Polysubstance abuse: definition, effects, dangers, and treatment

Polysubstance abuse refers to the concurrent misuse or abuse of multiple substances, such as alcohol, prescription medications, illicit drugs, or other psychoactive substances. Individuals engaged in polysubstance abuse use these substances in combination to enhance or alter the effects of each other.

The common effects of polysubstance abuse are diverse and intricate, as the interactions between different substances lead to a wide range of physiological and psychological outcomes, such as heightened central nervous system depression, sedation, impaired coordination, and an increased risk of respiratory suppression, which often results in fatalities.

The dangers associated with polysubstance abuse are dependence and addiction, injury and accidents, physical and mental problems, sleep issues, mental health challenges, and overdose.

The available treatments for polysubstance abuse include detoxification (detox), medication-assisted treatment (MAT), behavioral therapies, residential or inpatient treatment, outpatient treatment

What is Polysubstance abuse?

Polysubstance abuse, or polysubstance use disorder (PUD), involves the intentional or unintentional consumption of two or more substances either simultaneously or in close succession, causing physical and mental problems.

The definition of polydrug use has changed over time, leading to variations in self-report assessment methods. The World Health Organization (WHO) defined polydrug use as the chaotic consumption of more than one type of drug in the “Glossary of Some Key Terms”, presented during the 1986 March Conference of Ministers of Health on Narcotic and Psychotropic Drug Misuse.

Currently, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) broadens this definition to include the use of both illegal drugs and legal substances, such as alcohol and medications, either simultaneously or sequentially, as highlighted in the October 2021 update of “Polydrug use: health and social responses”.

While the combination of substances is typically done to enhance one’s experience, it also has the purpose of reducing overall substance consumption or self-medicating an existing health condition, as highlighted in the 2022 study by Boileau-Falardeau M. et al., titled “Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence”.

Intentional polysubstance use occurs when individuals take a drug with the purpose of diminishing or intensifying the effects of another substance or seek to experience the combined effects of the substances, as defined in the Centers for Disease Control and Prevention article “Polysubstance Use Facts,” last revised in February 2022.

Unintentional polysubstance use occurs when individuals consume drugs combined with other substances without realizing the potential negative interactions between them. Such a combination of substances has unpredictable and potentially dangerous consequences on an individual’s physical and mental health.

Given the dangerous outcomes caused by polysubstance abuse, understanding the motivations, risks, consequences, and prevalence of such abuse is crucial for developing effective prevention and intervention strategies in the realm of public health.

How common is Polysubstance abuse?

Polysubstance abuse is extremely common, with about 0.5% of 43,093 participants in the National Epidemiological Survey on Alcohol and Related Conditions, meeting the criteria for polysubstance use disorder, as stated by Agrawal et al. in a 2007 article, titled “A latent class analysis of illicit drug abuse/dependence: results from the National Epidemiological Survey on Alcohol and Related Conditions”.

The study revealed the diversity in patterns of polysubstance abuse and dependence. For instance, major depressive disorder and nicotine dependence were most strongly associated with polysubstance abuse or dependence, whereas anxiety disorders were more associated with prescription drug abuse.

The Substance Abuse and Mental Health Services Administration (SAMHSA), in a 2014 December report titled “Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes,” revealed that nearly a million emergency department visits associated with benzodiazepines (BZD) or a combination of BZD with alcohol or opioid pain relievers were reported between 2005 and 2011.

The report highlighted a 24-55% rise in the anticipated risk of severe outcomes when opioid pain relievers or alcohol were combined, compared to using BZD alone.

A 2013 cohort study “Prevalence and patterns of polysubstance use in a nationally representative sample of 10th graders in the United States”, conducted by Conway KP. et al., revealed that 7.6% of the total 2,524 10-graders comprised the predominant polysubstance user group, demonstrating high probabilities of using various substances, including marijuana, alcohol, binge drinking, cigarettes, medication for recreational use, and other illicit drugs. Medication misuse, associated with severe consequences like addiction and unintentional overdose, was identified as a significant aspect.

