Unpacking Polysubstance Abuse

  1. Home
  2. /
  3. Addiction
  4. /
  5. Unpacking Polysubstance Abuse

Paper | Polysubstance Abuse | The Hills

Polysubstance abuse is a type of substance abuse that has become more widely recognized in recent years. Even though this type of drug abuse has existed as long as drugs have existed, it has become officially acknowledged by both medical professionals and rehabilitation centers because of its need for special detox and rehabilitation and the dangers that are introduced by this specific drug abuse.

By definition, polysubstance abuse, also referred to as polydrug abuse, is characterized by the regular consumption of multiple drugs at the same time. It is an especially dangerous kind of drug abuse because polysubstance addiction doesn’t happen when the body becomes dependent on the drugs – it happens when the mind becomes addicted to the high that the combination of drugs brings.

What is Polysubstance Abuse?

Polysubstance abuse is the habitual use of 2 or more different drugs simultaneously. A study published in Psychopharmacology in 2006 revealed that, more often than not, alcohol is one drug that is involved in polysubstance abuse. Additionally, the study reported that the most preferred polydrug combination of its participants was the triple-threat of cocaine, alcohol, and heroin.

Some experts consider polydrug abuse to cover cases of using 3 or more drugs regularly. Others consider using only 2 drugs often and at the same time as behavior that falls under polysubstance abuse. This does not change the definition of the drug abuse, but it does affect the medical acknowledgment of the abuse. Polysubstance abuse can include the combined use of any of the following types of drugs – illicit drugs, prescription drugs, and legal drugs like alcohol.

The most common polysubstance abuse combinations today are:

  • Cocaine and Alcohol – Because of cocaethylene, a psychoactive metabolite that is present in the body, the amount of cocaine that is in your system increases by 30% when you drink alcohol.
  • Opioids and Cocaine – These drugs have totally opposite effects on the body; opioids depress the nervous system and cocaine stimulates it. Because the effects of these drugs cancel each other out, it is incredibly easy to overdose.
  • Opioids, Alcohol, and Benzodiazepines – All three of these drugs slow down the central nervous system, so their combined use quickly inhibits very important body processes. Respiratory depression is an extremely likely result of this polydrug combination.

Dangers Introduced by Polysubstance Abuse

The most unnerving fact about polysubstance abuse is this: you will never know the true dangers of polydrug abuse because there is an overabundance of drug combinations and not nearly enough known about all the possible outcomes of their interactions. Preventing the formation of polysubstance abuse is the only true way to avoid the dangers that it presents – both known and unknown.

Some dangers that are associated with polysubstance abuse are:

  • Increased number of side effects/severity of side effects – Every drug, whether legal or illegal, can cause side effects. When you use multiple substances together, you expose yourself to multiple lists of potential side effects, increasing your chances of experiencing more intense side effects or several separate side effects. Some drugs also interact with each other and cause adverse effects, which are usually more random and much worse than regular side effects.
  • Acute health problems – Many drug interactions cause your metabolism to slow down. This increases the amount of the substances you are using in your body. As a result, your body’s toxicity level rises, and the formation of altered, unhealthy metabolites can happen. This increases your chances of developing sicknesses and diseases. Chronic diseases, like hepatitis C, are often found in polydrug addicts.
  • Overdose – Using multiple drugs at the same time that can hide the effects of the others can result in overdose because you continue ingesting the drugs after you’ve consumed your body’s limit since you cannot feel their effects. Using drugs that give the same effects is equally as dangerous because they will work together in the same way within your body, essentially increasing your chances of overdose by halving the amount of each drug you need to consume.
  • Medically complicated treatment – The treatment for polysubstance abuse is much more difficult to determine and to personalize because of the different symptoms, withdrawals, and effects of the drugs you are using. Helping keep you comfortable and safe during your detox is also complicated by polydrug use.

How Does Polysubstance Abuse Form?

Some people fall victim to polysubstance abuse mistakenly while others actively seek out the high brought on by multiple drugs. Those with a history of drug abuse, especially polydrug abuse, in their family are at an increased risk of developing it. Social and environmental factors can influence for formation of this drug abuse because of peer pressure or availability of multiple drugs while you are already high on one drug. Mental health issues are another common cause of polysubstance abuse.

More specific ways that polysubstance abuse can develop are:

  • Alcoholics are at a higher risk of developing polydrug abuse
  • Drinking alcohol while taking anxiety, depression, or pain medications
  • Being active in the rave and club drug scene
  • Having ADHD or other impulsive behavior disorders

There are many reasons that people fall victim to polysubstance abuse. This is why it is extremely important to know the alcohol interactions for all of the prescription medication you take. All federally controlled prescriptions – opioids and benzodiazepines – should not be mixed with alcohol. In fact, alcohol shouldn’t be consumed with over the counter cold medications, either.

Since polysubstance abuse has become officially recognized, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV) has added ways to diagnose it. The manual explains that, for polysubstance abuse to be officially diagnosed, at least three of the specified symptoms must be present for three or more substances over a 12-month time period.

The polydrug abuse symptoms specified by the DSM-IV are:

  • Tolerance – You need more of the substance to get the same high. Tolerance will continue to build with regular use, and you will need more and more of the substance.
  • Withdrawal – You experience withdrawal symptoms while still actively using the drug because you need more of the drug. You take the drug in order to prevent feeling withdrawal symptoms.
  • Loss of Control – You regularly use more drugs for increasingly longer periods of time.
  • Inability to Stop – You cannot cut down or stop use of the substance no matter how many times you have tried.
  • Time – You spend most of your time getting, using, and recovering from drugs.
  • Interference with Activities – You give up or decrease the time you used to spend doing things you enjoy in exchange for doing drugs.
  • Harm to Self – You are aware of the health and mental issues you are dealing with because of your drug use, and you continue to do the drugs.

