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Polysubstance Abuse and Addiction

Polysubstance abuse is a general term for the abuse of more than one type of drug. This could be for therapeutic or recreational purposes. Polysubstance abuse usually refers to the misuse of several illicit drugs or prescription medications. The drugs may or may not be used simultaneously. People may use multiple substances in an attempt to enhance the effect of a single drug or create a more intense high.

What Is Polysubstance Abuse?

In many cases, people can become dependent on multiple drugs. Heroin and cocaine is a commonly abused combination (known as a “speedball”). The combined effects may be more pleasurable than those from each drug alone. This pattern of drug consumption would be characterized as polysubstance abuse.

However, this is not the only type of polysubstance abuse. Another person may alternate between multiple drugs to counteract the effects of the other. For instance, the illicit drug methamphetamine is a stimulant. After abusing this substance, a user will feel wired. To help them get to sleep, that person might later use prescription drugs like opioids (e.g. oxycodone) or benzodiazepines (e.g. Valium). They could also start using legal substances like alcohol or illicit drugs like heroin to take the edge off. Due to this pattern of consumption, a person could develop an addiction to both the “upper” (e.g. meth) and the “downer” (e.g. Valium).

Any drug abuse can be dangerous. However, people who are polysubstance dependent have an increased risk of:

  • Dependency and addiction
  • Injury
  • Relationship problems
  • Disruptions at work or school
  • Financial difficulties
  • Mental health issues
  • Overdose and fatal reactions

Polysubstance Abuse Demographics

In 2013, researchers conducted a large-scale survey on polysubstance use in several countries. The survey found that polysubstance use among teenagers was high, between 18 and 34 percent.

The study found that abuse of multiple substances is especially prevalent in the following situations:

  • Substance users seeking treatment
  • Men who engage in high-risk sexual behaviors
  • HIV-infected men who engage in sex with other men and transgender women

Older adults are more likely to use prescription drugs in the long-term and to have multiple prescriptions. This can lead to improper use of medications and polysubstance abuse. Researchers estimate that 25% of older adults use medications that could have a negative effect with alcohol.

A 2000 study found that nearly a quarter of a million people admitted to opiate treatment centers for heroin abuse reported the use of other drugs. Less than half (an estimated 42.7%) reported only using heroin. Per admission, the average number of substances was 1.8. According to the study, some substances had statistically significant patient usage rates, including:

  • Alcohol: 23.3%
  • Non-smoked cocaine: 22.2%
  • Marijuana/hashish: 12.1%
  • Smoked cocaine: 12.1%
  • Other opioids: 4.3%
  • Tranquilizers: 3.0%
  • Methamphetamine or amphetamine: 2.8%

Polysubstance Abuse and Dual Diagnosis

There are higher rates of mental health issues among people who use multiple substances. People who abuse alcohol and illicit drugs at the same time are more likely to have anxiety and depressive disorders. People who use marijuana with other substances are more likely to have depression, anxiety, mania and psychotic symptoms. One survey reported that 72% of adolescent marijuana users seeking substance abuse treatment have two or more psychiatric disorders.

The Difference Between Polysubstance Abuse and Co-Occurring Disorders

Co-occurring disorders (or dual diagnosis) is a term used to describe someone who struggles with both a drug abuse problem and a mental health condition. For example, someone struggling with major depression may drink or abuse illicit drugs to numb their symptoms. This form of self-medication can lead to alcohol addiction. When this happens, a psychiatrist would diagnose this person as having co-occurring disorders.

This is different from polysubstance abuse. A mental health professional can diagnose you with co-occurring disorders if you abuse a single drug. A diagnosis of polysubstance abuse requires that you abuse multiple drugs. As previously stated, polysubstance abusers often have underlying mental health issues. But this isn’t always the case. Someone may be addicted to multiple drugs without suffering from a mental health condition.

What Treatment Is Like for Polysubstance Abuse

There are different forms of treatment for polysubstance abuse. It’s important that the addiction treatments are tailored to the individual’s needs. For example, it matters what kinds of drugs a person has been abusing. A drug rehab team should also note how long a person’s pattern of substance abuse has lasted, and if they have any underlying mental health conditions. If a person doesn’t address their motivations for abusing multiple drugs, they are likely to relapse. Learning to cope with emotional pain is one of the most effective ways to avoid polysubstance abuse.