What are the causes of Polysubstance abuse?

Polysubstance abuse is influenced by various factors encompassing biological, psychological, and sociocultural factors. The causes of polysubstance abuse are listed below. 

• Genetic predisposition: Genetic factors contribute to an individual’s susceptibility to drug abuse, including polysubstance abuse. A 2023 March article on “Multivariate genome-wide association meta-analysis of over 1 million subjects identifies loci underlying multiple substance use disorders,” in the Nature Mental Health journal, pinpointed that a shared genetic pattern has the potential to elevate an individual’s susceptibility to developing substance use disorders, including polysubstance abuse.
• Individual personality characteristics: According to BMC Psychology journal’s 2021 article on “Temperament and character traits in substance use disorder in Iran: a case control study,“ personality traits, such as impulsivity, sensation-seeking, risk-taking propensity, and low self-esteem, contribute to polysubstance abuse. Individuals with such characteristics experiment with various substances without considering the potential consequences.
• Self-medication: A 2020 study from the International Journal of Drug Policy, titled “Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the U.S. Northeast,” revealed that among the participants of the research, one of many reasons for polysubstance use was coping with adverse effects of specific substances and self-treating inadequately addressed physical and mental health issues, such as anxiety, chronic pain, and depression.
• Concurrent mental health disorders: According to the MedlinePlus 2022 update of “Substance use disorder,” a significant number of individuals who develop substance use issues, including polysubstance abuse, often experience conditions like post-traumatic stress disorder, attention deficit disorder, depression, and other mental health issues.
• Peer pressure: In a 2013 study “Family process and peer influences on substance use by adolescents,” published in the International Journal of Environmental Research and Public Health, it was found that an adolescent’s engagement in risk activities over one year is significantly predicted by their friends’ smoking, alcohol consumption, and drug use. Social circles and peer pressure play a significant role, as individuals engage in polysubstance abuse to conform to gain acceptance within a particular group.
• Cultural norms: Cultural values play a crucial role in shaping individuals’ perspectives on substance use and impact their likelihood of experimenting with drugs, as stated by Soto C. et al., in a 2011 study, titled “Cultural values associated with substance use among Hispanic adolescents in southern California”.
• Accessibility and availability: Easy access to multiple substances and their availability in the community contribute to polysubstance abuse patterns.

What are the symptoms of Polysubstance abuse?

The symptoms of polysubstance abuse are listed below.

• Taking the substance in larger amounts and for a longer duration than intended: This symptom suggests a lack of adherence to prescribed guidelines, indicating a potential escalation in substance use beyond recommended levels—a key characteristic of polydrug abuse.
• Intense cravings or urge to use the substance: Strong desire signifies psychological dependence, a common feature of polydrug abuse where individuals feel compelled to engage in substance use despite negative consequences.
• Mood swings: The combination of various drugs leads to fluctuations in mood, ranging from euphoria to irritability and depression, as the substances interfere with the normal balance of neurotransmitters associated with mood regulation.
• Failed attempts to cut down or control substance use: Difficulty in reducing or controlling substance use highlights the addictive nature of polydrug abuse, where attempts to curtail usage often prove ineffective.
• Preoccupation with obtaining substances:  Individuals spending much time acquiring, using, or recovering from the substance’s effects engage in relentless efforts to obtain substance, even at the expense of personal, social, or occupational obligations.
• Facing challenges in fulfilling responsibilities at work, school, or home due to substance use: Impaired functioning in various life domains points to the negative impact of polydrug abuse on an individual’s ability to meet responsibilities and obligations.
• Continuing substance use despite causing problems in relationships: The persistence of substance use despite relational issues highlights the compulsive nature of polydrug abuse, where personal connections suffer due to ongoing substance use.
• Withdrawal from social, occupational, or recreational activities: Giving up on certain aspects of life suggests a significant impact of polydrug abuse, with individuals sacrificing social, occupational, and recreational pursuits due to substance use.
• Repeatedly using substances even when it jeopardizes personal safety: Engaging in substance use despite risking personal safety signifies reckless behavior associated with polydrug abuse, where individuals prioritize substances over their well-being.
• Ignoring health issues: Individuals engaged in concurrent use of multiple substances prioritize obtaining and using drugs over addressing their physical well-being. Neglecting or avoiding medical concerns is often a manifestation of the compulsive drug-seeking behavior characteristic of polysubstance abuse.
• Tolerance development: Tolerance development is a physiological adaptation seen in polydrug abuse, where individuals need higher doses over time to achieve the desired effects, contributing to escalating substance use.
• Withdrawal symptoms upon drug or substance discontinuation: As per the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2016 report “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” chapter 2, when the substance is unavailable, individuals go through withdrawal, encountering negative emotions such as stress, anxiety, or depression, along with physical discomfort. The occurrence of withdrawal symptoms, relieved by further substance use, signifies physical dependence in polydrug abuse, creating a cycle where continued use is driven by the need to avoid these adverse effects.

