Polysubstance Abuse Dependence Disorder – Doubles The Trouble

Drug dealer selling pillsmarijuana and cocaine to teens

By definition, polysubstance abuse occurs when someone consumes two or more drugs, including alcohol, regularly over an extended period of time.

They can be used either simultaneously or separately. Previously, the Diagnostic and Statistical Manual of Mental Disorders (DSM) included polysubstance abuse in its listings of mental health problems.

  • However, the DSM-5 has removed polysubstance dependence as a disorder. In addition, the diagnostic terms “dependence” and “abuse” have been centralized and renamed as “substance use disorder”.

Diagnostic Criteria

According to the DSM-V,  someone must present at least three of following symptoms to meet professional criteria defining PAD:

  • Tolerance for drugs where they need increasingly larger doses of drugs to feel high
  • Suffer withdrawal symptoms when they abstain
  • Repeatedly trying to stop using drugs with no success
  • Spending most of their time searching for and using multiple drugs
  • Experiencing life issues due to using drugs i.e losing jobs, getting arrested, failing relationships with family and friends
  • Continuing to engage in polysubstance abuse when they know it is harming them physically and mentally

ICD Codes

Why People Develop It

Drug abuse is a complex, biopsychosocial disease emerging from the interplay of genetics, history of childhood abuse/neglect, environmental factors and personality traits. Polysubstance abuse disorder also emerges from the interaction of these variables but is reinforced by other aspects of drug addiction as a disease.

For example, some people’s brain/body chemistry makes it more difficult for them to feel high. Consequently, they may find that drinking alcohol while smoking marijuana gives the sensations they crave. Once the brain becomes addicted to the combination of alcohol and pot, the person is compelled to continue using these two drugs together.

Another scenario may involve an individual addicted to heroin who suffers a serious and painful injury. Unfortunately, the physician prescribing pain medication knows nothing about their patient’s heroin addiction. Once the person mixes heroin with pain pills, the intense high cross-addicts them to both heroin and painkillers.

Most Common

Among opioid abusers, polysubstance abuse is “considered the norm instead of the exception”. These 3 drugs are often cross-addicted with alcohol and cocaine.

  • Heroin
  • morphine
  • pain pills

Alternately, amphetamine addicts tend to abuse alcohol and opioids to help them “come down” off a speed high. However, it isn’t unusual for a polysubstance abuser to be addicted to a variety of drugs, especially if they have a strong family history of drug and alcohol disorders and undiagnosed mental or physical illnesses.


Treatment for polysubstance abuse disorder involves the same psychotherapies, group counseling, experiential activities and ongoing support needed to treat people addicted to just one drug. The primary difference in treating a polysubstance abuser vs. a single drug abuser concerns supplemental anti-addiction medications that help reduce withdrawal symptoms and cravings. Depending on the severity of their addictions, patients in a recovery program may need to take several medications simultaneously, such as Naltrexone and Disulfiram for alcohol and opioid abuse.

Since there are no standard medications to treat methamphetamine or cocaine addictions, polysubstance abusers in detox for a meth and alcohol or cocaine and alcohol addiction may be given only Naltrexone, Disulfiram or Acamprosate, in addition to medical and psychiatric supportive care.