Table of ContentsView AllTable of ContentsCauses and Risk FactorsSigns and SymptomsRisks of Combining DrugsDangersTreatment
Table of ContentsView All
View All
Table of Contents
Causes and Risk Factors
Signs and Symptoms
Risks of Combining Drugs
Dangers
Treatment
Polysubstanceuse involves the use of two or more drugs in combination. The resulting drug intoxication often occurs in patterns, such as cocaine used with alcohol and prescription drugs.
Mixing thesesubstancescan prove lethal, or causestrokesand other serious health issues. Studies note that some combinations can lead to additional drug use, including heroin use that follows sedative use.
5m3photos / Getty Images
Causes and Risk Factors of Polysubstance Abuse
Substance use is a significant public health crisis. To complicate matters, many individuals use multiple substances.
A study looking at the prevalence and patterns of substances identified factors that increase the risk of polysubstance issues, including:
Genetics, family history of substance use,stress,trauma, and accessibility of drugs are other factors that can contribute to polysubstance use.
How Common Is Polysubstance Use?Mixing drugs is not uncommon and appears to be the norm. For example, one study noted that in people who useopioids, almost all of the participants used opioid or non-opioid substances together.Research also shows that people who use tobacco, alcohol, cannabis, prescription opioids, cocaine, and heroin are more likely to struggle with polysubstance use.
How Common Is Polysubstance Use?
Mixing drugs is not uncommon and appears to be the norm. For example, one study noted that in people who useopioids, almost all of the participants used opioid or non-opioid substances together.Research also shows that people who use tobacco, alcohol, cannabis, prescription opioids, cocaine, and heroin are more likely to struggle with polysubstance use.
Signs and symptoms of multiple substance use will depend on the substances involved. They often follow patterns of association. Studies that used artificial intelligence (AI) and machine learning to predict new drug use on the basis of existing drug use found combinations include:
Cocaine typically leads to elevated mood and energy, while benzos likeValium(diazepam) or Xanax (alprazolam) are sedatives often used to help you sleep. Different combinations will lead to different symptoms of the polysubstance use.
Physical Signs
A person dealing with polysubstance use may notice the following physical symptoms:
Psychological Signs
People with a polysubstance use disorder often experience psychological changes and mental health issues. These changes can include anxiety in people who usemethamphetamine, a drug often used with other substances.Other changes can include:
The cravings and urges to use substances, and the obsession with using and planning use, can change people’s priorities and the way they interact with others.
Social and Emotional Signs
People with a polysubstance use disorder often face challenges in their personal and professional lives, like getting arrested or other legal and financial woes.As with other addiction problems, people with these behaviors can experience:
What Happens When You Combine Specific Drugs?
People with polysubstance use disorders often combine drugs in ways that lead to specific patterns of symptoms.
Cocaine and Alcohol
Cocaine use alone can lead to symptoms including rapid heart rates and high blood pressure. But cocaethylene lasts longer in the body, and it’s more toxic to the heart and liver.
Opioids and Benzodiazepines
Both opioids and drugs like Valium can lead to substance use disorder and dependency, even when prescribed for chronic pain or other health conditions. In some cases, as with heroin, benzodiazepines are known to enhance the “high” people seek, despite the risks.
Studies of polysubstance use with this combination find increased death rates, with 20% or more of people who died found to be using both drug types.Both drugs act on areas of the brain that cause them to suppress a person’s ability to breathe, with a stronger effect when taken together.
Prescription Drugs and Non-Prescription Drugs
Many drug combinations occur in people who use alcohol and other street drugs while taking prescription medication. Some of the same adverse effects can occur.
Other effects can occur when combining certain statin drugs used to treathigh cholesterol, such as Luvox (fluvoxamine), withantidepressantsthat can raise statin levels.People with alcohol use disorder also need to be aware of liver damage when combining with medications likeIndocin.
Drug Interactions of Lipitor (Atorvastatin) and Other Statins
Dangers of Polysubstance Use
A person may mix drugs to enhance the effect of a single drug, to feel the effects of the drugs together, or to decrease the effects of a substance. Combining substances can have serious consequences.
Health Problems
Drugs and alcohol harm the body. Using multiple drugs puts a person at risk of developing or worsening health issues. The resulting health problems can be short or long term; they also can lead to death.
