Polysubstance abuse refers to the consumption of one or more illicit substances over a defined period or simultaneously. It was once a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, but it was eliminated from the DSM-5 criteria. Currently, substance use disorder is the proper term for anyone with a substance abuse problem, whether it is with one substance or many. Polysubstance abuse can include the combination of any substance to alter the body and/or brain. Combining alcohol with cigarettes, alcohol with benzodiazepines, or prescription pain medications with heroin are all examples of polysubstance abuse.

 Motivations behind polysubstance abuse

One common motivation for using multiple substances in excess is to enhance the effects on the brain and body. For example, many substances act on the same receptors in the brain, producing similar effects and, therefore, are combined into the same substance abuse class. Mixing alcohol with benzodiazepines (anti-anxiety medication) is common because this combination multiplies the effects on the body and brain, resulting in getting more intoxicated faster. Benzodiazepines and alcohol both work on the GABA receptors in the brain and, when both are taken together, these sedative effects are enhanced and the risk of withdrawal increases.

Another motivation for combining substances is to ameliorate the effects of one drug with another. For example, stimulants such as caffeine, cocaine and methamphetamine are used to overcome a low mood, while benzodiazepines are used to help alleviate the withdrawal effects from alcohol. Each substance can have its effect. The tendency is to use uppers when feeling down and downers when feeling up, regardless of the danger.

Who is at risk for polysubstance abuse?

Polysubstance abuse is more common among males, adolescents and those who begin using at an early age. People who abuse multiple substances are at an increased risk for mental illness.

“People with both an alcohol use disorder and a co-morbid drug use disorder are more likely to have less education and a lower income and are less likely to be involved in a stable relationship than people who have an alcohol use disorder and no co-morbid drug use disorder. In addition, co-morbidity is associated with a higher prevalence of personality, mood, and anxiety disorders and is a predictor for suicide attempts,” according to an article.

Treatment for polysubstance abuse

The treatment for polysubstance use is where the lines become blurred. There is limited evidence that shows whether treating all substance abuse simultaneously is better than treating each substance abuse individually.

“It is clear that individuals who use multiple substances are at elevated risk of developing comorbid psychiatric and other health conditions. They also have more pervasive deficits in cognitive functioning that place them at elevated risk of poorer treatment outcomes. Prevention and treatment approaches for polysubstance use are underdeveloped by comparison with treatments for abuse of single substances. Future research will tell what effects removing polysubstance dependence from DSM-5 will have on the identification and treatment of this group of substance users,” according to Medscape.

Education, raising awareness, letting go of the stigma, and treatment are the most important steps to decrease the rate of polysubstance use. Most people don’t realize that they are using two “drugs” when they combine caffeine and alcohol; hence, it is important to educate and raise awareness on this important topic.