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Most people are aware of the relationship between substance abuse and addiction, but not everyone is familiar with polysubstance abuse.
Understanding the difference between substance use and polysubstance abuse is important for identifying the signs, the health risks, and the specific challenges of successful treatment.
Polysubstance Abuse Definition
A simple polysubstance abuse definition is a person who habitually uses multiple substances without showing a specific preference to any single one of them.
Sometimes referred to as a poly addict or poly addiction, this describes a person who is dependent on getting high with a variety of substances, instead of a person who is only addicted to a specific type of substance such as alcohol, cocaine, or opioids.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, ultimately eliminated the diagnosis that was referenced in the previous DSM-IV version because it was often misunderstood.
A new substance disorder threshold, with a “two or more” criteria, replaced the polysubstance use term to describe drug use patterns.
Despite the change in the diagnostic language, polysubstance misuse is a distinct type of dependency and mental health disorder.
The hallmark of polysubstance dependence is an individual’s use, dependence, or addiction to the mind and mood-altering effects of substance use.
This differs from drug addiction to a single substance, like prescription opioid painkillers, that is driven by a need to not only get high but also to avoid painful withdrawal symptoms.
Poly drug users are generally looking for simultaneous use of a combination of drugs that enhance each other’s effects, creating a “high” that is perceived as better than the effects of a single substance.
When users mix multiple substances to amplify the effects of one substance it is known as a synergism.
An example of this might be using alcohol, weed, and cocaine together at the same time. In essence, the short term effects of marijuana are amplified by the other substances.
If that specific combination is not available, a drug like methamphetamine might replace cocaine.
Poly drug users are generally chasing a specific psychoactive effect created by various drug combinations, with the high itself being more important than the actual drugs used.
The Dangers of Polysubstance Use
Polysubstance abuse is not limited to only illegal drugs and alcohol. Misusing legally prescribed drugs can also have long-term effects on a person’s health.
The National Institute on Drug Abuse (NIDA) reports the misuse and abuse of legal prescription drugs is on the rise.
Any combination of misused drugs might also include the non-medical use of prescription medications.
Polysubstance drug combinations are dangerous because of the possible interactions each drug can have on the others.
All drugs come with potential side effects, yet when they are combined with others, the potential for more severe outcomes like a physical dependence increases exponentially.
Mixing drugs that produce too much serotonin causes a serious condition known as serotonin syndrome.
In addition, the effects of one drug, such as alcohol, might greatly increase the addictive nature or dangers of another drug, like benzodiazepines.
The combination of benzodiazepine anxiety medication side effects and alcohol increases the risk of drug overdose deaths and places a person’s long-term health in greater jeopardy.
Even more troubling is the difficulty first responders may have in resuscitating a polysubstance use victim who is experiencing an overdose.
While a drug like naloxone can help save a person who is having an opioid overdose, it will have no effect on a patient that has overdosed on a combination of cocaine, alcohol, meth, or other drugs.
Polysubstance Use Combinations
Alcohol is considered the most abused substance in the United States and is often included for those who engage in polysubstance use.
The simultaneous use of alcohol and prescription medications follows regular patterns of polysubstance dependence.
Research has shown that incidents of prescription drug abuse are nearly 20 times more likely in people who abuse alcohol.
Drugs commonly misused with other substances include:
- Alcohol
- Prescription Painkillers like Oxycodone, OxyContin, Percocet, or Vicodin
- Benzodiazepine Prescriptions such as Xanax, Valium, Klonopin, or Ativan
- Marijuana
- Cocaine
- Methamphetamine
- Heroin
- Psychedelics (LSD, Ecstacy, Mushrooms, Peyote, Ayahuasca, Mescaline)
Polysubstance Abuse Symptoms
It may be difficult to distinguish whether a person is addicted to the use of multiple substances or simply a single substance.
Both conditions share similar traits, although the degree of symptoms and usage patterns may distinguish between different forms of substance dependence or addiction.
Signs and symptoms of substance use disorder can include:
- Sudden change in behavior and personality
- Withdrawal from family, friends, and activities once enjoyed
- Lack of motivation at work or school
- Mood swings, along with bouts of anxiety or depression
- Acting secretively or demanding unreasonable amounts of privacy
- Increased health issues
- Looking disheveled, unkempt, or regularly appearing to be sick
- Unexplained absences from work, school, or home
- Visible signs of intoxication, such as slurred speech, dilated pupils, coordination issues, bloodshot eyes, clenched jaw, or speaking faster or more slowly than normal
Every individual is different and some people may not show all the outward symptoms associated with polysubstance addiction.
