Polysubstance use means using more than one substance, either together or within a short period of time. In clinical practice, a person may have one or more separate substance use disorders involving alcohol, opioids, stimulants, cannabis, sedatives, or other drugs. “Polysubstance use disorder” is commonly used informally, but current diagnostic systems generally diagnose each substance use disorder separately rather than using one single polysubstance diagnosis.
What does polysubstance use mean?
SAMHSA describes concurrent substance use as the use of more than one substance and notes that clinicians may also use terms such as polysubstance use or co-occurring substance use. The substances may be taken at the same time or during the same general period.
Examples include using opioids with benzodiazepines, cocaine with alcohol, methamphetamine with fentanyl, or regularly using several substances for different effects.
Is polysubstance use disorder an official diagnosis?
Not as one broad diagnosis in the current DSM framework. A clinician evaluates whether the person meets criteria for a substance use disorder involving each specific substance or drug class.
For example, someone may have both alcohol use disorder and opioid use disorder, or stimulant use disorder plus sedative use disorder. The treatment plan should address the complete pattern rather than focusing only on one drug.
Why can using multiple substances be more dangerous?
Combining substances can make effects less predictable and increase overdose risk. SAMHSA notes that polysubstance use is an important overdose factor, especially when substances with overlapping sedating effects are involved.
Mixing opioids with alcohol, benzodiazepines, or other depressants can greatly increase respiratory-depression risk. Combining stimulants with other stimulants can increase cardiovascular stress, overheating, agitation, and other complications.
Can polysubstance use be unintentional?
Yes. A person may knowingly combine drugs, but exposure can also be unintentional because illicit cocaine, methamphetamine, counterfeit pills, or other drugs may contain fentanyl or additional substances.
How does polysubstance use affect withdrawal?
Withdrawal planning can become more complex when several substances are involved. Alcohol, benzodiazepines, opioids, stimulants, cannabis, and other substances have different withdrawal patterns and risks.
A clinical assessment should identify all regularly used substances, recent amounts and timing, prescription medications, and prior withdrawal complications. Trinity Behavioral Health provides adult detox and withdrawal-management information, but the appropriate level of care depends on the individual assessment.
How is polysubstance use treated?
Treatment should address each substance use disorder and the reasons the substances are being used. That can include behavioral therapies, medications for specific substance use disorders when appropriate, relapse-prevention planning, treatment of co-occurring mental-health conditions, and attention to medical risks.
SAMHSA emphasizes that treatment of concurrent substance use should be individualized because evidence and medication options differ by substance.
Why is it important to tell clinicians about every substance being used?
Leaving out a substance can affect withdrawal safety, medication decisions, overdose-risk assessment, and level-of-care planning. Even substances that seem secondary can change the clinical picture.
Frequently asked questions
Does polysubstance use mean someone is addicted to every drug they use?
No. Using multiple substances does not automatically mean the person has a substance use disorder involving each one. Diagnosis depends on the pattern of impairment and symptoms associated with each substance.
Is polysubstance use more common than people realize?
Yes. SAMHSA national data show that use of multiple substances is common, and some people meet criteria for more than one substance use disorder.
Can someone be treated for multiple substance use disorders at the same time?
Yes. Treatment planning can address multiple substance-related problems together while still tailoring interventions to each substance and the person’s medical and behavioral-health needs.
When is emergency care needed?
Call 911 for suspected overdose, severe breathing problems, loss of consciousness, seizures, severe agitation, chest pain, or other acute medical emergencies.
Sources
- SAMHSA: Treating Concurrent Substance Use Among Adults
- SAMHSA: Use of Multiple Substances in the Past Month
- SAMHSA: Non-Fatal Overdoses and Polysubstance Use
This article is general educational information and does not replace individualized medical or addiction-treatment assessment.