What Is Polysubstance Use Disorder? 5 Facts To Know

Polysubstance use disorder is a mental health condition that means regularly using two or more substances. This often follows a pattern, such as every evening or every weekend. People with this condition may develop substance dependence, which can disrupt daily life.

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It can be hard to predict how multiple substances will interact with each other, which makes polysubstance use disorder especially dangerous. Fortunately, treatment can help. Here’s what you should know about this sometimes underreported problem.

1. Polysubstance Use Disorder Isn’t Always a Separate Diagnosis

The American Psychological Associations’ manual of mental health conditions is called the Diagnostic and Statistical Manual of Mental Disorders (DSM). In DSM-5, “polysubstance use disorder” was removed as a separate diagnosis, and that approach continues in DSM-5-TR — the most recent version.

The term “polysubstance dependence” was listed in the manual’s fourth edition and is also included in the National Survey on Drug Use and Health. This annual survey gathers information about trends in substance use and treatment in the United States.

Some researchers and doctors think the term “polysubstance use” isn’t specific enough. They feel it doesn’t give enough information about which substances are involved and may get in the way of proper treatment.

There’s a push to redefine the condition based on the primary and secondary substances used. For example, someone may have opioid use disorder with secondary use of methamphetamines. This matters because talking about polysubstance use in more specific ways can help improve the quality of research and treatment available.

2. Polysubstance Use Disorder Can Develop by Accident

Because polysubstance use disorder is such a general term, it’s not the same for everyone. People develop this condition for different reasons. Sometimes, they don’t even realize it’s happening.

Unintentional polysubstance use means you didn’t realize you were taking more than one substance at the same time. This can happen with prescription or over-the-counter medications. Maybe you usually have a few beers after dinner, and then you take a prescribed sleeping medication before going to bed. The routine use of both substances can be risky and may be considered polysubstance use, especially if it starts to affect daily life.

Self-medicating — trying to treat a condition without a healthcare provider’s guidance — can also lead to polysubstance use disorder. It’s important to let your doctor know if you have certain symptoms or concerns (including withdrawal symptoms). They can help you find safe ways to manage them without mixing substances on your own.

3. Polysubstance Use Risks Are Complex

Using more than one substance raises the chances of overdosing. Polysubstance use can also make mental health issues harder to treat and harm physical health.

If someone has started treatment for substance use disorder, adding other substances may get in the way of recovery. The mix may affect the withdrawal process and make it harder to break unhealthy routines.

Using substances with overlapping or opposing effects can be especially risky. For example, alcohol is a depressant. Drinking alcohol while taking other “downers” (like opioids or antianxiety pills) can strengthen the effects. This can slow breathing and heart rate, which may be life-threatening.

Mixing stimulants with depressants is another dangerous combination. People sometimes think that uppers and downers cancel each other out, but that’s not true. The effects of multiple substances can be unpredictable, creating a false sense of security that can increase the risk of overdose death.

4. Finding the Right Treatment Can Be Hard

Many people who face polysubstance use disorder are held back by the stigma linked to the condition. Stigma affects how people feel about themselves and how others, including employers, friends, and family members, view them.

Moving past these barriers is crucial to accessing life-changing treatment. About 90 percent of people with substance use disorder don’t get treatment.

People may worry about being judged because of substance use or mental health issues. However, these conditions are actually quite common. In the U.S., 1 in 7 people have a substance use disorder, and about 1 in 5 have a mental health disorder. These two conditions often overlap.

Effective treatment for polysubstance use disorder includes a few key parts. First, treatment should be accessible, and people with the condition should have the will and support to engage in it. Second, treatment should address any underlying mental health conditions. Finally, it should focus on the individual’s specific substances and behaviors. This can look very different from one person to another.

Collaborative care is an integrated treatment approach for polysubstance use disorder. This care often starts in the primary care setting, where clinicians are usually the first healthcare providers to notice signs of polysubstance use. Collaborative care brings in behavioral healthcare managers and other specialists to help treat and monitor complex issues in polysubstance use disorder.

5. Relapses Are Possible, but So Is Recovery

Treatment for polysubstance use disorder involves several steps. Some need to happen right away, and others are ongoing. When someone begins treatment, they may go through detoxification. This process helps the body safely reduce or stop substances it has become dependent on.

Detoxification may happen in an inpatient treatment center, an outpatient setting, or at home. It’s a challenging experience that requires strong support. In some cases, medication can help ease withdrawal symptoms.

Mental health therapy is another critical part of recovery. Several forms of therapy are available. A mental health professional can help explain the reasons behind polysubstance use. They can also work with people on a plan to change behavior, modify their environment, and set healthy goals. Sometimes, this includes planning rewards for achievements or involving loved ones in counseling sessions.

Recovery isn’t easy. It takes hard work and dedication. It also depends on finding the right path forward, which can include unexpected detours.

It’s not unusual for people with substance use disorders to relapse (return to substance use during recovery). Getting back to care quickly can help people get on track. No one should feel ashamed to seek help after a setback. Keep your goals in view and keep going.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

Do you struggle with the use of multiple substances and have you tried treatment programs? Let others know in the comments below.