What are the risk factors for Polysubstance abuse?

Polysubstance abuse involves a diverse array of social, psychological, and biological risk factors that can serve as triggers. The risk factors for polysubstance abuse are listed below.

• Genetic factors: According to an article in the 2016 issue of the Child and Adolescent Psychiatric Clinics of North America titled, “Opioid Use Disorders,” genetic factors contribute to 40% to 60% of susceptibility to any substance use disorder. The chances of developing a substance use disorder increase if the individual has a first-degree relative, like a biological sibling or parent, with the condition.
• History of childhood abuse: A cross-sectional study, highlighted in the 2022 issue of Cureus journal, titled “Family, Individual, and Other Risk Factors Contributing to Risk of Substance Abuse in Young Adults: A Narrative Review,” examined mothers with children aged six or younger. Out of the 733 participants, 36% acknowledged a background of substance abuse, with a higher prevalence noted among those with a history of childhood abuse.
• Family relationships: The 2014 study by Jadidi N. and Nakhaee N., titled “Etiology of drug abuse: a narrative analysis,” involved 33 interviews exclusively with males aged 18–40. Participants highlighted parental discipline styles, emotional emptiness, and lack of supervision at home as influential factors for developing substance abuse. The absence of a warm environment, disrupted family structures, and family relations were also identified as risk factors.
• Co-occurring mental disorders: The 2004 study by Kessler RC., titled “The epidemiology of dual diagnosis,” revealed significant connections between mental disorders and alcohol-drug use disorders. Mental disorders were linked to the initiation, problems, dependence, and long-term persistence of alcohol and drug use of individuals. Onset patterns indicated that the majority experienced mental disorders before substance disorders.
• Social and environmental factors: Environmental elements like poverty, neighborhood characteristics, a scarcity of recreational facilities, and a normalized attitude towards drug abuse contribute to increased substance use, as mentioned in the 2014 study by Jadidi N. and Nakhaee N., titled “Etiology of drug abuse: a narrative analysis”. The participants of the study reported socioeconomic challenges, such as easy access to drugs, and societal pressures, as contributing factors for shaping substance abuse behaviors.
• Previous substance abuse: Individuals with a history of substance abuse are at a higher risk of developing polysubstance abuse patterns, driven by the development of tolerance and dependence. Individuals who have engaged in substance abuse find that the effects of a single substance diminish over time, prompting an exploration of various substances to intensify or prolong desired effects. This cycle leads to escalating substance use as individuals pursue heightened experiences.
• High-stress professions: Between the ages of 26 and 64, adults commonly encounter significant life challenges and struggle to balance work and family responsibilities. This dynamic increases the likelihood of substance abuse, particularly for individuals in high-stress professions like lawyers, healthcare workers, or military personnel, as emphasized in the article, titled “Family, Individual, and Other Risk Factors Contributing to Risk of Substance Abuse in Young Adults: A Narrative Review” published in 2022 issue of the journal Cureus 
• Personality traits: The 2002 issue of The Pediatric Clinics of North America, titled “Prevention and risk of adolescent substance abuse The role of adolescents, families, and communities,” highlighted individual traits such as gender and age of starting drug abuse as a factor contributing to the risk of drug abuse. Research indicates that males exhibit higher rates of substance use compared to females. The highest risk for initiating alcohol and marijuana use occurs between ages 16 and 18, with 18 being the most vulnerable period for starting other illicit substances. Additionally, starting substance use before age 15 significantly heightens the risk of future substance use and abuse, but the overall risk decreases by age 20.

