When you’re using one substance (such as alcohol, opioids, or cocaine), it gets much easier to start taking additional substances as well. Over time however, this habit of using two or more substances and a regular basis can lead to polysubstance abuse and addiction. But what exactly is polysubstance use disorder (PUD) and how can you know if you have it? And in what ways does it impact addiction treatment and recovery?
What is Polysubstance Abuse?
Polysubstance use is actually a common occurrence. According to the Centers for Disease Control and Prevention (CDC), polysubstance use occurs when two or more drugs are taken together (or within a short time period of each other) either intentionally or unintentionally. Intentional polysubstance use may involve purposefully taking an additional drug to increase the effects of the first one, as well as to feel the effects of the combination. On the other hand, unintentional polysubstance use happens when you use a drug that has been secretly laced with another substance. This has often occurred in illicit opioids mixed with fentanyl, for example.
Any combination of substances can be considered polysubstance abuse, whether it’s cocaine and heroin, alcohol and pain pills, or even multiple prescription medications. When polysubstance use occurs, the combined effects of multiple drugs can be stronger, more unpredictable, and even deadly, shares the CDC. The effects of one drug may be masked for example, causing you to assume that the drugs aren’t harming you. Unfortunately, however, this can lead to accidental overdose.
As your polysubstance use persists, you’re not only taking risks with your physical health; you could also develop polysubstance dependence. As you form dependence on multiple drugs, you start engaging in polysubstance abuse. According to the Cleveland Clinic, polysubstance abuse occurs when you’re dependent on multiple substances and routinely use them in a way that damages your health, quality of life, and ability to function. Eventually, your polysubstance abuse can develop into a complete addiction, also known as polysubstance use disorder.
Polysubstance Use Disorder and Its Warning Signs
Polysubstance use disorder is a diagnosable medical condition associated with the long-term use or misuse of two or more substances, according to Drugs.com. As the formal name for polysubstance abuse, having PUD means you’re addicted to multiple substances. Because of your addiction, you’re unable to stop taking these substances, even though they may be causing you negative consequences.
Individual substance use disorders are highly prevalent in the US, with about 35 million people meeting the criteria today. Among those, 11.3% diagnosed with a substance use disorder will also struggle with polysubstance abuse. In fact, having a substance use disorder with one substance puts you at greater risk of developing a polysubstance addiction down the road. For example, the risk of developing a heroin addiction, a common polysubstance pairing, is as follows:
- Twofold for alcohol misusers
- Threefold for cannabis users
- 15-fold for cocaine users
- 40-fold for prescription misusers
SOURCE: Frontiers in Neuroscience
Considering the chances of developing a polysubstance abuse disorder, it’s important to recognize the symptoms of PUD so you can make changes in your life or a loved one’s before things get worse. With that said, the signs and symptoms of polysubstance use disorder include:
- Feeling relaxed, euphoric, excited, and/or sleepy when you take substances
- Prioritizing substance use over personal responsibilities or relationships
- Requiring substances in order to function
- Neglecting your hygiene, appearance, nutrition, and personal care
- Hiding your substance use from others
- Being hostile or angry when others express their concerns about your substance use
- Experiencing withdrawal symptoms after your substance’s effects wear off, such as nausea, vomiting, diarrhea, mood changes, and sleep difficulties
SOURCE: Cleveland Clinic
Why Polysubstance Addiction Happens
Polysubstance use disorder or polysubstance addiction begins with the desire to use multiple substances. But what would drive someone to use more than one drug? According to studies by Health Promotion and Chronic Disease Prevention in Canada, polysubstance abuse occurs for a variety of reasons, including:
- Alleviating withdrawal symptoms: combining a stimulant and depressant, cannabis, or opioid, for example, to calm down, reduce stress, or avoid drug cravings
- Prolonging a high: combining simulants and opioids, for example, in a single day or over several days to keep any euphoric feelings going
- Balancing effects: using substances with opposing psychoactive effects to achieve a desired mental state or temper effects you don’t want
- Counteracting effects: using substances with complementary effects to counteract any negative effects (it’s important to realize that polysubstance use for balancing or counteracting the effects of substances doesn’t actually work)
- Enhancing a high: combining substances to create new psychoactive effects in hopes of enhancing the effects of another substance, such as using both opioids and simulants together, for example
- Reducing overall substance use: using substances simultaneously in hopes of decreasing general substance consumption, such as taking an opioid in advance so you won’t drink as much alcohol in one night
- Mimicking the effects of another substance: mixing substances to achieve a similar effect to another drug if that substance is unavailable or too expensive
- Self-medicating: taking multiple substances to manage physical or mental health conditions or to alleviate pain
To answer why polysubstance addiction occurs, it’s necessary to understand the common root causes of addiction in general. In many ways, trauma and substance abuse are very much intertwined. Unresolved past trauma — even trauma from adverse childhood experiences decades ago — can drive you to seek out different ways to cope with the negative feelings, flashbacks, or triggers (not to mention mental health disorders) it causes on a regular basis. Consequently, you may begin to drink alcohol or use drugs as your preferred way to self-medicate.
