Polysubstance dependence is a term used to describe someone who regularly consumes and abuses three or more substances capable of producing symptoms of dependence and addiction over a 12 month period.
The use of multiple drugs, along with alcohol, can greatly complicate the course of addiction treatment. In addition, whether addicted or not, a person engaged in polysubstance abuse has an increased chance of experiencing a fatal overdose.
Among people who abuse drugs or alcohol, regular consumption of multiple substances is more the norm than the exception. In fact, current research indicates that people involved in polysubstance use make up the majority of those seeking treatment for their substance use problems[i].
There are a range of potential motivations for getting involved in this form of substance intake. For example, people dealing with severe symptoms of pain sometimes begin taking multiple substances in an attempt to decrease those symptoms as much as possible. In contrast, others may start consuming multiple substances in a search for a more potent or intense “high.” Other potential motivations include:
While some people may know the risks of their actions, others have no idea of the new dangers they face when they combine substances.
Alcohol is almost certainly the most common substance associated with polysubstance abuse. This makes sense, since drinking is socially acceptable despite its potential to lead to abuse and addiction problems. In the 21st century, opioid medications[ii] and drugs also frequently appear on the list of abused substances. Other identified targets of polysubstance intake include:
One of the greatest risks of polysubstance dependence is the possibility of getting addicted to more than one substance. Researchers from the Substance Abuse and Mental Health Services Administration (SAMHSA) have studied this issue in detail. Their work shows that almost one-third of all people seeking treatment for opioid use disorder (opioid abuse/addiction) also qualify for a diagnosis of cocaine abuse and addiction. In addition, nearly 19 percent of people in treatment for opioid problems are affected by diagnosable alcohol abuse/addiction. Overlapping abuse/addiction issues related to marijuana occur in roughly 16 percent of people in opioid treatment, while issues with tranquilizers affect roughly 13 percent of people in opioid treatment.
It’s worth noting that these figures exclude people with opioid problems who also have diagnosable mental health issues. The rate of multiple addiction is significantly higher when these issues enter the picture. For example, almost half of those people with overlapping opioid and mental health problems have diagnosable substance use disorder symptoms related to the use of another substance.
Current research findings indicate that people affected by polysubstance abuse experience physical and mental changes that distinguish them from people who only abuse a single substance. These changes affect the basic structures of the brain, as well as the ability to control behavior and use higher-level mental functions such as logic and decision-making. In fact, the differences between polysubstance abusers and single-substance abusers are large enough that doctors may need to develop unique approaches for dealing with the problems that affect each group.
The need for unique approaches to treatment is underscored by the impact that polysubstance abuse can have on techniques designed to help people addicted to just one substance. For example, SAMHSA researchers found that people with alcohol problems have a harder time sticking to the guidelines of opioid treatment than people without such problems. They also experience worse treatment outcomes.
People affected by benzodiazepine abuse show up for their scheduled opioid treatment sessions less often than those who don’t abuse benzodiazepines. In addition, they take longer to make progress in their treatment programs. The combined use of alcohol and cocaine can lead to especially significant problems for people in opioid recovery.
In a study published in 2014 in the Western Journal of Emergency Medicine, researchers from the University of California Irvine examined the impact that polysubstance abuse has on the risks for dying from an overdose[iii]. Specifically, these researchers looked at the combined use of three substances: alcohol, prescription opioids and benzodiazepine tranquilizers. They chose these substances because each of them significantly reduces the normal rate of activity in the central nervous system. When taken together, they have an additive effect that makes a fatal overdose more likely to occur.
The researchers found that more than a quarter of all Americans who receive emergency treatment for an alcohol-related overdose (i.e., alcohol poisoning) also have a benzodiazepine in their system. In addition, they found that over 18 percent of all people receiving treatment for alcohol poisoning have a prescription opioid in their system. Alcohol use plays a contributing role in roughly 26 percent of all fatal benzodiazepine overdoses. In addition, alcohol plays a contributing role in roughly 22 percent of all fatal opioid overdoses.
While polysubstance abuse and addiction pose substantial treatment challenges, their effects can be addressed by skilled professionals. As a rule, successful treatment is done on a case-by-case basis and considers the needs of the individual, as well as the specific substances contributing to a person’s symptoms. In many cases, the right combination of appropriate options provides the same benefits gained by people dealing with only one type of substance problem.
At Transformations Treatment Center, we specialize in the treatment of substance use disorders, including the complex issues that tend to characterize polysubstance abuse. Our team of caring counselors and therapists take the time to develop personalized care plans for each client enrolled in our treatment programs. This individualized approach allows us to meet the challenges of addiction treatment in the most effective way possible.