Polysubstance Abuse: What You Need to Know About Mixing Alcohol And Drugs

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Polysubstance abuse refers to combining medications, illicit drugs, and/or alcohol for therapeutic, recreational, or non-medicinal purposes. It has become an increased focus of addiction treatment and healthcare research as the consequences and prevalence increase. In most situations, the risks and outcomes of polysubstance abuse versus mono-, or only one, substance use, are much greater.¹

If you are prescribed multiple medications for medical use, you would not be considered a polysubstance abuser, though your prescriber should review with you your elevated risk for adverse events.

What is Polysubstance Abuse?

Polysubstance use is more common today than in the past. Many researchers attribute that to the rave subculture that started in the early 1990s, where participants learned to “stack” medications to achieve an optimal experience. Within subcultures like this, polysubstance use can be normalized and encouraged, and access to illicit drugs can proliferate.^1,5

Young adults are the most common subset of polysubstance users, but for many, it begins during adolescence as young people experiment with the common triad of alcohol, marijuana, and tobacco. Some may experiment with more readily accessible substances, such as over-the-counter depressants before using controlled substances. Many researchers attribute lower socioeconomic status, race, and other social factors to the higher prevalence of polysubstance abuse among more marginalized populations. Factors that predict higher risk for polysubstance use include:⁵

• Normalized, pro-drug use communities
• History of behavioral issues
• Previous drug use
• Mental illness
• Marginalized social status

Common combinations of polysubstance use include:¹

• Alcohol with caffeine
• Alcohol with nicotine
• Alcohol with weed or other cannabinoids
• Alcohol with allergy medication, like antihistamines
• Alcohol with antibiotics
• Alcohol with antidepressants such as fluoxetine (Prozac)
• Alcohol and ibuprofen
• Alcohol with prednisone
• Alcohol with prescription medication for mental health conditions
• Alcohol with prescription stimulants
• Alcohol with common over-the-counter medications
• Opioids and benzodiazepines
• Stimulants and opioids
• Stimulants and hallucinogens
• Alcohol with insulin
• Alcohol with Dramamine

Common reasons people mix substances include:

• Enhance the effects of one drug with another
• Prolong intoxication
• Counteract negative side effects of one drug with one that has the opposite effect
• Prevent withdrawal
• Engage in subculture experiences such as raving

Polysubstance use can also happen accidentally when prescription medication is mixed with alcohol. Many prescriptions recommend that you do not use any alcohol while on the medication, such as blood thinners or statins, while others recommend not using alcohol until you know how the medication affects you. To get help with your polysubstance abuse, call 800-948-8417 Who Answers? to speak to a treatment advisor about your rehab options.

Polysubstance vs. Monosubstance Use

Monosubstance use refers to the use of one drug for recreational or therapeutic purposes. It is less common among drug users to be a monosubstance user than a polysubstance user.⁵

You may have a “drug of choice” and thus not consider yourself a polysubstance abuser, but if you are like most drug users, you likely use a combination of substances. Understanding how this combination can put you at greater risk for worse outcomes is essential to your safety and recovery. Even tobacco is considered a substance of misuse that can seriously complicate your health status when seeking treatment for polysubstance or monosubstance use.

As evidenced by the opioid crisis and other well-known addiction prevalence, monosubstance abuse can alone be highly problematic. Polysubstance use, however, common as it is, has worse consequences than monosubstance use.⁵

Effects of Mixing Drugs and Alcohol

Mixing alcohol with other substances is perhaps the most common example of polysubstance use. The combination of alcohol, tobacco, and cannabis is widespread. A common progression from this combination is to add a stimulant drug, such as cocaine, and then eventually other illicit drugs.

Alcohol combined with caffeine or stronger drug stimulants is also popular as many believe they can drink more or stay awake longer with these combinations. Additionally, alcohol is also often mixed with benzodiazepines such as Xanax, Valium, or Klonopin, as it can enhance the effects of benzodiazepines. As mentioned earlier, some people also self-medicate with benzodiazepines to treat the symptoms of alcohol withdrawal.¹

You may think of alcohol as an innocuous substance because it is legal—when used in moderation, to a certain extent this is true. However, when used in excess or in combination with other substances, the risk of harm to yourself and your quality of life becomes much greater.