What is a drug cocktail?

A drug cocktail is the combination of two or more drugs or substances, either purposefully mixed for various effects, or unintentionally consumed simultaneously or within a short timeframe.

Drug cocktails often involve legal or illicit drugs, prescription medications, or over-the-counter (OTC) substances. Drug cocktails have varied effects on the body, with potential interactions and consequences that differ from the effects of each substance taken individually.

According to the United Nations Office on Drugs and Crime 2009 report on “Deadly Drug Cocktail,” when individuals combine different drugs or consume substances that are adulterated or mixed with other drugs serious adverse effects arise.It is worth noting that drug cocktails are not exclusively designed to get high. Medical professionals create them for treating conditions like cancer and infections, addressing issues of drug resistance, as cocktails prove to be more effective than certain drugs alone, as highlighted by Zimmer A. et al., in the 2017 study, titled “Prediction of drug cocktail effects when the number of measurements is limited”.

What are uppers and downers?

Uppers (stimulants) and downers (depressants) refer to two broad categories of psychoactive substances with contrasting effects on the central nervous system (CNS).

The Oxford Dictionary defines stimulants as substances that increase the activity of the central nervous system and the body, leading to increased alertness, energy, and elevated mood. 

Nicotine, caffeine, amphetamines, and cocaine are all classified as stimulants. Among them, caffeine stands out as the most widely consumed stimulant globally, as outlined in the 2023 July update of StatPearls on “Stimulants”. Legal stimulants are commonly used to enhance performance and address specific symptoms depending on the drug. On the other hand, illegal and prescription stimulants serve medical purposes but are frequently used recreationally.

Downers or depressants induce sleep, prevent seizures, and relieve anxiety and muscle spasms, as outlined in the Department of Justice/Drug Enforcement Administration Drug Sheet on “Depressants”, published in April 2020. Depressants often hinder cognitive functioning and judgment, induce memory loss, and result in a state of confusion.

Unlike stimulants, depressants are typically controlled substances, categorized from Schedule I to Schedule IV under the Controlled Substances Act, based on their risk for abuse and accepted medical use.

Common depressants include alcohol, benzodiazepines (such as Xanax and Valium), barbiturates, and certain prescription medications like sleep aids and muscle relaxants.

People misuse depressants to experience euphoria, and they are sometimes combined with other drugs to enhance their effects or manage side effects. The combination of uppers and downers is particularly dangerous, as it leads to unpredictable interactions, increased risk of overdose, and adverse health consequences.

What are the common drug combinations and their effects?

The common drug combinations and their effects are listed below.

• Mixing stimulants
• Mixing depressants
• Mixing stimulants and depressants
• Mixing alcohol with drugs

1. Mixing stimulants

Mixing stimulants is the concurrent use of substances that have stimulating effects on the central nervous system. Mixing stimulants results in unpredictable and potentially harmful interactions, amplifying the effects of each substance and increasing the risk of adverse reactions, such as liver damage, brain injury, heart attack, and stroke, as stated in the issue of the Centers for Disease Control and Prevention, titled “Polysubstance Use Facts,” last revised in February 2022.

Cocaine is a strong habit-forming stimulant that can be ingested through snorting, smoking, or injection, as described in an article by the National Institute on Drug Abuse (NIDA) titled “Cocaine Research Report” published in May 2016. It is often mixed with other drugs or stimulants and functions as a CNS psychostimulant by directly influencing dopamine pathways, which accounts for its well-known reinforcing effects and addictive nature.

