• Inability to stop using despite negative consequences
• Using more substances than planned or for a longer amount of time than intended
• Spending the majority of time obtaining, using, or recovering from substances
• Neglecting personal and professional obligations because of drug use

Substance use disorders replaced polysubstance abuse, but many criteria remain similar. Many professionals mistakenly took polysubstance abuse criteria to mean a person must be addicted to 3 specific substances rather than displaying addictive behaviors related to various but non-specific substances.

The requirements for substance use disorders listed in the DSM-5 offer clearer, easier-to-understand guidelines, helping more people to receive a proper diagnosis and treatment options.

Side Effects and Risks of Polysubstance Abuse

The side effects and risks of polysubstance abuse will vary based on the misused substances and the individual; however, there are some broad and common dangers regardless of drug combinations. The primary risks of polysubstance abuse are amplified side effects of each substance and unique side effects from drug interactions.

Common risks and side effects of polysubstance abuse include:

• Nausea
• Vomiting
• Changes to heart rate and blood pressure
• Confusion
• Disorientation
• Appetite changes
• Breathing changes
• Increased alertness
• Excessive drowsiness
• Lowered inhibitions
• Risky sexual behavior
• Increased risk of overdose
• Death

Mixing drugs with similar effects, like central nervous system depressants, increases the risk of extreme side effects like respiratory depression, resulting in death. Taking things with opposing properties, like mixing alcohol and stimulants, increases the risk of masking the effects of each substance, resulting in overdoses and death. Essentially, mixing drugs with other drugs or alcohol is never safe.

Additionally, the misuse of multiple substances to self-medicate health problems, mental health issues, or even the unpleasant after-effects of drugs can have the opposite effect in the long term and worsen those conditions.

Long-Term

Substance abuse of any kind is hard on the mind and body. Polysubstance addiction increases the damage and likelihood of long-term effects and chronic disease, not to mention the impact on relationships, careers, and legal troubles.

Long-term risks of abusing multiple substances include:

• Increased risk of stroke
• Organ damage
• Increased risk of chronic diseases like HIV and hepatitis from sharing drug paraphernalia
• Loss of cognitive function
• Worsening mental health issues
• Weakened immune system
• Sleep disturbances
• Paranoia
• Anxiety
• Depression
• Weightloss
• Withdrawal symptoms

Struggling with polysubstance dependence also increases the risk of experiencing post-acute withdrawal syndrome (PAWS). Effective treatment for polysubstance abuse must put some focus on the withdrawal process to keep people safe and reduce the risk of PAWS and relapse. Most treatment programs for polysubstance addiction recommend residential treatment facilities because of immersive treatment models’ overwhelming benefits and positive outcomes.

Polysubstance Addiction Treatment in Northridge, California

Polysubstance addiction treatment requires a specialized, custom-tailored treatment plan to help you achieve a life free from substance abuse. White Oak Recovery Center can help you plant those seeds that will lead to a life rooted in recovery.

Our private residential treatment center offers a quiet place with a fresh start to focus on healing. We offer onsite medical detox with around-the-clock medical care and support to monitor your vital signs and ease the uncomfortable withdrawal symptoms. Using cognitive behavioral therapy (CBT), guided support groups, and several other therapies, we uncover and address negative thought patterns and habits that contribute to addictive behaviors and replace them with constructive and healthy skills.

Reach out to us today to plant a seed of sobriety.