However, addressing a person’s unhealthy behavior with compassion and understanding may be enough to open a dialogue about seeking help.
Addiction Treatment for Polysubstance Use
Addiction treatment options can be challenging because each person’s pattern of use is not necessarily driven by the physical and psychological need for just one substance like with an alcohol use disorder.
Instead, an individual might be chasing the combination of alcohol and poly drug effects.
Like any form of substance use disorder though, poly drug abuse is treatable. The most effective treatment outcomes can be found at a residential, inpatient treatment program with a trained staff of addiction professionals.
The first phase of polysubstance abuse treatment usually requires drug and alcohol detox provided by medical professionals experienced in safely and comfortably overcoming withdrawal symptoms.
A residential facility allows a person time to safely detox and then begin to address the underlying causes of drug use and addiction.
Therapies usually include one-on-counseling, group therapy and, if appropriate, family counseling.
Specific treatment modalities such as Cognitive Behavioral Therapy (CBT) and relapse prevention therapy should also be provided as a way to create a strong foundation for lasting recovery.
Cognitive behavioral therapy techniques have shown to be effective for a wide range of polysubstance abuse and mental health conditions.
If a mental health issue like depression or PTSD is also present with the use of a drug or alcohol, dual diagnosis treatment for a co-occurring disorder will be necessary to recover from both conditions.
Whether it’s polysubstance use disorder or a single drug misuse, addiction is treatable.
Countless people who struggled for years with drug and substance use addiction are now living happy, healthy, and drug-free lives because they decided to seek treatment.
Frequently Asked Questions
What does polysubstance abuse mean?
Polysubstance Abuse means using multiple drugs or substances at the same time in an unhealthy or harmful manner. It is now commonly referred to as polysubstance use disorder.
It often combines alcohol with sedatives like opioids and benzos or stimulants like cocaine and meth. Marijuana is also used with many of these other substances.
Combining multiple substances can increase the danger and risk of an overdose or other health conditions.
Is polysubstance abuse in the DSM-5?
Polysubstance abuse and polysubstance use disorder are not included in the DSM-5 as a distinct diagnosis.
The previous version, DSM-IV, listed polysubstance dependence as a diagnosis, but it was removed in the DSM-5 update.
Even though medical professionals still identify it as a common condition, The DSM-5 recognizes each substance as a separate disorder, such as opioid use disorder or alcohol use disorder.
What are some polysubstance dependence statistics?
According to the American Journal of Public Health, in 2022, approximately 20.9 percent of adults reported using two or more prescription or recreational drugs.
Among 10th‑grade adolescents in a large U.S. sample, about 7.6 percent were considered ‘predominant polysubstance users’ with high probabilities of using alcohol, marijuana, cigarettes, prescription medications, and other illicit drugs.
Youth overdose data from 2020 to 2023 showed that nearly half of the estimated 23,000 opioid overdose deaths among people ages 15 to 24 involved multiple substances rather than just opioids alone.
A national analysis shows the average number of drugs involved in fatal overdoses in the U.S. increased from 1.72 in 2012 to 2.29 in 2023. The share of overdose deaths involving at least two substances has increased substantially.
What are the challenges in treating polysubstance use compared to single-substance addiction?
Treatment for polysubstance use disorder is more complex than treating a single substance because usage patterns for poly users can vary widely and each substance acts differently on the brain.
This complicates detox protocols since many substances have different timelines and severity of withdrawal. Symptoms of one substance can amplify or obscure the symptoms of another, making the detox process more difficult.
Medication interactions are always a consideration, especially when using medication assisted treatment. MAT may be effective for opioids and alcohol but not for stimulants or sedatives.
Poly addicts also have higher rates of co-occurring mental health disorders, which requires integrated dual diagnosis treatment.
What is the polysubstance abuse ICD-10 code?
The World Health Organization stopped maintaining ICD-10 in 2018 and recommends using ICD-11 for updated health data.
The previous ICD-10 code used the F19.x block for ‘mental and behavioral disorders due to use of other psychoactive substances and multiple drug use.’
The ICD-11 code uses a range within the 6C4F block for ‘disorders due to use of multiple specified psychoactive substances, including medications.’
An extension is added to the code to specify the clinical pattern, such as 6C4F.1 for ‘harmful pattern of use of multiple specified psychoactive substances.’
