WHAT IS POLYDRUG USE DISORDER?

Polydrug use disorder, also called polysubstance abuse, refers to using more than one drug (which can include alcohol) at the same time. This behavior can be described as harmful, habitual, and/or compulsive.

While many addicts may express preference for a “drug of choice,” some of them combine more than one drug at a time to create different or more intense effects. Others may alternate drug usage on different occasions—for example, substituting when they can’t find their preferred substance.

Harboring multiple addictions is not uncommon. In a survey of 6,000 Canadian adults, published in the Journal of Behavioral Addictions, 21% reported having at least two addiction problems in the past year. The authors pointed to previous study findings that “addictions frequently co-occur in the same individual…there might be a systematic progression from having difficulties with one excessive behavior to struggling with another.”

 Struggling with multiple addictions, the study added, leads to increased risk for negative outcomes, including being the victim of a crime, physical health issues, and suicide.

Co-occurring addictions can also complicate both diagnosis and treatment. For example, “One excessive behavior might mask another addiction,” the authors stated, “or addictions may alternate with each other.”

POLYDRUG ABUSE: A DEADLY COMBINATION

According to the National Institute on Drug Abuse, annual drug overdose deaths rose between 2019 and 2022, to 107,941. Of those, 73,838 involved synthetic opioids other than methadone (illicitly manufactured fentanyl was the #1 cause). Stimulant-related overdoses, including cocaine and methamphetamine, also increased, to 27,569 and 34,022 deaths, respectively, in 2022.

Not surprisingly, combining substances greatly increases the risk of overdose. The CDC reports that in 2022, nearly half of drug overdose deaths involved multiple drugs.

While an individual may use any combination of drugs, some substances tend to be combined in polydrug use disorder. Common possibilities include:

Alcohol and prescription drugs.

Mixing alcohol with sleeping pills, opiates, stimulants, and/or benzodiazepines is a recipe for disaster. The National Institute on Alcohol Abuse and Alcoholism warns that mixing alcohol with medications can lead to:

• Nausea and/or vomiting
• Headaches
• Drowsiness
• Fainting or loss of coordination
• Increased risk for internal bleeding, heart problems, and difficulty breathing

Furthermore, when alcohol, a depressant, is paired with another depressant (such as a sleeping pill), the person can experience blackouts—even driving while under the influence and having no memory of the event. An overdose death may occur when the body’s systems slow down to the extent that breathing and heartbeat stop altogether.

Cocaine and heroin.

Known as a speedball, this combination mixes two powerful drugs that create opposite effects (a stimulant and a depressant). This deadly cocktail is notorious for killing celebrities such as John Belushi.

Cocaine and alcohol.

People reach for this drug duo thanks to its “longer-lasting, as well as more intense, psychoactive effect,” according to a 2022 study in the medical journal Cureus. Unique among any other drug combination, these two drugs actually create an entirely new psychoactive substance, called cocaethylene, within the body.

Alcohol and cannabis.

These drugs are socially approved and widely legalized, making them another common combination, especially among teens and young adults. Both have a long list of damaging health effects on the brain.

SIGNS AND SYMPTOMS OF POLYDRUG USE DISORDER

Addiction, also known as substance use disorder (SUD), means that the use of illicit drugs, prescription medications, and/or alcohol has veered into harmful territory. Habitual use of any substance, or multiple substances, can change the way the brain experiences pleasure.

When the individual becomes addicted, they have lost control of their usage and can’t easily quit the habit even if they want to. And, when multiple drugs are involved, quitting can involve a unique and difficult mix of withdrawal symptoms.

Whether you or a loved one has polydrug use disorder, you’ll likely notice a variety of behavioral, physical, and psychological indicators. Here are some signs and symptoms of substance use and polydrug use disorders:

• Changes in weight, eating or sleeping patterns, and/or activity or energy levels
• Lack of personal hygiene
• Red, watery, or glassy eyes
• Feeling sick, hung over, and/or “hangxiety”
• Blackouts or brownouts (forgetting some or all of what happened while under the influence)
• Requiring increasing amounts of substances to get the same effects
• Cravings or withdrawal symptoms when trying to quit or cut down
• Using substances to reduce stress or mental health symptoms
• Mental preoccupation or obsession with using substances
• Negative changes in school, work, or day-to-day performance
• Isolation from family and friends
• Suspicious behavior (e.g., lying, stealing, hiding, or making excuses)

THE DANGERS OF POLYDRUG USE

When more than one drug is being abused, an individual can be more likely to experience negative consequences, including health issues and overdose. Furthermore, using multiple drugs can increase the potential for short- and long-term impacts on brain health and overall well-being.

