Polysubstance Use Disorder

What is polysubstance use disorder?

Polysubstance use disorder, formerly called polysubstance abuse, is using more than one drug or substance at the same time or within a short period of time. You become dependent on these substances and follow a pattern of use that interferes with your ability to function, your health and your quality of life.

Mixing or combining substances isn’t safe. The effects it can have on your body are often unpredictable, and in many cases, life-threatening. Polysubstance use disorder is a treatable mental health condition. Help is available when you’re ready.

What is considered a polysubstance?

Any combination of drugs or substances would be considered polysubstance use. For example, drinking alcohol while taking cocaine qualifies, as you’re using more than one substance.

Are prescription medications a polysubstance?

Yes, prescription medications can be polysubstance if you take them with other substances, even if they’re prescribed to you.

It’s very important to only take medications that your healthcare provider prescribes to you.

If you take medications as part of your daily routine, it’s important to tell your provider about all of the medications and supplements you currently take. Some drugs interact with each other. Your provider will choose medications that are safe for you to take and follow up with you to make sure you don’t experience any side effects.

What are the symptoms of polysubstance use disorder?

The symptoms of polysubstance use disorder vary based on substance type and amount. When you take substances, you may feel:

• Excited.
• Intense joy (euphoria).
• Relaxed.
• Sleepy.

You may experience the following symptoms when substances wear off (withdrawal symptoms):

• Mood changes (anxiety, agitation, depression).
• Muscle aches and cramping.
• Difficulty sleeping.
• Sweating.
• Diarrhea.
• Nausea and vomiting.

Common behavioral signs and symptoms associated with polysubstance use disorder include:

• Choosing substance use over social and personal responsibilities.
• Hiding substance use from others.
• Needing to use substances to function.
• Neglecting personal care (physical appearance, hygiene, eating meals).
• Showing hostility or denial when confronted about substance use.

Sometimes, it can be hard to recognize the signs and symptoms of polysubstance use disorder. A lot of people hide these patterns of behavior or adapt their substance use into their everyday lives.

What causes polysubstance use disorder?

The exact cause of polysubstance use disorder isn’t exactly understood. But research suggests the addictive potential of substances and their effect on your brain causes the condition.

Substances activate your brain’s reward system. They send chemicals (dopamine) through your brain that make you feel good. Your brain prioritizes these “good” feelings over healthy ones until you become dependent on them.

Many factors might make you seek out more than one substance. Common reasons may include:

• Achieving the desired effect of another substance that’s unavailable.
• Balancing/counteracting the effect of another substance. (It’s important to note that substances don’t actually have this effect, though it might seem like they do.)
• Preventing withdrawal symptoms.
• Prolonging or enhancing a high.
• Reducing how much of one substance you use by substituting it with another.
• Self-medicating or managing underlying physical or mental health conditions.

What are the types of polysubstance use disorder?

There are two classifications of this condition:

• Intentional polysubstance use: You take or use another drug or substance to increase the effects of another drug or substance.
• Unintentional polysubstance use: You aren’t aware that a drug or substance that you take or use was made or mixed with another drug or substance.

What are the risk factors for polysubstance use disorder?

You may be more at risk of polysubstance use disorder if you:

• Have a substance use disorder.
• Have a biological relative with substance use disorder or polysubstance use disorder.
• Have an underlying mental health condition.
• Have access to and exposure to substances.
• Had adverse childhood experiences.

What are the complications of polysubstance use disorder?

Polysubstance use can lead to many complications, but the two most severe are overdose and, in many cases, death. An overdose happens when a harmful (toxic) amount of a substance (or multiple substances) enters your body. An overdose can cause your organs to stop working, which is life-threatening if not treated quickly.

How is polysubstance use disorder diagnosed?

A healthcare provider will diagnose a polysubstance use disorder by learning more about you during an exam. They’ll ask you questions about the symptoms you experience, your history with substances, and if you’ve ever tried not using substances and how you felt when that happened.

Your provider may perform a routine physical to learn more about your general health at the same time. They may offer a urine test or blood test to understand more about what substances are currently in your system to help with treatment.

Polysubstance use disorder in the DSM-5

The American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is a diagnostic tool that healthcare providers use for certain mental health conditions. While there are several substance use disorders listed in the DSM-5-TR, polysubstance use disorder isn’t in the most recent update.