Healthcare providers are working to increase awareness of the risks of combining medication with alcohol and illicit substances (street drugs). Substance use disorders can cause damage to vital organs like thebrainand liver, causeseizures, and lead to health complications including:
Experimental Pain Medication May Relieve Acute Pain Without Risk of Addiction, Study Finds
Worsening Mental Disorders
In some cases, substance use can lead to mental health symptoms. In other cases, an individual may self-medicate or use drugs to manage their symptoms. More than one in four adults diagnosed with a serious mental health problem also has a substance use problem.
Taking drugs or combining them can aggravate mental health symptoms and make them worse. This includes using substances on top of prescription medications for mental health conditions.
Relapse
Relapseprevention is a vital part of treatment and recovery. Polysubstance use can make it difficult for someone to be consistent with treatment. It can also lead to relapse. Relapse is serious and, depending on the situation, can increase the risk of health problems and overdose.
Overdose
The risk of overdosing is higher when using multiple substances, especially when one of them is an opioid. Depending on the type of drug, the effect on the body can vary.
When drugs are taken together, the effects can be intensified. For instance, taking more than one depressant drug can increase the risk of overdose or death. According to the CDC, almost half of overdose deaths in the United States in 2019 were related to polysubstance use.
Help Is Available
Because polysubstance use involves using multiple drugs, the first step in treatment isdetoxification. Healthcare providers often supervise this process to manage and alleviate withdrawal symptoms. Withdrawal can be intense and physically taxing.
Symptoms of withdrawal vary based on the substances used. Common symptoms include:
After detox, a patient may begin treatment at a residential or intensive outpatient facility.
A mental health professional will conduct an evaluation to get a sense of the patient’s mental health and substance use history. This information can also help a healthcare provider and patient determine the best approach to treatment. For instance, it’s imperative to identify whether substance use disorders will be treated concurrently or independently, and what other professionals may be part of the care team.
Intensive and outpatient environments allow people to explore their thoughts, feelings, and behaviors related to using, learn coping and problem-solving skills, and develop a relapse prevention plan.
Some types of therapy that can help include:
In addition to detox and therapy, healthcare providers may integrate medications into a treatment plan to manage mental health or medical conditions, as well as reduce cravings or urges to use.
Treatment varies from patient to patient. Working closely with a treatment team will determine the best approach.
Summary
Polysubstance use is the intentional or unintentional mixing of substances. While people combine drugs for many reasons, consuming multiple drugs is dangerous. Certain combinations, such as opiates taken with sedatives, can prove fatal.
Individuals who use multiple substances have a higher risk of developing health problems, experiencing a decline in mental health, and overdose or death. Substance use treatment can help people reduce and stop their behavior.
Talk to your healthcare provider if you have concerns about polysubstance use or questions about how prescribed medications might interact with alcohol or other substances.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pan Y, Feaster DJ, Odom G, Brandt L, Hu MC, Weiss RD,et al.Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment.Drug Alcohol Depend Rep. 2022 Dec;5:100128. doi:10.1016/j.dadr.2022.100128.Cicero TJ, Ellis MS, Kasper ZA.Polysubstance use: a broader understanding of substance use during the opioid crisis.Am J Public Health. 2020;110(2):244-250. doi:10.2105/AJPH.2019.305412McLellan AT.Substance misuse and substance use disorders: why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu LT.Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients.Drug Alcohol Depend. 2018;187:79-87. doi:10.1016/j.drugalcdep.2018.01.035Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM,et al.The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis.Int J Environ Res Public Health. 2022 Jul 21;19(14):8882. doi:10.3390/ijerph19148882.Fiorentini A, Cantù F, Crisanti C, Cereda G, Oldani L, Brambilla P.Substance-Induced Psychoses: An Updated Literature Review.Front Psychiatry. 2021 Dec 23;12:694863. doi:10.3389/fpsyt.2021.694863.Cyders MA, Fry M, Fox T, Shircliff K, Jacobs M, Scott H.Age, 12-Step Group Involvement, and Relapse Affect Use of Sobriety Date as Recovery Start Date: A Mixed Methods Analysis.Inquiry. 2023 Jan-Dec;60:469580231220476. doi: 10.1177/00469580231220476.Pergolizzi J, Breve F, Magnusson P, LeQuang JAK, Varrassi G.Cocaethylene: When Cocaine and Alcohol Are Taken Together.Cureus. 2022 Feb 22;14(2):e22498. doi: 10.7759/cureus.22498.Boon M, van Dorp E, Broens S, Overdyk F.Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events.Ann Palliat Med. 2020 Mar;9(2):542-557. doi: 10.21037/apm.2019.12.09.National Institute on Drug Abuse.Is it safe to use prescription drugs in combination with other medications?Palleria C, Roberti R, Iannone LF, Tallarico M, Barbieri MA, Vero A,et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Food and Drug Administration.Highlights of prescribing information: Indocin.Substance Abuse and Mental Health Services Administration.Mental health and substance use co-occurring disorders.Centers for Disease Control and Prevention.Polysubstance use facts.National Institute on Drug Abuse.Commonly Abused Drugs and Withdrawal Symptoms.National Institute on Alcohol Abuse and Alcoholism.Treatment for Alcohol Problems: Finding and Getting Help.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pan Y, Feaster DJ, Odom G, Brandt L, Hu MC, Weiss RD,et al.Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment.Drug Alcohol Depend Rep. 2022 Dec;5:100128. doi:10.1016/j.dadr.2022.100128.Cicero TJ, Ellis MS, Kasper ZA.Polysubstance use: a broader understanding of substance use during the opioid crisis.Am J Public Health. 2020;110(2):244-250. doi:10.2105/AJPH.2019.305412McLellan AT.Substance misuse and substance use disorders: why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu LT.Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients.Drug Alcohol Depend. 2018;187:79-87. doi:10.1016/j.drugalcdep.2018.01.035Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM,et al.The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis.Int J Environ Res Public Health. 2022 Jul 21;19(14):8882. doi:10.3390/ijerph19148882.Fiorentini A, Cantù F, Crisanti C, Cereda G, Oldani L, Brambilla P.Substance-Induced Psychoses: An Updated Literature Review.Front Psychiatry. 2021 Dec 23;12:694863. doi:10.3389/fpsyt.2021.694863.Cyders MA, Fry M, Fox T, Shircliff K, Jacobs M, Scott H.Age, 12-Step Group Involvement, and Relapse Affect Use of Sobriety Date as Recovery Start Date: A Mixed Methods Analysis.Inquiry. 2023 Jan-Dec;60:469580231220476. doi: 10.1177/00469580231220476.Pergolizzi J, Breve F, Magnusson P, LeQuang JAK, Varrassi G.Cocaethylene: When Cocaine and Alcohol Are Taken Together.Cureus. 2022 Feb 22;14(2):e22498. doi: 10.7759/cureus.22498.Boon M, van Dorp E, Broens S, Overdyk F.Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events.Ann Palliat Med. 2020 Mar;9(2):542-557. doi: 10.21037/apm.2019.12.09.National Institute on Drug Abuse.Is it safe to use prescription drugs in combination with other medications?Palleria C, Roberti R, Iannone LF, Tallarico M, Barbieri MA, Vero A,et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Food and Drug Administration.Highlights of prescribing information: Indocin.Substance Abuse and Mental Health Services Administration.Mental health and substance use co-occurring disorders.Centers for Disease Control and Prevention.Polysubstance use facts.National Institute on Drug Abuse.Commonly Abused Drugs and Withdrawal Symptoms.National Institute on Alcohol Abuse and Alcoholism.Treatment for Alcohol Problems: Finding and Getting Help.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Pan Y, Feaster DJ, Odom G, Brandt L, Hu MC, Weiss RD,et al.Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment.Drug Alcohol Depend Rep. 2022 Dec;5:100128. doi:10.1016/j.dadr.2022.100128.Cicero TJ, Ellis MS, Kasper ZA.Polysubstance use: a broader understanding of substance use during the opioid crisis.Am J Public Health. 2020;110(2):244-250. doi:10.2105/AJPH.2019.305412McLellan AT.Substance misuse and substance use disorders: why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu LT.Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients.Drug Alcohol Depend. 2018;187:79-87. doi:10.1016/j.drugalcdep.2018.01.035Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM,et al.The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis.Int J Environ Res Public Health. 2022 Jul 21;19(14):8882. doi:10.3390/ijerph19148882.Fiorentini A, Cantù F, Crisanti C, Cereda G, Oldani L, Brambilla P.Substance-Induced Psychoses: An Updated Literature Review.Front Psychiatry. 2021 Dec 23;12:694863. doi:10.3389/fpsyt.2021.694863.Cyders MA, Fry M, Fox T, Shircliff K, Jacobs M, Scott H.Age, 12-Step Group Involvement, and Relapse Affect Use of Sobriety Date as Recovery Start Date: A Mixed Methods Analysis.Inquiry. 2023 Jan-Dec;60:469580231220476. doi: 10.1177/00469580231220476.Pergolizzi J, Breve F, Magnusson P, LeQuang JAK, Varrassi G.Cocaethylene: When Cocaine and Alcohol Are Taken Together.Cureus. 2022 Feb 22;14(2):e22498. doi: 10.7759/cureus.22498.Boon M, van Dorp E, Broens S, Overdyk F.Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events.Ann Palliat Med. 2020 Mar;9(2):542-557. doi: 10.21037/apm.2019.12.09.National Institute on Drug Abuse.Is it safe to use prescription drugs in combination with other medications?Palleria C, Roberti R, Iannone LF, Tallarico M, Barbieri MA, Vero A,et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058Food and Drug Administration.Highlights of prescribing information: Indocin.Substance Abuse and Mental Health Services Administration.Mental health and substance use co-occurring disorders.Centers for Disease Control and Prevention.Polysubstance use facts.National Institute on Drug Abuse.Commonly Abused Drugs and Withdrawal Symptoms.National Institute on Alcohol Abuse and Alcoholism.Treatment for Alcohol Problems: Finding and Getting Help.
