While the term “substance abuse” has made its way into the mainstream, with most people understanding that it’s a condition related to the disease of addiction, fewer people are aware of a similar condition referred to as polysubstance abuse.
Understanding the difference between substance abuse and polysubstance abuse is important for identifying the signs and symptoms of the condition, the added health risks, and the specific challenges that can manifest during treatment.
What is Polysubstance Abuse?
A simple definition of polysubstance abuse disorder refers to a person who habitually uses three or more substances without showing a specific preference to any single one of them.
Sometimes referred to as a “polyaddict,” this describes a person who is only interested in getting high with any variety of substances, instead of a person who is 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 use disorder threshold, with a “two or more” criteria, replaced polysubstance abuse.
Despite the change in the diagnostic language, polysubstance abuse is a distinctive type of dependency.
The hallmark of polysubstance dependence is an individual’s use, dependence, or addiction to the mind and mood-altering effects of drug use.
This differs from the addiction to a single drug, like prescription opioid painkillers, that is driven by a need to not only get “high,” but also avoid painful withdrawal symptoms.
Poly-drug users are generally looking for a combination of drugs that enhance the other’s effects, creating a “high” that’s perceived as better than the effects of a single substance.
Some users who mix substances to amplify the effects of each other call it a synergism.
One example of this might be using alcohol, marijuana, and cocaine together at the same time. If that specific combination is not available, a drug like methamphetamine might replace cocaine.
Polysubstance abusers are generally chasing a specific high created by a certain combination of drugs, with the high itself being more important than the actual drugs used.
The Dangers of Polysubstance Abuse
It’s necessary to point out that drug abuse of any kind, including polysubstance abuse, is not limited to just illicit drugs and alcohol. The misuse and abuse of prescription drugs, reports the National Institute on Drug Abuse (NIDA), is actually currently on the rise as well.
So, any combination of misused drugs might also include prescription medications.
One of the reasons polysubstance drug combinations are so dangerous is due to the unknown reactions that one substance will have on the others.
All drugs come with potential side effects, yet when they are combined with other substances, the potential for more severe outcomes increases exponentially.
In addition, the effects of one drug, such as alcohol, can greatly increase the addictive nature or dangers of another drug, like benzodiazepines. These combinations often increase the risk of overdose and place a person’s long-term health in greater jeopardy.
Even more chilling is the difficulty first responders may have in resuscitating a polysubstance use victim who is experiencing a substance overdose.
While a drug like naloxone can help save people who have overdosed on opioids, it will have no significant effect on a patient that has overdosed on a combination of cocaine, alcohol, meth, or other drugs.
Typical Polysubstance Abuse Combinations
Alcohol is considered the most abused substance in the United States and is almost always in the mix for polysubstance abusers.
Research has shown that incidents of prescription drug abuse are nearly 20 times more likely in people who abuse alcohol.
Drugs commonly misused in combination with other substances can include:
- Alcohol
- Prescription Painkillers like Oxycodone, OxyContin, Percocet, or Vicodin
- Benzodiazepine Prescriptions such as Xanax, Valium, Klonopin, or Ativan
- Marijuana
- Cocaine
- Methamphetamine
- Heroin
- Psychedelics including LSD, Ecstacy, Mushrooms, Peyote, Ayahuasca, Mescaline
Polysubstance Abuse Symptoms
It may be difficult to distinguish whether a person is suffering from polysubstance abuse disorder as compared to a single substance use disorder.
Both conditions present with similar signs and symptoms, so displaying a number of symptoms may signify some form of substance dependence or addiction.
Common 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
Everyone is different and some people may not show all of the above outward symptoms of substance abuse. However, addressing a person’s troubling behavior with compassion and understanding may be enough to open a dialogue about seeking help.
Polysubstance Abuse Treatment
Treatment for polysubstance abuse can be challenging because each person’s addiction is not necessarily driven by the physical and psychological need for just one substance. Instead, he or she might be chasing the effects of a combination of drugs.
Like any form of addiction though, polysubstance dependence is treatable. The most effective approach can be found at a residential, inpatient treatment facility with a trained staff of addiction professionals.
The first phase of recovery usually requires drug and alcohol detox provided by medical professionals who are experienced in safely and comfortably overcoming withdrawal symptoms.
The security of a residential facility allows a person time to safely detox and then begin to address the underlying causes of substance use and addiction.
Therapies usually include one-on-counseling, group therapy and, if appropriate, family counseling.
Specific recovery 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.
If a mental health issue like depression or PTSD is also present, dual diagnosis treatment for a co-occurring disorder will be necessary to recover from both conditions.
Whether it’s polysubstance abuse disorder or a single substance use disorder, the disease of addiction is treatable.
Countless people who struggled for years with addiction are now living happy, healthy, and productive drug-free lives because they decided to get help.
