Polydrug Use & Misuse: Mixing Drugs Together

Polydrug use is a dangerous practice that can pose multiple harms to your health and well-being. According to the Centers for Disease Control and Prevention, 50% of drug overdose deaths in 2019 involved multiple substances.¹ Furthermore, polysubstance misuse is relatively common, with a 2020 study indicating that 11.3% of people with a substance use disorder (SUD) diagnosis also had concurrent alcohol and/or illicit drug use disorders.²

If you or a loved one are struggling with polysubstance misuse, you should know the risks involved with mixing drugs and/or mixing drugs and alcohol. This article will help you understand several things regarding polysubstance misuse, including the effects of polydrug use, polydrug overdose, and treatment for polysubstance use disorder.

What is Polysubstance Abuse?

Polysubstance misuse means that a person uses multiple substances at a time or within a short time of each other.¹ Polysubstance misuse can be intentional or unintentional.¹

Intentional polysubstance misuse occurs when a person purposely takes a substance to increase or decrease the effects of another substance, or when they take multiple substances together to experience their combined effects.¹ Unintentional polysubstance misuse can occur when someone unknowingly takes drugs that have been mixed or cut with other substances, such as fentanyl.¹

Common Polydrug Combinations

While people can misuse any combination of drugs and/or alcohol, certain combinations are more common.

Common combinations include:^2,3,4

• Cannabis and alcohol to enhance the effects of each of these substances.
• Heroin and cocaine to balance out the effects of each substance.
• Cocaine and opioids to increase the effect of one or the other.
• Prescription stimulants combined with alcohol to calm down from stimulants.
• Methadone and benzodiazepines to mimic the effect of heroin.
• Benzodiazepines and alcohol to increase the effects of alcohol and to mitigate alcohol withdrawal symptoms.

Why Do People Mix Multiple Drugs?

People combine substances for a variety of reasons. Some people may use different substances sequentially (using one after the other one wears off) as a way to alleviate withdrawal symptoms or to prolong a high, or they may use the substances simultaneously (at the same time or within a short time of each other) for different reasons, such as to balance or counter their effects, enhance their high, mimic the effects of another substance, or self-medicate pain or symptoms of other conditions.³

Additionally, people may be more susceptible to substance misuse in general due to a combination of risk factors, such as:^5,6

• A family history of substance misuse or mental illness.
• A history of abuse or maltreatment.
• Neighborhood poverty or violence.
• A lack of economic opportunity.
• Peer pressure or associating with people who use drugs or alcohol.

What Are the Dangers of Polydrug Use?

When people misuse more than one substance at a time, dangerous and unpredictable outcomes can develop as a result.¹

Depending on the specific combinations, polydrug use risks can include:¹

• An increased risk of overdose.
• A risk of brain damage.
• Risk of damage to your heart and other organs.
• Risk of stroke.
• Unpredictable or worsened side effects.
• Death.

Polysubstance Dependence vs. Misuse

Polysubstance dependence and misuse may seem similar, and though they can be related, they are two distinct terms. Dependence involves physiological adaptations caused by repeated substance misuse that result in withdrawal symptoms when you stop using the substance.⁷ Misuse means using alcohol, illegal drugs, and/or prescribed medications in a way that causes harm to yourself or others; people can misuse substances just once or over time.⁸

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides diagnostic criteria for SUD, the diagnosis of addiction.⁹ Polysubstance dependence was formerly a diagnosis in the last edition of the DSM but has been eliminated; due to changes in criteria, people are now diagnosed with specific SUDs based on the substance(s) they use.^9,10

People must meet different criteria to receive an official SUD diagnosis. Some of these criteria include, but are not limited to:⁹

• Using the substance(s) in higher amounts or for longer than originally intended.
• Being unable to cut down or stop substance use despite a desire to do so.
• Being unable to fulfill obligations at home, work, or school due to substance use.
• Tolerance, meaning you require more of the substance to achieve prior results.
• Withdrawal when you stop using the substance.

It is not advisable to attempt to diagnose yourself or someone else with a potential substance use disorder. Seeking professional help is the most effective way to obtain an official SUD diagnosis.

Polydrug Overdose

People who misuse multiple substances face an increased likelihood of overdose.² This is because the effects of combining substances can result in unpredictable and dangerous changes to your body, including increased heart rate, slowed breathing, and heightened blood pressure, which can lead to potentially lethal outcomes.¹

The symptoms of an overdose can vary depending on the substances that you use. An overdose is a medical emergency so it is important to act immediately. If you suspect an overdose, you should:¹¹

• Call 911 immediately.
• Administer naloxone, if available.
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Remain with them until emergency assistance arrives.

Detox for Polydrug Use

As mentioned above, the continued misuse of substances can lead to physical dependence, which refers to adaptations that occur due to repeated substance use and associated withdrawal symptoms when you stop using them.⁷ Polysubstance use can complicate withdrawal, as you can experience withdrawal symptoms from the substances you use, and it’s also not always possible to determine how interactions between different substances will impact withdrawal.¹²

Suddenly reducing your dose or stopping cold turkey may trigger the onset of withdrawal symptoms, so it’s important to discuss your substance use with a medical professional.⁷ Withdrawal symptoms can vary by substance, but seeking help from a professional medical detox is advisable to help prevent serious or even life-threatening symptoms, address potential complications, and treat symptoms of co-occurring mental health disorders, such as depression, which are common among people who misuse substances.¹²

Treatment for Polysubstance Use Disorder

Treatment for polysubstance misuse/use disorder can look different for everyone based on individual factors, and also depends on the substances you use. Treatment can involve medications, counseling, behavioral therapies, and/or mutual support groups, or a combination of these.¹³

If you or a loved one are struggling, you should know that treatment is available to help you take back control of your life. Sunrise House, an inpatient rehab in New Jersey, provides expert, evidence-based care to help you or your loved one start the path to recovery from polysubstance misuse. You can learn more about our levels of addiction treatment, insurance that covers substance abuse treatment, and other ways of paying for rehab, and you can get admitted today.

To get started on your recovery, get your insurance verified with us by filling out our secure online .