Treatment for Polysubstance Abuse – How Different is It?

The treatment of polysubstance abuse includes the same three steps as the treatment for a single drug abuse – detox, rehabilitation, and maintenance. However, the treatment differs from single drug abuse treatment because it requires careful monitoring and balancing of multiple withdrawal symptoms, specialized rehabilitation in order to ensure the body and mind are free of all drug dependencies, and more aggressive maintenance once the recovering polydrug abuser is living a normal life again.

To understand how polysubstance abuse detox can be difficult, consider the following scenarios:

  1. You enter rehab because you are addicted to Benzodiazepine Medication and alcohol. Your withdrawals take a turn for the worst during your detox when you begin have panic attacks because you cannot take the pain that your body is in. Normally, in this situation, a medical professional would use Benzodiazepine Medication or another medicine for anxiety to calm you down. Can she do this if you are already addicted to the drug and are supposed to be detoxing from it?
  2. You are addicted to opioids, alcohol, and heroin. Every single one of these drugs are depressants. The regular use of them has caused your body’s functions to regularly perform much more slowly than normal. The first issue with this drug combination is that, during your detox, your body will be shocked because of the regular and high dose of depressants it is used to. The second issue is that Opioid Maintenance Medication is often needed to treat heroin abuse, and Opioid Maintenance Medication is an opioid – how do you treat the heroin addiction without feeding the opioid addiction? How do you choose? Which is treated first?
  3. You are addicted to cocaine and alcohol, and you have been diagnosed with anxiety. First, your withdrawal will be incredibly confusing to your body because these drugs have opposite effects; your body will be getting rid of a stimulant and a depressant at the same time. Side effects can get extreme, and you begin to experience crippling anxiety out of fear of the detox hurting you more than helping you. You’ve never taken medicine for anxiety before, and the medical professional wants to give you a benzodiazepine for the anxiety. Do you take it to get through your detox? Are you taking the risk of potential addiction to a third substance by taking it?

Now that you understand how polysubstance abuse can cause issues with detox, you may be able to better understand how the rehabilitation and maintenance steps will also require more specialized and targeted methods.

Bathroom | Polysubstance Abuse | The Hills


When you are detoxing from polysubstance abuse, medical detox is required. This is the most dangerous part of the recovery process for a polydrug abuser, and it can be a rather terrible and even fearful experience for the abuser. Medical detox provides an inpatient detox that includes care and supervision by medical professionals 24/7. This is absolutely vital for polydrug abuse cases because their detox can be wildly different from a single drug abuse detox.

During medical detox, you can be given medication to lessen the severity of your withdrawal symptoms. In cases of polysubstance abuse, this becomes complicated if the medicine that is needed is, in fact, an addictive drug itself. In these cases, the decision is determined by each individual situation. Commonly, opioids and heroin withdrawal symptoms can be managed with Opioid Maintenance Medication or other opioid replacement medication. Benzodiazepine detox can be handled with tapering that is supervised by a medical professional.

The combination of drugs within your polysubstance abuse and the severity of each individual addiction will determine which withdrawal the doctor chooses to treat with medication – if they choose to do so. Another factor that determines the medicine you are given during detox is if you suffer from a co-occurring mental illness with your polysubstance abuse. This mental illness adds another disorder to the mix to monitor and balance with the drug withdrawals.


Rehabilitation centers come in many types and program lengths. However, the most recommended rehabilitation treatment for a polysubstance abuser is a long-term inpatient rehab stay. During this kind of rehabilitation, the recovering patient lives in their chosen rehab facility for 60 to 90 days, typically. Within this time, the patient attends both individual and group counseling, lives in a completely sober environment, and has medical help on call if needed.

For a polysubstance abuser, the rehabilitation process is more difficult because they are undergoing rehab for multiple addictions, and many times the combination of drugs they were abusing taken have different courses of action when it comes to becoming sober. The patient will attend both individual and group therapy, and they may attend more than one kind of therapy because of the polydrug label. Most often, cognitive behavioral therapy is used because it focuses on the behavioral and thought processes of substance abuse, which fits best with the type of addiction polysubstance abuse is.

Furthermore, if any co-occurring mental disorders are present, they must be added and figured into the treatment plan. Making sure the patient’s mind stays healthy throughout the recovery process is paramount to the recovery’s success.


The last and final step of the recovery process is maintaining your sobriety. If you do not feel you are ready to stay sober on your own, you can first become a resident of home that is designed to help ease you into living independently again while continuing to provide you with a sober living environment.

If you are confident enough to re-assume your daily life, be sure to find a local support group as soon as possible – within days of finishing treatment at a facility such as The Hills, preferably. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are two very well-known support groups with meetings that are available almost anywhere. As a former polysubstance abuser, you may benefit from attending regular meetings for both AA and NA.

In Conclusion…

Polysubstance abuse is a very dangerous type of addiction with a rather difficult recovery process. It is important to prevent the formation of this abuse for the best chance of staying away from the dangers of it. If you or anyone you know suffers from polydrug abuse, it is imperative to seek out treatment sooner rather than later. The faster you address your addiction, the less severe it has a chance to become.

Are you struggling to break free from polysubstance abuse? You have options and The Hills can help. If you’re interested in learning more about how our treatment center can help you move forward on the road to recovery, reach out today!

Related posts