The prolonged use of cocaine disrupts the normal functioning of the brain’s reward circuit, leading to dependence and ultimately to cocaine addiction.

2. Mixing depressants

Mixing depressants refers to the concurrent use of substances that slow down brain activity by acting on an individual’s brain and respiratory system, posing serious risks to one’s health. This combination increases the vulnerability to adverse outcomes, including potential damage to vital organs and the brain, as stated in the article from the Centers for Disease Control and Prevention, titled “Polysubstance Use Facts,” last revised in February 2022.

As per the National Institute on Drug Abuse “Heroin Research Report” from 2018 June, heroin is an illicit opioid depressant derived from morphine. People mostly use it for the intense pleasurable and euphoric effects known as the “rush,” but this drug carries health dangers, including the potential for dependence, which later develops into heroin addiction with the risks of fatal outcomes.

According to the National Institute on Drug Abuse November 2022 issue on “Benzodiazepines and Opioids,” combining opioids with other CNS depressants, such as benzodiazepines, alcohol, or xylazine, heightens the risk of a potentially fatal overdose since both drugs induce sedation, respiratory suppression (a major factor in overdose fatalities), and cognitive function impairment.

Mixing heroin with other drugs or depressants like alcohol, BZDs, cocaine, and other opioids increases the risk of serious health problems and overdose. A heroin overdose often results in slowed and shallow breathing, leading to coma and, in severe instances, death, as stated by the Centers for Disease Control and Prevention publication on “Heroin,” last revised in August 2023.

3. Mixing stimulants and depressants

Mixing stimulants and depressants involves the concurrent use of substances that have stimulating and depressing effects on CNS activity. This combination results in unpredictable interactions and amplifies the effects of each substance, increasing the risk of adverse reactions.

The simultaneous use of stimulants and depressants leads to harmful consequences. As per the Australian National Drug and Alcohol Research Centre 2014 report on “Polydrug Use; What you need to know about mixing drugs,” mixing methamphetamine (stimulant) and alcohol  (depressant) places additional stress on the heart, especially for individuals with pre-existing heart issues, which in certain cases lead to heart attack or stroke. Combining cocaine and alcohol results in the formation of cocaethylene, a toxic substance associated with potentially fatal consequences.

MDMA is a strong CNS stimulant, while cannabis has a relaxing effect. They produce contrasting effects when used together, and users experience enhanced sensory perception, altered mood, and increased sociability. However, the mix poses a potential risk for adverse effects on memory and cognitive function, as outlined in the 2007 study “Cannabis and Ecstasy/MDMA (3,4-methylenedioxymethamphetamine): an analysis of their neuropsychobiological interactions in recreational users,” published in the Journal of Neural Transmission.

4. Mixing alcohol with drugs

Mixing alcohol with drugs refers to the concurrent use of alcohol alongside other substances, including prescription medications, over-the-counter drugs, or illicit substances. This combination often results in unpredictable interactions, altering the effects of both alcohol and the other substance.

The Food and Drug Administration (FDA) demanded a Boxed Warning, the highest safety alert,  in the product information for all benzodiazepines, as combining BZDs with other sedatives, opiates, or alcohol heightens the risk of severe side effects, as highlighted in the October 2020 update of “FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class”. When alcohol is combined with BZDs, the CNS experiences heightened depression, leading to sedation, impaired coordination, and an increased risk of respiratory suppression, ultimately elevating the likelihood of overdose.

Combining alcohol with specific medications results in symptoms such as fainting, nausea, vomiting, drowsiness, headaches, or loss of coordination. Moreover, this combination increases the risk of internal bleeding, heart issues, and breathing difficulties, as highlighted in the  National Institute on Alcohol Abuse and Alcoholism’s report on “Harmful Interactions mixing alcohol with medicines,” last revised in 2014.

Beyond these health issues, alcohol’s interaction with medication potentially reduces the effectiveness of the medication, making it not only ineffective but also toxic to the body.

What are the dangers of Polysubstance abuse?

