Polysubstance Abuse | What is Polysubstance Abuse?

Polysubstance abuse is the abuse of two to three or more substances. Frequently, is one of the substances. In many countries, like the United States, alcohol consumption is legal and widespread. Someone’s consumption of alcohol does not mean they are going to use other substances. However, alcohol does lower inhibitions and impair judgment. For many people, they are more willing to try new substances after drinking. 

People engage in polysubstance abuse for various reasons. Sometimes a person’s desire is to enhance the perceived positive effects of whatever substances they are consuming. Other times, they mix substances in hopes of cancelling out any negative effects. One way this is done is to use the drugs concurrently, at the same time, to attempt to prevent negative effects. Another method is to use another substance once a user begins to experience any negative effects from the first substance. Unfortunately, mixing substances is something many do without realizing that it often heightens the negative effects of each substance. Furthermore, the more some consumes a substance the higher their tolerance becomes. Subsequently, they will take more to feel the same effects. This then increases the risk of experiencing negative effects and the severity of them.

Risk of Mixing Substances

There is risk in mixing substances whether they are legal or not. If anyone is taking medicine prescribed by doctors, they should speak with their doctor about how it will interact with various other consumable items. With substance abuse and addiction, it is possible a person is not concerned with negative effects, they are unaware, or they assume it will not happen to them. Even without ill intentions it is still dangerous.

While prescription drugs are legal, there is also widespread misuse and abuse. According to the National Institutes of Health (NIH), alcohol and medications are dangerous regardless of when you consume each substance.

Further, depending on the medication, some of the possible side effects include:

  • Nausea & vomiting
  • Drowsiness
  • Fainting
  • Loss of coordination
  • Internal bleeding
  • Difficulties in breathing

It is possible for these effects to occur without necessarily consuming a large amount of the substances. Various factors will influence this including weight, metabolism, height, and genetic factors among other possibilities. Mixing substances like opioids and alcohol is particularly dangerous for many reasons. In particular, both suppress breathing and this becomes more of a risk the more either substance is consumed. Furthermore, benzodiazepines also depress the central nervous system (CNS), and they are also frequently taken in conjunction with alcohol. With consumption of all three substances, a person is at significant risk for overdose and death. As these substances frequently cause slowed breathing, a person mixing them often appears to be asleep. Unfortunately, many people mix various substances without understanding these risks.

Frequent Polysubstance Combinations

It is common to mix illicit substances with legal substances. While prescription drugs are legal, many people find and use them illegally. In doing so, the risk increases as often these drugs are cut with more dangerous substances. Someone might buy Xanax off the street. They do so without realizing there is a significant chance it is cut with fentanyl. In fact, many illegal substances are increasingly cut with fentanyl.

Heroin is an opioid that is illegal in the United States with no accepted medical use. As it depresses the CNS, many combine it with cocaine, a stimulant, hoping to enjoy only positive effects from both. However, according to the National Institute on Drug Abuse (NIDA), taking stimulants with depressants causes a number of negative side effects including:

  • Incoherence
  • Blurred Vision
  • Drowsiness
  • Paranoia

The combination also increases risk of death through:

  • Stroke
  • Heart attack
  • Aneurysm
  • Respiratory failure

There are, of course, a large number of other dangerous combinations. Adderall abuse is common among younger people who typically combine with alcohol. In fact, many people consume prescription drugs with alcohol and do not realize the consequences.

Risk of Overdose and Death from Polysubstance Abuse

A common combination is also opioids and benzodiazepines. Both are potentially highly addictive and in combination present significant risk. Furthermore, it is best to only use either for short-term prescriptions and it is best not to use at the same time if it can be helped. Despite this, according to NPR prescriptions are both increasing and they are continually used in combination long-term. Using them long-term not only increases the risk of addiction, but also the risk that someone’s tolerance will go up. Subsequently, they will feel the need to take more of the substance to feel the same effects. Even with normal use there is risk in combining. A higher tolerance is undoubtedly more dangerous. However, it is possible for overdose to occur with mixing substances if there is enough of one.

According to NIH, “In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepines.” Of course, it is possible for this to be illicit use, but NIH does note that unfortunately many people are prescribed both at the same time. They further cite a study from North Carolina that found the overdose rate among patients using both medication was 10 times higher than if they only used opioids. If possible, it is best to avoid using both at the same time. If you have prescriptions, speak with a doctor about any concerns.

The risk of overdose and death from polysubstance abuse of course extends to substances beyond opioids or benzodiazepines. Suppressed breathing is a dangerous and common symptom of any CNS depressants. Further, there are other individual drugs and combinations that cause strokes, heart attacks, and aneurysms.

Mental Health and Polysubstance Abuse

In a proposed study, the NIH cites resources that as many as “…20% to 30% of youth and young adults engage in PSU [polysubstance use] and the majority of treatment seekers are polysubstance abusers.” Further, they explain that, “Compared to users of a single drug, polysubstance users are more likely to present with comorbid mental health conditions…”

Mental health and addiction frequently occur together. It is possible for a number of combinations behind this. This includes: addiction causing mental illness, mental illness existing prior and using substances to cope, or both. Polysubstance abuse and addiction increase the complication in treatment. However, it is not impossible. What is important is that a treatment center thoroughly treats each issue, for each substance and each mental health issue. Addiction with mental illness is known as dual diagnosis or co-occurring disorders. Reflections is able to treat co-occurring disorders. 

At Reflections, the intake process helps identify all issues to individualize treatment for each person. It is important to address and treat all underlying causes in addiction. Without doing this, relapse is more likely.


Polysubstance abuse is more difficult to treat than addiction to one substance. Any mental health issues or mental illness makes adds another layer of complication. Remember though: it is not impossible. Further, it is important for anyone and their loved ones not to give up hope or let that deter them. Finding a treatment center, like Reflections, that treats polysubstance abuse and mental illness is important. Further, it is important to treat each issue individually but also in tandem with each other. 

Most likely various types of therapy are necessary for polysubstance abuse. You can find this at Reflections. Additionally, treating the addiction and mental health issues are central. However, it is also very important to develop skills and relapse prevention plans for after treatment. With addiction, it is often likely that relapse will occur. It is important not to see this as the ultimate failure, but as part of the process. 

If you or someone you know is in need of help for polysubstance abuse, reach out today. We are ready and willing to help.