For example, the all-too-common combination of alcohol and cocaine over time can have damaging effects on your brain, which can impair your brain functions, such as memory.¹

There is also evidence to show that if you use alcohol in combination with other drugs, you are at higher risk of compromising your livelihood than if you used alcohol alone. One study found that people who combine alcohol with other substances are at higher risk for homelessness and other negative lifestyle factors than those that did not.³

Mixing Drugs with Other Drugs

People mix drugs with other drugs to:

• Manage cravings
• Avoid withdrawal symptoms
• Enhance the effects of the drugs taken
• Treat side effects

Many of those who are brought to the hospital for opioid withdrawal or overdose have multiple illicit substances in their system, which all contribute to the condition. Research backs up this phenomenon: mixing drugs can lead to health consequences, addiction treatment failure or relapse, overdose, and death.⁴

Dangers of Polysubstance Abuse

As the rise of polysubstance use, dependence, and abuse becomes more evident, so do its risks. Polysubstance use creates greater risk for:³

• Depression
• Suicidality
• Infectious disease
• Incarceration
• Social and behavioral problems
• Arrests
• Health problems
• Financial and legal consequences

Polysubstance Use and Mental Illness

It has been found that mental illness can lead to polysubstance abuse and polysubstance abuse can lead to mental illness.³

For instance, you may use multiple drugs with or without alcohol to treat an existing mental illness, such as depression, anxiety, or delusions, even if you don’t recognize it as a mental health problem.

On the other hand, there are links between misuse of certain drugs and the onset of new mental illness. For example, opiates can lead to depression-like symptoms and marijuana can lead to psychosis.³

Because withdrawal from substances can resemble different mental illnesses, it is essential that you disclose your substance use to your doctor. This can prevent them from incorrectly prescribing you medications for a mental illness that certain substance withdrawal mimics. For example, withdrawal from various substances can resemble anxiety or depression. Treatment for withdrawal could be very different from treatment for the mental illnesses it may look like. In more severe cases, this could be a matter of life or death.³

Polysubstance Use and Withdrawal

The relationship between polysubstance use and withdrawal is multifaceted. On the one hand, you may use one or multiple drugs to mitigate the effects of withdrawal from one substance. On the other hand, you may be at higher risk for withdrawal based on how and which substances you combine.

For example, you may use an anxiety medication, such as a benzodiazepine like Xanax, to treat the effects of withdrawal from alcohol. This is relatively common considering that alcohol withdrawal in its milder states resembles anxiety and panic.² You may also use Xanax or other sedatives in combination with alcohol to complement, or enhance, the effects of alcohol.

Treatment for Polysubstance Abuse

Treating abuse, dependence, or overdose from polysubstance abuse can be complex, but it is effective and worthwhile. Different substances interact with your brain and body in nuanced ways and require specific interventions according to those interactions. It is important to disclose the full extent of your polysubstance use to your provider so that you can receive the most appropriate and effective treatment.

Call 800-948-8417 Who Answers? about seeking help today to start to live a healthier life.

References

1. Connor, J. P., Gullo, M. J., White, A. & Kelly, A. B. (2014). Polysubstance use. Current Opinion in Psychiatry, 27(4), 269–275.
2. Diagnostic and statistical manual of mental disorders: DSM-5. (Fifth edition.). (2013). American Psychiatric Association.
3. Bhalla, I. P., Stefanovics, E. A., & Rosenheck, R. A. (2017). Clinical epidemiology of single versus multiple substance use disorders: polysubstance use disorder. Medical Care, 55, S24-S32.
4. Cicero, T. J., Ellis, M. S., & Kasper, Z. A. (2020). Polysubstance use: a broader understanding of substance use during the opioid crisis. American Journal of Public Health, 110(2), 244-250.
5. Ogbu, U.C., Lotfipour, S., & Chakravarthy, B. Polysubstance abuse: alcohol, opioids and benzodiazepines require coordinated engagement by society, patients, and physicians. West J Emerg Med. 2015, 16(1):76-9.