Polysubstance abuse poses certain dangers and risks to individuals’ health and well-being. The dangers of polysubstance abuse are listed below.

• Dependence and addiction: Polydrug abuse significantly increases the risk of dependence and addiction, as the combined use of multiple substances can lead to heightened tolerance and craving. The intricate interplay of various drugs can intensify the addictive potential, making it challenging for individuals to break free from substance dependence.
• Injury and accidents: Polysubstance abuse elevates the likelihood of injuries and accidents due to impaired coordination, cognitive function, and judgment. According to the National Institute on Drug Abuse 2019 December issue on “Drugged Driving DrugFacts,” alcohol, prescription drugs, tetrahydrocannabinol (THC) and illicit substances cause extreme drowsiness and dizziness and impair driving by slowing coordination, judgment, and reaction times. The combination of two or more substances, including alcohol, intensifies these drugs’ impairing effects, doubling the risk of having car accidents.
• Physical and mental problems: Physical and mental effects of drug abuse range from cardiovascular complications to psychological disorders. According to the Australian National Drug and Alcohol Research Centre 2014 report on “Polydrug Use; What you need to know about mixing drugs,” the practice of mixing substances like stimulants, depressants, alcohol, and illegal drugs, leads to unpredictable and potentially dangerous effects. Those risks include cardiovascular problems, substance-induced psychosis, fatal overdose, accidents, and permanent brain damage. Specific combinations, like smoking cannabis with tobacco, increase exposure to harmful chemicals, while alcohol and ecstasy together lead to dehydration and overheating, risking serious consequences such as kidney failure.
• Sleep issues: Polysubstance abuse disrupts normal sleep patterns, leading to insomnia or other sleep disorders. Different substances’ combined impact on the CNS interferes with the natural sleep-wake cycle, contributing to chronic sleep disturbances that further exacerbate overall health problems.
• Mental health challenges: Polysubstance abuse complicates mental health challenges, creating a cyclical relationship between substance use and psychological disorders. Individuals often struggle with exacerbated symptoms of anxiety, depression, or other mental health conditions, and the presence of these issues, in turn, drives further substance abuse as a coping mechanism.
• Overdose: The risk of overdose significantly escalates with polysubstance abuse, as the combined effects of multiple drugs overwhelm the body’s physiological systems. The intricate pharmacological interactions increase the chances of reaching toxic levels, potentially leading to a life-threatening overdose that requires immediate medical intervention.

What is Polysubstance overdose?

Polysubstance overdose refers to the ingestion or exposure to multiple substances or drugs in amounts that exceed the body’s capacity to metabolize and process them safely. The combination of different substances leads to unpredictable interactions, amplifying the toxicity and risks associated with each substance.

Polysubstance overdose involves a diverse range of drugs, including prescription medications, illicit substances, or a combination of both. The severity of the drug overdose depends on factors such as the types and quantities of substances involved, individual tolerance, and overall health.

The findings from the 2013 July study by Gudin JA., titled “Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use,” reported that polysubstance overdose fatalities were most commonly attributed to the combined use of opioids and BZDs. Certain studies, highlighted in this study, suggested that BZDs contribute to up to 80% of unintentional overdose deaths involving opioids, primarily due to respiratory depression.

As per the data from O’Donnell J. et al.’s 2020 study “Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019,” there was a rise in drug overdose deaths in 2019, with a continued uptick in fatalities linked to opioids and illicitly manufactured fentanyl (IMFs), often observed in conjunction with other opioids. Specifically, out of 16,236 drug overdose fatalities in 24 states and the District of Columbia, around 80 percent of the cases were associated with more than one opioid.

What drug withdrawals can you die from?

You can die from alcohol and barbiturate withdrawals due to the potential for severe complications, including seizures and delirium tremens.

The incidence of fatalities related to drug withdrawals is influenced by factors such as the duration and intensity of substance use, individual susceptibility, untreated alcohol withdrawal, the presence of delirium tremens, seizures, hyperthermia, circulatory failure, and the lack of medical supervision during the withdrawal process.

