Combating Polysubstance Abuse

Posted on September 10th, 2009

Polysubstance abuse is defined as the use of three or more groups of addictive substances over a period of 12 months. It occurs when an individual abuses several substances over a short period of time, often in an attempt to enhance the effect of a single drug to create a more intense high.

Other individuals take a drug to counteract the effects of a drug they had taken previously (like taking sedatives to come off a stimulant high). Strictly speaking, polysubstance abuse is where no single substance is identified as the user’s dru

g of choice.

Some combination drug users have “patterned” use. These include alcoholics who use cocaine only after they’ve reached a certain state of intoxication (so they don’t overuse), addicts who speed-ball (mix cocaine and heroin for intravenous use), and other combinations.

There is another polysubstance subgroup, consisting mostly of adults already addicted to alcohol. After an injury or surgery, they were placed on opiate medications and developed a pain syndrome over time. They then mixed substances or switched to opiates as their drug of choice.

Polysubstance Abuse Among Different Populations

Adult polysubstance abuse, according to literature, is often associated with other mental health conditions. Homelessness, personality disorders, and psychiatric disorders such as major depression, psychosis, and bipolar disorder are common. The overlap of polysubstance dependence and psychiatric problems points to a lot of self-medication. Typically, among multiple substance users, individuals used alcohol or marijuana at an early age and then added other substances (or changed their drugs of choice) without quitting their original substances.

• In 2008, the so-called “Preppie Killer” Robert Chambers used psychiatric “polysubstance abuse” as his defense. His lawyers described Chambers’ lifelong addiction to heroin, cocaine, and prescription drugs.

Among young people, polysubstance abuse is often the norm, and not the exception. The most commonly abused polysubstances by adolescents are marijuana, alcohol, and heroin. Other drugs used include MDMA (ecstasy), dextromethorphan, multiple forms of opiates, cocaine, hallucinogens, and inhalants.

• A 2004 study of young people reported that one-half had used an illicit street drug by the end of their senior year. Two million young people need treatment for alcohol and drug addiction, but only 8 percent actually get it. Nearly one-third of young people addicted to psychostimulants also suffered from attention deficit hyperactivity disorder (ADHD), and 20 percent said they gave their medications to others.

• One treatment facility said that 33 percent of the adolescents currently in treatment had polysubstance addiction.

The elderly are another population that clearly has a problem with polysubstance abuse.

• Older people have more medical conditions that often require prescriptions. Over time, and with debilitating illnesses such as Alzheimer’s disease, the tendency to overmedicate (taking more of a drug, more often, forgetting when and if medication was already taken) increases the likelihood of polysubstance abuse. Combined with alcohol, the results can be devastating, even fatal.

• Elderly women tend to keep their substance abuse and chemical dependency secret. Alcoholism occurs later in women’s lives, perhaps due to problems associated with divorce or separation. Women who are over 55 have less tolerance for alcohol and are therefore more prone to addiction. They are also less likely than men to seek treatment and also use prescribed psychoactive drugs.

Polysubstance abuse is increasingly prevalent among the street drug user population. Different substances abused include heroin, prescription opioids, benzodiazepines, cocaine, crack, alcohol, and marijuana.

• Among one study of incarcerated women, 40 percent had used illicit drugs during the days before being sent to prison.

Detoxification for Polysubstance Abuse and Addiction

Before treatment to address underlying causes of polysubstance addiction, detoxification has to occur. Detox is more complex and problematic with polysubstance addiction for several reasons. An accurate history of total substances abused must be obtained, and the patient may not be able or willing to provide complete details. Determination of the actual substance being used has to be made using screens for breath, urine, and/or blood.

• Some patients can be treated on an outpatient basis, but others, particularly those with alcohol, sedative, hypnotic, opioid, and anxiolytic abuse may require hospitalization or inpatient detox. Repeated abstinence failures or severe anxiety, depression, or psychotic symptoms lasting 1 to 3 days after abstinence may also require inpatient substance abuse treatment.

• After patients admitted for detox for opioids began to show classic alcohol withdrawal symptoms, some treatment professionals opted to routinely treat their detox patients with thiamine until a determination could be made that there was no history of alcohol use.

• Diagnosis and treatment of patients who have been on psychotropic medications while they were already addicted is more difficult.

• If a patient doesn’t know, or is unable to discuss, use of opioid drugs and it’s been days since their last drug use, opiate withdrawal symptoms can lag. Urine screens my not be able to detect the drug.

• Treatment for mixed addiction that also includes alcohol use may include benzodiazepines during the acute phase of alcohol withdrawal. Benzodiazepines can help decrease tremors and prevent or reduce increases in heart rate and blood pressure.

• Medication to treat symptoms of diarrhea or muscle aches may also be prescribed. Folic acid, thiamine, and Vitamin B-12 may counteract vitamin deficiencies.

Evaluation Factors

The length of the treatment program is determined by how long and what type of substance dependence the patient has, whether or not organ damage exists, any underlying mental illness, the patient’s desire to change and willingness to undergo treatment, adequacy of the patient’s social support system, treatment choice, and plans for ongoing care.

Treatment After Detox

After drug use patterns and substances have been identified, a thorough psychological evaluation is important. There needs to be enough time for detox, history evaluation, and a thorough understanding of any psychiatric conditions that exist.

Although there are many different aspects of treatment, they generally include four phases. The first is the acute phase, where the focus is on alleviating symptoms or physiological withdrawal. This typically lasts 3 to 5 days, but is dependent on the number, type, and length of substances abused.

Next is the abstinence period, which is usually about one month. This phase concentrates on changing the patient’s behavior.

The early remission phase follows and can last up to 12 months. The sustained remission phase lasts as long as the patient refrains from alcohol or substance use and no longer exhibits any of the criteria for polysubstance abuse.

Treatment during early remission may involve education on the physical, emotional, and psychological aspects of addiction and recovery. The patient learns to identify stressors and triggers that cause drug use. They learn ways to manage those stressors and also build up coping skills. They can also undergo assertiveness training and relaxation techniques.

Cognitive behavioral therapy (CBT) can also prove helpful with its focus on correcting attitudes and behaviors. These include education on the nature of cross-addiction, the necessity for abstinence, sober living techniques, avoidance of self medication, and the need to avoid all addictive substances to maintain stability.

Ongoing self-help programs such as Alcoholics Anonymous, Narcotics Anonymous, and others are recommended as an adjunct to treatment. Part of the recovery program may include regular and random drug screens.

Polysubstance Addiction – Is There Hope?

Combating polysubstance abuse is more difficult than abuse of a single substance, but it can be successful. The likelihood of success depends on the individual’s determination and discipline to follow through on the requirements to abstain completely from substance abuse. Such determination and discipline does not come easily, especially for hard-core or long-term abusers and addicts. There may be repeated relapses before stability becomes a part of the recovering addict’s life. After treatment, recovery from polysubstance abuse and addiction—just like for any addiction—requires ongoing diligence and participation in a support network.

Is there hope for polysubstance addicts? There absolutely is. Belief in self and the ability to stay clean and sober are two important building blocks for recovery.

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