What Is Polysubstance Abuse and Why Is It So Dangerous?

Substance abuse of any kind is dangerous, but polysubstance abuse, meaning abusing more than one substance at a time, is particularly dangerous. It is also more complex to treat a polysubstance use disorder. If you abuse multiple substances or have a loved one who you suspect of polysubstance abuse, it’s important to understand the dangers and how it can be treated successfully.

What Is Polysubstance Abuse?

Polysubstance abuse involves using multiple substances either at the same time, or in close succession. Often people do this either to counteract the effects of one substance with another, or to achieve a more intense high by combining the substances. This can lead to addiction to both substances, which complicates treatment because the addiction to each substance must be treated separately.

Dangers of Polysubstance Abuse

Several significant dangers are associated with polysubstance abuse, including:

• Overdose: Overdose risk can be significantly increased when using certain substances together, particularly multiple depressants. Additionally, certain substances can mask the overdose symptoms of another substance. For example, a stimulant like cocaine can mask the overdose symptoms of opioids.
• Respiratory failure: Combining depressants can slow breathing to dangerous levels, which can be fatal.
• Heart issues: Mixing stimulants and depressants can strain the heart, leading to heart failure.
• Interaction complications: The interaction between certain substances can cause reactions that can damage organs.
• Intense withdrawal symptoms: When substance use stops, withdrawal can be intense and require medical supervision.
• Mental health risks: Severe psychiatric issues can occur and may increase suicide risks.

Common Substance Combinations and Dangers

Several combinations of substances are common and have specific dangers. These include:

• Benzodiazepines (i.e. Valium or Xanax) and Alcohol: Both depress the central nervous system, which can lead to respiratory failure.
• Opioids and Cocaine (known as speedballing): Together, these substances may mask the signs of overdose and also cause tremendous strain on the heart.
• Stimulants and Alcohol: Stimulants can reduce feelings of intoxication from alcohol, leading to excessive drinking that can cause alcohol poisoning.
• MDMA (ecstasy or molly) and Antidepressants: This combination can lead to serotonin syndrome, meaning overstimulation of serotonin receptors, which can be fatal.
• Hallucinogens (i.e. LSD) and Marijuana: This can lead to unexpected effects that may trigger psychosis or severe anxiety.
• Opioids and Muscle Relaxers: Can cause extreme sedation leading to unconsciousness.
• Heroin and Benzodiazepines: These can cause intense depression of the central nervous system, leading to brain damage, coma, or death.

Signs of Polysubstance Abuse

If you have a loved one who you suspect is using multiple substances, you may notice certain signs that include:

• Extreme and unpredictable mood swings
• Health issues that can’t be explained
• Confusion and memory problems
• Isolation
• Secretive behavior
• Failing to meet responsibilities
• Financial issues

Treating Polysubstance Use Disorder

The first step in treating polysubstance use disorder is detoxification. This process needs to be carefully monitored by medical professionals in an inpatient setting because withdrawal symptoms may be unpredictable and dangerous because multiple substances are involved. Sometimes medications may be used to ease the withdrawal symptoms and reduce the dangers.

Detoxification is followed by intensive therapy that addresses the use of multiple substances. Several types of therapy are typically used, some of which will be in a group setting. Types of therapy used may include:

• Cognitive Behavioral Therapy (CBT): In CBT, patients learn how to recognize their negative or dangerous thoughts and to alter those thoughts based on educated reasoning. For example, if someone thinks “I can keep using in moderation”, they will learn to change that thought into something like “Using drugs is dangerous. If I continue to use I may not survive.” In CBT, patients also learn healthy coping mechanisms that can replace the use of substances to handle challenges.
• Motivational Interviewing: In motivational interviewing, the therapist encourages the patient to find their own motivation to engage in treatment, whether their motivators are their family, their career, or some other aspect of their life.
• Relapse Prevention Therapy: In relapse prevention therapy, patients learn to identify their triggers and practice coping mechanisms to handle those triggers in a healthy way.

Group therapy as a part of treatment is also critical. Participants learn to be mutually supportive as they share feelings, experiences, challenges, and strategies. Often, participants in these groups form friendships that last beyond treatment.

All of these therapies may be in an inpatient or outpatient setting, although since polysubstance abuse treatment is more complex, inpatient treatment followed by outpatient treatment is recommended. This comprehensive treatment is usually structured into three phases.

• Inpatient Treatment: Inpatient treatment lasts for 30 to 90 days and includes a period of medically supervised detox followed by intensive daily therapy, both in group and one-on-one settings. If the patient has any co-occurring disorders, such as anxiety or depression, those are treated as well, often with medication.
• Partial Hospitalization Program (PHP): A partial hospitalization program allows the patient to live at home while attending treatment for four to six hours per day, usually five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually. In some cases, a PHP can be an alternative to inpatient treatment.
• Intensive Outpatient Program (IOP): An intensive outpatient program consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held in the evenings so that patients can still go to work or attend school. Treatment, again, involves individual and group therapy.

After treatment, many people continue to find support through programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Recovery from a polysubstance use disorder is a lifelong process, requiring continuous support, which these programs can provide. Support from other sources, such as family, friends, and peers, is also critical.

In Closing

Polysubstance abuse is extremely dangerous. If you are abusing multiple substances, you are essentially playing Russian Roulette. Bridges of Hope is here to help you get back on a healthier, more fulfilling and productive path with comprehensive treatment programs. We are committed to providing personalized, compassionate care. Give us a call to learn more.