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What is Polysubstance Abuse?

Polysubstance abuse or polydrug use is when a person consumes more than one illicit or licit drug at any given moment. Illicit drugs include any type of substance that is:

  • Illegal 
  • Does not have a medical application for the user
  • Poses a health risk to the individual (with misuse and dependence potential)

For instance, you can consider heroin or cocaine as illicit drugs. Both substances can be dangerous and place users and even local community members in danger. 

Conversely, licit drugs include substances that are not illegal but have effects on the body and mind. Alcohol is a typical example of a licit drug. Marijuana is also licit in some states (e.g., California). 

When a person uses or misuses multiple drugs, it does not matter whether the drug is licit or not. All drugs, including even prescription medications, have the potential for drug interactions and side effects. However, it is important to remember that the types and quantity of drugs consumed will raise the risk of more severe consequences. 

For example, people who combine cocaine and alcohol are taking part in polysubstance consumption

Polysubstance abuse is harmful to a person’s health. Taking various drugs can increase the risks of severe side effects, overdose, and death. 

What is a Poly Addict? Why Do People Misuse Multiple Drugs?

A poly addict is a term that describes a person who has become addicted to taking multiple substances, including prescription drugs, at once.

However, this term is becoming less and less popular in usage. Scientific evidence has grown to support making distinctions between the person consuming the drug and the addiction as a legitimate health problem. 

When a person consumes drugs, physiological changes occur, both mentally and physically, to produce possible dependence, tolerance, and intensified cravings.

So, through changing or eliminating this type of language, clinicians and local communities can:

  • Address stigmatization issues (which can be the cause of shame and self-criticism among those who use drugs)
  • Encourage those with a problem to seek help
  • Shift the paradigm to focus on the drug problem 

There are many reasons why a person may misuse or use multiple drugs. Polysubstance use can occur to:

  • Maximize the effects (a “high”) caused by the different substances
  • Balance or manage negative effects (e.g., combined use of alcohol and cocaine)
  • Substitutes sought-after effects 

The European Monitoring Center for Drugs and Drug Addictions (EMCDDA) identified recreational polysubstance use in specific social settings (e.g., dance clubs).5  

What are the Most Common Poly-Abused Drugs? 

The most usual patterns of poly-abused drugs include:

  • Heroin combined with other opiates (methadone) or benzodiazepines 
  • Heroin combined with cocaine 
  • Cannabis combined with stimulants or alcohol 
  • Combining alcohol or stimulants with cocaine 

In a closer look, the European Monitoring Center for Drugs and Drug Addictions found the following poly-abused drug trends among people in treatment: 5

  • Older individuals (primarily males) taking opiates with other opiates or cannabis
  • Younger individuals (males and females) taking cannabis and stimulants while consuming alcohol or substances like hallucinogens  
  • Individuals aged under 30 years (males) taking both alcohol (or other stimulants) and cocaine  
  • Individuals between 20 and 39 years old (males) taking both cocaine and heroin 

Various epidemiological studies spanning several decades have shown that people with opioid use disorder (OUD) are likely to have taken different drugs.1 

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Who is at Risk for Polysubstance Abuse?

There is no one decisive risk factor for polysubstance abuse. Those people with polysubstance use problems may have one or more of the risk factors listed below, including:

  • Family history of drug abuse
  • Early exposure to substances and alcohol 
  • Genetics
  • Mental health disorders, e.g., schizophrenia, bipolar disorder, or substance use disorders (SUD)
  • Trauma, such as post-traumatic stress disorder (PTSD) or sexual abuse
  • Stress

The most significant risk of polysubstance abuse is present among those with serious drug problems, especially those who inject opiates or other substances. 

In data figures released by the Centers for Disease Control and Prevention, pregnant women who received opioid pain medication prescriptions faced a higher likelihood of smoking tobacco than those who did not.

Symptoms of Polysubstance Use

Polysubstance use can cause different symptoms and signs. However, these symptoms can vary based on the drugs consumed. 

If you take multiple substances at once, you may experience the following health issues:

  • Irregular heartbeat (arrhythmia)
  • Cardiovascular disease
  • Liver disease
  • Respiratory depression
  • High blood pressure (hypertension)
  • Infections
  • Weakened immune system
  • Coma
  • Intensified cravings
  • Impaired memory
  • Poor judgment
  • Disorientation
  • Difficulty focusing

Signs that a person with a drug use problem include:

  • Social isolation from friends and family
  • Borrowing or stealing money to pay for drugs
  • Lack of professional or emotional stability 
  • Lack of concern for personal hygiene

Potential Side Effects of Polysubstance Use

Polysubstance use is dangerous. Taking more than one drug can not only cause different side effects but can also heighten their severity.

For example, alcohol, opioids, and benzodiazepines are all central nervous system depressants. Mixing drugs like these two substances increases your risk for death dramatically.  Your central nervous system relaxes so much as to affect your breathing and heart rate and cause respiratory failure. 

In general, those who use various drugs have been reported as experiencing nausea, vomiting, myalgia (body pain), balance problems, and changes in heart/respiration rates and blood pressure. 