Pan Y, Feaster DJ, Odom G, Brandt L, Hu MC, Weiss RD,et al.Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment.Drug Alcohol Depend Rep. 2022 Dec;5:100128. doi:10.1016/j.dadr.2022.100128.
Cicero TJ, Ellis MS, Kasper ZA.Polysubstance use: a broader understanding of substance use during the opioid crisis.Am J Public Health. 2020;110(2):244-250. doi:10.2105/AJPH.2019.305412
McLellan AT.Substance misuse and substance use disorders: why do they matter in healthcare?Trans Am Clin Climatol Assoc. 2017;128:112-130.
John WS, Zhu H, Mannelli P, Schwartz RP, Subramaniam GA, Wu LT.Prevalence, patterns, and correlates of multiple substance use disorders among adult primary care patients.Drug Alcohol Depend. 2018;187:79-87. doi:10.1016/j.drugalcdep.2018.01.035
Chhabra N, Smith DL, Maloney CM, Archer J, Sharma B, Thompson HM,et al.The Identification of Subphenotypes and Associations with Health Outcomes in Patients with Opioid-Related Emergency Department Encounters Using Latent Class Analysis.Int J Environ Res Public Health. 2022 Jul 21;19(14):8882. doi:10.3390/ijerph19148882.
Fiorentini A, Cantù F, Crisanti C, Cereda G, Oldani L, Brambilla P.Substance-Induced Psychoses: An Updated Literature Review.Front Psychiatry. 2021 Dec 23;12:694863. doi:10.3389/fpsyt.2021.694863.
Cyders MA, Fry M, Fox T, Shircliff K, Jacobs M, Scott H.Age, 12-Step Group Involvement, and Relapse Affect Use of Sobriety Date as Recovery Start Date: A Mixed Methods Analysis.Inquiry. 2023 Jan-Dec;60:469580231220476. doi: 10.1177/00469580231220476.
Pergolizzi J, Breve F, Magnusson P, LeQuang JAK, Varrassi G.Cocaethylene: When Cocaine and Alcohol Are Taken Together.Cureus. 2022 Feb 22;14(2):e22498. doi: 10.7759/cureus.22498.
Boon M, van Dorp E, Broens S, Overdyk F.Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events.Ann Palliat Med. 2020 Mar;9(2):542-557. doi: 10.21037/apm.2019.12.09.
National Institute on Drug Abuse.Is it safe to use prescription drugs in combination with other medications?
Palleria C, Roberti R, Iannone LF, Tallarico M, Barbieri MA, Vero A,et al.Clinically relevant drug interactions between statins and antidepressants.J Clin Pharm Ther. 2020;45(2):227-239. doi:10.1111/jcpt.13058
Food and Drug Administration.Highlights of prescribing information: Indocin.
Substance Abuse and Mental Health Services Administration.Mental health and substance use co-occurring disorders.
Centers for Disease Control and Prevention.Polysubstance use facts.
National Institute on Drug Abuse.Commonly Abused Drugs and Withdrawal Symptoms.
National Institute on Alcohol Abuse and Alcoholism.Treatment for Alcohol Problems: Finding and Getting Help.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