How is polysubstance use disorder treated?

Polysubstance use disorder treatment may include:

• Detoxification.
• Therapy.
• Medications.

A healthcare provider will learn more about your goals for treatment and they’ll work with you to find a treatment plan to help you reduce or stop polysubstance use.

What is polysubstance use disorder detoxification?

Detoxification is getting rid of the harmful substances that are in your body. This is one of the most difficult parts of treating this condition. It’s a painful and often emotional process. You’ll likely feel terrible for a few days until the substances clear your system. Some medications are available to ease these symptoms.

You may prefer to detox in a healthcare facility where you have around-the-clock support. But outpatient options are available if you’d be more comfortable at home.

What is polysubstance use disorder therapy?

Therapy is a way for you to set goals for yourself and work with a mental health professional to achieve them. The focus of polysubstance use disorder therapy is to:

• Understand why you use substances.
• Learn more about yourself, your motivations and your behaviors.
• Find better ways to manage stress, conflict or triggers.

There are different types of therapy to help you manage this condition, including but not limited to the following:

• Cognitive behavioral therapy (CBT): You’ll learn more about how your thoughts affect your behaviors, set goals and work toward achieving them.
• Contingency management: You’ll set goals that are reinforced with rewards when you achieve them.
• Motivational enhancement therapy: This is an approach to inspire you to set attainable goals and take steps to reach them.
• Family therapy: Family therapy involves the people closest to you who may be able to support you in your recovery. You can learn more about each other in a safe space to work on shared goals.

What medications treat polysubstance use disorder?

A healthcare provider may recommend taking medications, especially if one of the substances you preferred was an opioid. Opioids can take a serious toll on your body, especially as you withdraw from them. Medications may ease some cravings and withdrawal symptoms.

Some U.S. Food and Drug Administration (FDA)-approved medications for opioids include:

• Buprenorphine.
• Methadone.
• Naltrexone.

These medications also come with side effects that your provider will explain to you before you begin the course. It’s important that you follow your provider’s instructions and stick to their treatment plan to prevent side effects. Let them know if you have any questions.

Medications are also available to help relieve cravings and withdrawal symptoms of alcohol (naltrexone, disulfiram, acamprosate) and nicotine (nicotine replacement, bupropion, varenicline).

How soon after treatment will I feel better?

There isn’t a set amount of recovery time that works for everyone. No one can predict how long it’ll take for you to feel well. This is a chronic condition. You’ll most likely need to manage polysubstance use disorder for the rest of your life.

Can polysubstance use disorder be prevented?

There are a lot of steps you can take to reduce your risk of polysubstance use disorder. But understand that the condition can’t entirely be prevented, as many environmental, biological and social factors influence how substances affect your body.

The best way to reduce your risk of this condition is education. Learning more about the effects of each substance on the human body can help you understand why they’re unsafe.

If you have polysubstance use disorder, consider keeping the following with you so you can stay safe:

• An overdose reversal medication like naloxone.
• Fentanyl test strips to detect the presence of fentanyl on different substances.
• The phone number of someone you trust to contact in case of an emergency.

What’s the outlook for polysubstance use disorder?

Your outlook varies. A healthcare provider can give you the most accurate information on what you can expect from your situation.

Polysubstance use disorder is a treatable condition and recovery is possible. Treatment takes time and a lot of effort. You may need to try different treatment options to find one that works best for you.

You may relapse (return to substance use after stopping for a period of time). You’ll then need to detox and start the treatment cycle over again. This may happen many times throughout your recovery.

But remember, you’re not alone in this. Your care team and loved ones will be with you every step of the way. They can help support you when you need it.

When should I see a healthcare provider?

Talk to a healthcare provider if you use substances and they’re interfering with your health and ability to function. Some examples may include being distracted by a desire to stay “high,” which gets in the way of maintaining your routine. You might miss days of work or school and have trouble keeping your grades or performance up. You may struggle to maintain relationships with friends.

A provider can help you get the care you need.

When should I contact emergency services?

If you or a loved one experiences any of the following symptoms of a substance overdose, contact emergency services immediately:

• Loss of consciousness (you can’t wake them).
• Making gurgling or snoring sounds.
• Slow or stopped breathing.
• Small, pinpoint pupils.
• Discolored lips or fingernails.