According to StatPearl’s publication on “Withdrawal Syndromes,” updated in April 2023, patients experiencing alcohol withdrawal syndrome (AWS) face prolonged hospital stays and high mortality rates. The risk of fatal outcomes is significantly elevated in cases of untreated alcohol withdrawal and delirium tremens (DT).

Barbiturates, alone or in combination with other drugs, have the potential to create both psychological and physical dependence, leading to withdrawal symptoms after discontinuation. These symptoms encompass anxiety, rhythmic intention tremors, dizziness, psychosis, and seizures. According to Sarrecchia C. et al.’s 1998 study, titled “Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication,” if these symptoms are not treated on time and appropriately, they result in severe complications, including hyperthermia, circulatory failure, and death.

Although fatalities associated with benzodiazepine withdrawal are very rare, the US Food and Drug Administration claimed in the October 2020 update titled, “FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class” that abrupt cessation or rapid reduction of benzodiazepines can lead to severe withdrawal reactions, including life-threatening seizures.

Opiate withdrawal, though uncomfortable, rarely leads to fatalities. Withdrawal from cocaine and amphetamines results in sedation and a state resembling adrenergic blockade, however death is very rare.

It is crucial to seek medical attention for proper management and supervision, especially during withdrawal from substances with life-threatening risks.

What are the available treatments for Polysubstance abuse?

The available treatments for polysubstance abuse are listed below.

• Detoxification (detox): Detox in the treatment of polysubstance abuse is a critical phase that focuses on safely managing withdrawal, ensuring physical stability, and providing a gateway to comprehensive treatment. It addresses immediate health concerns, facilitates medical stabilization, and motivates individuals to continue with rehabilitation and ongoing support for sustained recovery.
• Medication-assisted treatment (MAT): MAT is a comprehensive approach that combines medications with counseling and behavioral therapies to address polysubstance abuse. Medications, such as methadone, buprenorphine, and naltrexone, have proven effective in aiding individuals struggling with opioid addiction. Acamprosate is used for alcohol dependence, while those addicted to nicotine benefit from nicotine replacement products or oral medications as part of a comprehensive behavioral treatment program, as outlined in the 2012 “Principles of Drug Addiction Treatment; A Research-Based Guide” from the National Institute on Drug Abuse.
• Behavioral therapies: Behavioral therapies, such as cognitive behavioral therapy, individual, family, or group counseling, constitute the most widely employed modalities in the treatment of polysubstance abuse. These therapies address a patient’s motivation to change and develop skills to resist drug use, replacing drug-related activities with constructive alternatives, enhancing problem-solving abilities, and fostering improved interpersonal relationships, as highlighted in the NIDA 2012 publication “Principles of Drug Addiction Treatment; A Research-Based guide”. Additionally, engagement in group therapy and peer support programs, both during and after treatment, proves beneficial in sustaining abstinence.
• Residential or inpatient treatment: For individuals with severe polysubstance abuse, a residential or inpatient treatment program is often recommended. This involves a structured and immersive environment with 24/7 medical and therapeutic support.
• Outpatient treatment: Outpatient programs allow individuals to receive treatment while living at home. This is suitable for those with less severe substance abuse issues who are able to maintain a level of functionality in their daily lives.

How does Polysubstance abuse make addiction treatment more complex?

Polysubstance abuse makes addiction treatment more complex by adversely impacting the success of treatment programs, as individuals involved in concurrent drug use face an increased risk of treatment discontinuation, reduced responsiveness to interventions, increased impulsivity, and diminished overall treatment effectiveness, as highlighted in the Bonfiglio NS. et al.’s 2022 study “Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis”.

Additionally, polysubstance use poses more significant challenges in practice and substance treatment compared to mono-substance use, as it has higher relapse rates, increased mortality, and poorer treatment retention.

Therefore, it is crucial to develop targeted interventions, informed by a comprehensive understanding of the mechanisms driving polysubstance use, to improve and enhance long-term treatment outcomes for individuals with polysubstance abuse.