Treatment for polysubstance abuse usually begins with medically-supervised detoxification.

Detox for Polysubstance Abuse and Addiction

The first step in tackling polysubstance abuse is medical detox. Detox is more complex with polysubstance addiction. It is important to obtain an accurate history of the substances that a client abuses. This will help determine if a drug rehab team can safely use certain medications during detox. The client may not be able or willing to provide these complete details. Determining these substances requires breath, urine and/or blood screening tests.

Some clients may require hospitalization or inpatient detox, such as those who abuse:

  • Alcohol
  • Sedatives
  • Hypnotics
  • Opioids
  • Anti-anxiety drugs

Others can be treated on an outpatient basis. However, someone with repeated relapses may require inpatient treatment.

Treatment Evaluation Factors

The length of treatment is determined by a number of factors, including:

  • The duration of abuse
  • Type of substance dependence
  • Presence of organ damage
  • Co-occurring mental illness
  • Desire to change and willingness to undergo treatment
  • Adequacy of a social support system
  • Plans for continuing care

Post-Detox Rehab

After a drug rehab team uncovers drug-use patterns, a psychological evaluation is necessary. The team should obtain a thorough evaluation and history of mental health disorders from the patient. They must then spend adequate time on treatment methods—such as therapy—in addition to detox.

The first phase of treatment for polysubstance abuse will focus on alleviating symptoms of withdrawal. This is part of medical detox. But even after detox, the client may continue to experience withdrawal symptoms. This could include physical cravings, psychological dependence and a host of triggers that can elicit relapse. Depending on the substance abused, the client may be prescribed safe medications to help with their withdrawal symptoms. At this point, the user should begin working on coping skills and behavior changes with their addiction counselor.

Residential Programs for Polysubstance Abuse

A residential program (or inpatient treatment) involves the client staying on the premises of the treatment facility during recovery. This involves round-the-clock care. If a client is struggling with withdrawals or mental health problems, a specialized drug rehab team will be available for support. Inpatient treatment is ideal for polysubstance abuse.

After about 90 days of continuous abstinence, clients may transition from residential programs to outpatient rehab centers. The client will reach the final stage of recovery when they have achieved complete abstinence for five years.

Outpatient Rehab for Polysubstance Abuse

After the most difficult stages of recovery are over, a client may attend an outpatient rehab center. This involves regular visits to an addiction treatment facility. Unlike residential programs, a client can leave the facility after completing scheduled treatments and therapies. Outpatient programs allow clients to go to work, attend school and fulfill their other personal responsibilities.

Treatment Options for Polysubstance Abuse

During inpatient or outpatient rehab, a drug rehab team will offer different treatments for clients struggling with polysubstance abuse. Treatment options may include:

  • Psychotherapy: This process helps patients to get to the root causes of their pain. This might involve exploring past trauma, abuse, neglect and other childhood issues. Finding out the deeper motivation for polysubstance abuse is an important step in beating the urge to abuse drugs. Furthermore, cognitive behavioral therapy (CBT) helps people learn to identify and transform distorted thoughts into ones that are empowering, realistic and positive.
  • Self-help programs and support groups: A drug rehab team may recommend Alcoholics Anonymous, Narcotics Anonymous and other support groups. Participation in these groups will provide a supportive network of people who understand the unique struggles of addiction. Participants motivate and help each other stay on the path of sobriety. Part of the recovery program may include regular and random drug screenings.
  • Alternative therapies: Meditation, yoga, fitness, art classes and music therapy can provide clients with healthy coping mechanisms. These therapies also provide hobbies to keep an addict’s mind off of substance use and stresses that may lead to substance abuse.

Polysubstance Addiction – There Is Hope

Combating an addiction to multiple substances is difficult. But it is possible to recover. An individual’s determination to abstain from the use of substances is important. Treatment success also depends on the individual’s support system.

It’s important to remember that relapsing can be a normal occurrence. Sometimes it is a necessary step before stability can become part of the recovering person’s life. Recovery after polysubstance abuse requires ongoing diligence and a strong support network. By committing yourself to treatment you can develop the tools you need to get better.

Posted on August 5, 2016 and modified on June 10, 2019

Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

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