Why is Polysubstance Abuse More Difficult to Treat? The term polysubstance abuse normally indicates that three or more different classes of substances are abused by one individual. An example of polysubstance abuse would be if a person drank alcohol, took ecstasy (MDMA), and also used heroin. An individual can indeed be dependent upon or addicted to more than one drug.
The situation is very common among those abusing alcohol and is becoming more common among cannabis users. One study examined drug use among alcoholics specifically and found that 64% of the alcoholics seeking help also used or were dependent upon other drugs. These drugs included marijuana, cocaine (powder and crack cocaine), and opiates such as oxycodone and heroin. These individuals reported drinking an average of 14 standard-sized drinks daily as well as using an average of $67 worth of drugs daily. The majority of these users took drugs while drinking alcohol.
Prescription drug users are often prescribed a number of drugs at once. There is even a slang term for it – a drug cocktail. In the last ten years, the number of individuals using five or more prescription drugs at once has almost doubled. The most commonly prescribed drugs include antidepressants (Paxil, Zoloft), stimulants (Ritalin, Adderall), and painkillers (Vicodin, Percocet).
Studies show that those most likely to abuse multiple substances are young adults as well as seniors (people over 60.) Both sets of people are often prescribed multiple substances for depression, ADHD, and pain.
When looking at the causes of this trend, the subject of marketing cannot be overlooked. As a prime example, advertisements for the antipsychotic drug Abilify (aripiprazole), tell people: “If an antidepressant alone isn’t enough, talk to your doctor. You options may include adding ABILIFY to
the antidepressant you’re already taking.” Many of these drugs (in particular antidepressants) include warnings of suicidal ideation and they all contain long lists of adverse physical and mental side effects. When multiple drugs are prescribed, we get the situation of more and more side effects and a vicious circle wherein one drug is prescribed to offset the adverse effects of another drug. It can be very confusing for people when their doctor prescribes them heavy psychoactive drugs apparently as a result of print and television ads that instruct the viewer to “talk to your doctor.” The fact is that pharmaceuticals companies market and push their product, and the bottom line (i.e. money and stock value) all too often overshadow professional and medical ethics.
Dangers of Polysubstance Abuse
Abusing just one substance is extremely dangerous and has its own set of side effects and potential for overdose. The abuse of multiple drugs at the same time increases the number of side effects one can suffer as well as the chances of overdose.
Additionally, since polysubstance abuse is specifically the abuse of different classes of drugs, the drugs may interact in a way which seems hard to predict. For example, a popular mix of drugs is an opiate like heroin and the stimulant cocaine (called a speedball). These two drugs taken together can kill. When they are also paired with alcohol, they are even more likely to be deadly.
Mixing a depressant like heroin, a stimulant like cocaine, and another depressant like alcohol can give the human body some nasty issues. This drug mix tries to both speed up the vital organs (heart and lungs) while also slowing them down. Symptoms of this dangerous mix include such things as seizure, unconsciousness, heart attack, and death.
Finally, the way drugs interact can be unpredictable. For example, mixing the following drugs can be extremely dangerous:
- Xanax (benzodiazepine prescribed for anxiety)
- Vicodin (opioid prescribed for pain)
- Ritalin (amphetamine-like drug prescribed for ADHD)
The ingredients of Xanax and the ingredients of Vicodin both cause sedation, slowed breathing and the like. At the same time, the stimulant effects of Ritalin can cause unpredictable effects in individuals using all three drugs. Ritalin (methylphenidate), although it is classified as a stimulant, when given to children and youth often has a depressive effect. These drugs are complicated enough by themselves, but when combined the results can be quite unpredictable and tragic.
Difficulties in Treating Polysubstance Dependence
When an individual wants to stop using the multiple substances to which they have become addicted, difficulties can arise in that they will likely experience withdrawal symptoms associated with different drugs. Additionally, different drugs require different procedures for detoxification. Some require more time and a much more gradual process than others.
An example of this is if one were using heroin, methamphetamine, Abilify, and Celexa.
Heroin: The physical heroin withdrawal symptoms like muscle pain, fever symptoms, and nausea are expected to abate in about 3-5 days. Mental withdrawals (depression, anxiety, and craving) can last longer.
Methamphetamine: Withdrawal symptoms like exhaustion, extreme fatigue, extreme hunger, difficulty concentrating, and temporary psychosis can last 1-4 weeks. Generally speaking the mental symptoms like depression and craving can last 1-3 months, but the first month is usually the hardest part of withdrawing from meth.
Abilify: Getting off of Abilify can take 90 days or longer and include withdrawal symptoms like depression, psychosis, panic attacks, and suicidal thoughts.
Celexa: Withdrawal symptoms for Celexa can last for about 2 weeks and can include loss of coordination, nightmares, sleep problems, depression, mood swings, and mania.
When one looks at the different types of withdrawal symptoms and the amount of time it can take to withdraw from each drug, one can see why polysubstance abuse can be harder to treat. Another point to consider is the overlap of symptoms. For example, withdrawal from meth, Abilify, and Celexa can cause psychotic behavior. Withdrawal from these three drugs can thus amplify that particular symptom.
Signs of Polysubstance Abuse
If you are concerned that a friend or family member is abusing multiple drugs at once, here are several signs to look for:
- Mood swings
- Multiple prescription bottles
- Prescription bottles under different names (not the individual’s name)
- Drug paraphernalia like baggies, pipes, or needles
- Increased or more frequent alcohol consumption
- Purchasing large quantities of over-the-counter medication
- Requiring refills on prescriptions much faster than predicted
- Visiting multiple doctors for the same condition or for nonspecific symptoms
- Getting angry when asked about drug usage
- Lying about whereabouts
- Consistently missing work or classes to get high
- Using drugs or alcohol at work or during school
- Stealing money or pills from friends or family
- Changes in sleep patterns
- Frequent or extreme weight fluctuations
It may appear hopeless for anyone suffering from polysubstance abuse, but fortunately that is not at all the case. Modern techniques in detoxification have allowed for safe passage from addiction to drug-free living. The current landscape of poly drug abuse, the scourge of prescription abuse, and other factors such as synthetic or “designer” drugs, while disastrous to people’s lives, have also motivated forward-thinking rehabilitation facilities to adopt a combined medical and holistic approach in order to address this multi-faceted problem.
Once you have identified that an individual is abusing or dependent upon even just one drug, be sure to get them help. You may be saving their life. If that person is you, you could be saving your own life.