Dangers of Polysubstance Abuse 

Polysubstance use can pose serious problems, including:

  • Severe side effects — as mentioned earlier, polysubstance use can produce more undesirable side effects and even increase their severity. If the side effects of the combined drug use are extreme, the risk of life-threatening health problems rises. 
  • Increased risk of fatal overdose — any type of substance use presents drug addiction and overdose possibilities. Taking multiple drugs can increase that risk, though. Because certain drugs eclipse the effects of other drugs, some people may take higher doses than they usually do to achieve that “high” and overdose accidentally. Overdose may result in death or long-term health problems. 
  • Complicated treatment — Treatment for polysubstance use is challenging. On the one hand, clinicians may not know what treatment to administer in cases of overdose. Delays in treatment can increase the likelihood of death. At the same time, multiple studies have suggested that those who use various substances face a high chance of relapse. 

The risk of overdose increases when you take multiple drugs at once. For example, it is difficult to overdose on benzodiazepines (a type of prescription medication) alone. However, when you mix higher doses of benzodiazepines with large quantities of alcohol or an opiate, death is possible.  

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Health Effects of Polysubstance Abuse

Polysubstance use can lead to different short- and long-term health effects. The effects will vary depending on the pharmacological properties and quantities of the drugs consumed and the person’s characteristics.  

Short-Term

People who use multiple drugs can experience the following:

  • Loss or increase in appetite
  • Insomnia
  • Elevated heart rate (tachycardia)
  • Slurred speech
  • Alcohol intoxication (due to alcohol abuse or mixing alcohol with other substances)
  • Cognition issues
  • Coordination issues
  • Elevated risk of more risk-taking behaviors 
  • Poorer hygiene 
  • Relationship issues  

Long-Term

People who use more than one drug have an increased risk of overdose. When you overdose, you may experience potentially life-threatening consequences, including permanent damage to bodily organs. 

At the same time, those with a drug use problem can develop physiological dependence. This means that they will need higher doses of substances to achieve the desired effects or “high.” However, the intake of larger quantities of the substances can heighten the risk of overdose and death. 

How is Polysubstance Abuse Diagnosed? 

Polysubstance use diagnosis requires comprehensive assessments from a general practitioner, psychiatrist, psychologist, or licensed alcohol and drug counselor. 

Health professionals may perform blood, urine, or other lab tests to determine drug use. While positive test results do not suggest an addiction, they may help define treatment plans. 

Lastly, health professionals may also consider polysubstance use as a substance use disorder. In these cases, they may refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment Options for Polysubstance Use 

Seeking addiction treatment is crucial and possible. Different treatment options are available for polysubstance use, such as:

  • Comprehensive addiction treatment program (inpatient and outpatient)
  • Detoxification 
  • Cognitive-behavioral therapy (CBT)

Treatment centers must identify any co-occurring mental health disorder or mental health issue early in treatment (during initial evaluations) to provide well-rounded care.

Detoxing from Polysubstance Abuse: How Does it Work?

If you have a drug use problem or substance use issue, detoxification will be necessary. However, withdrawal from more than one substance is more challenging than that from one substance. For this reason, the withdrawal process is recommended to be done on an inpatient basis. 

If you are admitted to a medical detox center, you will receive 24-hour supervision from healthcare professionals. They will be able to monitor your vital signs continually and administer prompt treatments for medical emergencies that arise. 

They may also prescribe certain drugs to offset withdrawal symptoms that may make the experience uncomfortable and unpleasant.  

Additionally, tapering may be an intervention considered by healthcare professionals for those who use drugs on a long-term basis. Tapering helps to wean a person off of drugs and minimize the likelihood of severe withdrawal symptoms. 

Finally, people seeking treatment may take advantage of cognitive-behavioral therapy (CBT) sessions or support groups. CBT is an effective treatment in many cases of drug use problems. These resources can help them address emotional or mental issues that give rise to polysubstance abuse. 

Tips: How to Help Your Loved One Seek Treatment

If you have a loved one experiencing problems with polysubstance abuse, you can take on different approaches to get them help, including:

  • Seeking professional help  — It may be difficult for you to address the topic of treatment with a loved one. However, a local addiction or mental healthcare treatment provider could provide you with the tools and resources to help your loved one take the first step on the path of recovery. 
  • Reaching out to local support groups  — Groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) can offer a network of encouragement and support.
  • Being encouraging  — People with a drug use problem may experience feelings of shame or unworthiness. Letting them know that you are available for support can remind them that a better life is possible.

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Resources

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Compton, Wilson M, et al. “Polysubstance Use in the U.S. Opioid Crisis.Nature News, Nature Publishing Group, 13 Nov. 2020.

Hannah, Haylea A., et al. “Using Local Toxicology Data for Drug Overdose Mortality Surveillance.Online Journal of Public Health Informatics.

Is Heroin the Worst Drug? Implications for Drug Policy.Taylor & Francis.

Peppin, John, et al. “The Polysubstance Overdose-Death Crisis.Journal of Pain Research, Dove, 15 Dec. 2020.

Polydrug Use, European Monitoring Center for Drugs and Drug Addictions. 1 Oct. 2002.

Polysubstance Use in Pregnancy.Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 25 Nov. 2020.

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