As you use substances, your brain releases dopamine, a pleasure chemical that signals to you that substance use is rewarding. However, drugs or alcohol only provide temporary relief, so you keep using them to replicate the good feelings they cause. Unfortunately, your brain develops a tolerance for dopamine produced by substances, so you have to use more drugs or alcohol in greater frequency to get the same high. Continuing to persist with regular substance use can lead to addiction.
Once you have a substance use disorder, you may begin to seek out additional substances for some of the reasons listed above. Over time, you may develop a polysubstance addiction as a result. And as others have done the same, mortality and overdose rates today continue to rise. The popular polysubstance combination of stimulants, benzodiazepines, and alcohol has been considered one of the key factors in the rise of opioid-related mortality in North America, for example.
The Impact of Polysubstance Use Disorder on Treatment and Recovery
When polysubstance use disorder moves into advanced stages of addiction, it creates a whole host of additional problems. For one, many people who struggle with polysubstance abuse also struggle with mental health disorders. Consequently, a polysubstance addiction only makes mental health challenges even worse. PUD can also lead to additional health challenges, such as brain damage, infections, and chronic disease. According to a study by Medical Care, veterans with higher levels of PUD, for example, were more likely to:
- Be homeless
- Have liver disease
- Struggle with schizophrenia, bipolar disorder, depression, and/or personality disorders
- Require more psychiatric inpatient care, rehabilitative treatment, and psychotropic medication
With that said, polysubstance use disorder is a treatable condition. Overcoming multiple addictions makes the treatment and recovery process more challenging, but it can be done. Each drug has unique toxicologic and treatment implications, shares the Journal of General Internal Medicine, so polysubstance addiction treatment is never one size fits all. The withdrawal process of physically removing the drugs becomes more complicated, so a medically supervised inpatient detox is often a must.
Because polysubstance use disorder is often associated with co-occurring mental health disorders, treatment becomes much more specialized. In these situations, dual diagnosis treatment is necessary, as it has the capability of addressing both conditions at the same time. This process often involves a combination of trauma-informed care, evidence-based practices, and experiential therapies in order to provide comprehensive healing.
Medication-assisted treatment may also be utilized to help control cravings and lessen any ongoing withdrawal symptoms. In the recovery stage, your polysubstance abuse history can leave you more vulnerable to relapsing in the real world. You likely will need to advance through step-down levels of treatment, such as outpatient and aftercare programming.
Overcome Polysubstance Addiction at Defining Wellness Centers
If you’re struggling with polysubstance use disorder, as well as co-occurring mental health challenges, we can help. Our team at Defining Wellness Centers in Mississippi offers comprehensive dual diagnosis treatment tailored to your unique needs and goals. We take a holistic, collaborative approach to polysubstance addiction treatment, addressing your physical, mental, psychological, and spiritual needs during the course of your care. By partnering with us, you can achieve both lasting sobriety and profound personal transformation. To get started, contact us today.