A 2017 study on polysubstance use disorder among nearly 500,000 veterans—26.7% of which had two or more substance issues—showed how multiple addictions impacted them. Veterans with higher levels of polydrug use were more likely to have liver disease, schizophrenia, bipolar disorder, major depressive disorder, and personality disorders.

Multi-drug abuse was also associated with greater use of medical interventions: psychiatric inpatient care, residential and rehabilitative treatment, and multiple psychotropic medication prescriptions.

In the face of so many dangers, why do people engage in polydrug use? There are numerous contributing factors, from psychological and environmental triggers to trauma and stress.

Some people with addiction also have undiagnosed mental health conditions. When they remain untreated for these issues, they may use illicit drugs to cope with their symptoms instead. This begins a cycle of self-medication—with potentially devastating consequences.

Indeed, substance abuse and mental health conditions often overlap. Dual diagnosis refers to those with a mental health condition as well as addiction. Substance use disorder is strongly associated with mental health issues such as:

• Anxiety
• Depression
• Bipolar disorder
• ADD/ADHD
• Post-traumatic stress disorder (PTSD)
• Traumatic brain injuries (TBI)

THE IMPACT OF POLYDRUG USE ON THE BRAIN

All brains are wired to seek out rewards, such as food and sex, but healthy brains are able to regulate their seeking behavior with self-control. In those who have addictions, the brain’s drive circuits (the nucleus accumbens and deep limbic system) prevail, while the self-control circuit (the prefrontal cortex, or PFC) is underworking.

However, as with any mental health issue, every case of addiction is unique. Through brain imaging work utilizing an imaging technology called SPECT (single photon emission computed tomography), Amen Clinics has identified six types of addicts:

• Compulsive addicts tend toward obsessive thoughts. This type is associated with low serotonin levels and increased anterior cingulate gyrus (ACG) activity.
• Impulsive addicts have difficulty with impulse control. This type often shows low activity in the PFC and low levels of dopamine.
• Impulsive-compulsive addicts combine both of the above: low activity in the PFC and low dopamine, plus overactivity in the ACG and low serotonin levels.
• Sad or emotional addicts are prone to depression, boredom, or loneliness. SPECT scans often show increased activity in the deep limbic system and low activity in the PFC.
• Anxious addicts battle anxiety, tension, nervousness, and fear. This type is associated with too much activity in the basal ganglia, likely due to low levels of GABA.
• Temporal lobe addicts often have decreased activity (or increased activity) in the temporal lobes. Issues such as temper outbursts, emotional ups and downs, learning difficulties, and memory may be related to past head injuries, infections, environmental toxins, genetics, or a lack of oxygen.

The experts at Amen Clinics have found that brain scans of those who abuse substances reflect toxicity, with less activity and a shriveled, scalloped appearance.

HOW TO DIAGNOSE AND TREAT POLYDRUG USE DISORDER

Using multiple drugs at the same time can take a devastating toll on the body and brain. Brain imaging tools like SPECT help determine how different substances are impacting the brain and how to rehabilitate it back to a healthier state.

With multiple drugs—as well as potential mental health challenges—involved, addressing polydrug use disorder is complex. Brain scans combined with a targeted treatment plan inform a comprehensive addiction care for those with polydrug use disorder.

Functional brain imaging, such as SPECT, is a powerful tool in treating polyuse drug disorder because it helps:

• Determine if there are co-existing conditions requiring treatment
• Increase treatment compliance
• Decrease shame and stigma
• Reframe addiction as a brain health issue, rather than a personal weakness or character flaw

After a comprehensive evaluation including brain scans, individuals can receive personalized treatment options for polydrug use disorder. This may include:

• Detoxification
• An inpatient or outpatient rehabilitation program
• Psychotherapy, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy
• Support groups and/or addiction recovery programs
• Holistic lifestyle recommendations (diet, exercise, supplements, meditation, etc.)

While any of the above recommendations will promote progress, taking a brain-based approach to addiction recovery is crucial. Personalized care, education, early intervention, and addressing underlying mental health issues are all important steps in the process.