What is Polysubstance Abuse?

polysubstance pills

What is Polysubstance Abuse?

polydrug abuse is associated with a significant number of negative health and societal issues

Updated on August 7th, 2020

Polysubstance abuse is a common practice. Although any type of drug use can be detrimental to a person’s health and well-being, polydrug abuse is associated with a significant number of negative health and societal issues.

What is Polysubstance Abuse?

Polysubstance abuse is a type of substance use disorder that is characterized by the regular abuse of at least two or more different substances without preference for any single one.1,2 People who struggle with polysubstance abuse don’t have a regular go-to drug. Instead, they regularly abuse multiple different types of drugs to achieve a high.

Why Do People Abuse Multiple Drugs?

Polysubstance abuse may be intentional or unintentional and may involve illegal drugs, over-the-counter drugs, and prescription medications. Some people may unintentionally abuse multiple drugs at once, such as taking a prescription medication and then drinking an alcoholic beverage without realizing the medication should not be combined with alcohol.

In other instances, a person may engage in polysubstance abuse intentionally for the purpose of enhancing the effects of the primary substance. For example, a person may take prescription painkillers and benzodiazepines like Ambien, Valium, or Xanax together to enhance the sedating effects of the narcotics.

Who Is At Risk for Developing Polysubstance Abuse?

Although anyone can develop a polysubstance abuse disorder, certain characteristics or behaviors may increase some individuals’ risks of developing a polysubstance addiction, such as:

  • People who are already addicted to alcohol
  • People who take prescription medications (especially several different ones simultaneously)
  • People who like to party or are into the rave/clubbing scene

What Are the Risks of Polydrug Abuse?

There are many different health-related risks associated with specific drug and alcohol combinations, but generally speaking, any kind of polysubstance abuse has many risks and harmful side effects. Here are some of the biggest risks of polydrug use:

  • People who abuse multiple types of drugs simultaneously have a higher risk of overdosing. Although overdose is always a risk when any drug use is involved, most overdoses occur when substances are mixed with sedating drugs like opioids.2
  • Polydrug abuse causes more severe side effects. This increases the risk of accidents and unintentional injuries.
  • Drug users who abuse multiple different substances regularly are much more likely to develop tolerance, physical dependence, and addiction, especially if they abuse several different drugs on a long-term basis.
  • Polysubstance abuse can amplify the effects of a mental health problem and people with mental disorders may abuse drugs to self-medicate.3 As the cycle continues, mental health problems and addiction can continually worsen.
  • According to the Department of Health and Human Services, people who suffer from polysubstance abuse are more likely to have employment problems and legal issues, as well as academic problems. They may also be more likely to drop out of school or fail to complete a program.4
  • Polydrug abuse can cause unpredictable effects, especially when it comes to the mood and behavior of the drug user. As a result, using multiple substances simultaneously may increase a person’s risk of becoming physically violent toward friends, family members, or strangers.
  • Since the physical and psychological side effects of polysubstance abuse are unpredictable, the treatment process is also more complex. Quitting drugs “cold turkey” can quickly become life-threatening and treating the symptoms of polysubstance withdrawal is a complicated process that requires medical assistance and continued care.
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    What Are the Signs of a Polysubstance Overdose?

    The signs of a polysubstance overdose can vary greatly due to the wide variety of drugs that a person may have used. However, indications of a drug overdose often include several of the following signs:

    • Dilated or pinpoint pupils
    • Blue lips, fingertips, and/or body
    • Chest pain
    • Irregular heartbeat
    • Abnormal breathing (gasping for air, slow and difficult breathing, or rapid breathing)
    • Confusion and disorientation
    • Nausea and vomiting
    • Convulsions or seizures
    • Shivering and trembling
    • Violent behavior
    • Unconsciousness

    What Are the Causes of Polysubstance Abuse?

    There is a lack of research and data concerning the cause of polysubstance abuse, but according to the Mayo Clinic, general substance abuse is often caused by several different contributing factors, such as:5

    • Home and social environment
    • Exposure to drugs, alcohol, and substance abuse
    • Genetics
    • A family history of addiction
    • Mental health disorders like depression, ADHD, or PTSD
    • Lack of family involvement
    • Early use of drugs and/or alcohol

    What Are Common Signs of Polysubstance Addiction?

    If a person has developed a polysubstance abuse disorder, he or she may demonstrate certain behavioral and physical signs that could indicate they need help. Common signs of polysubstance addiction and abuse often include:

    • Continuing to take a prescription drug after it’s no longer needed.
    • Taking prescription drugs with alcohol or other drugs.
    • Needing more of a drug to achieve the desired effects (developing a tolerance).
    • Experiencing uncomfortable physical and psychological symptoms when the effects of the drugs wear off (these are called withdrawal symptoms).
    • Being unable to stop using drugs or control your usage.
    • “Doctor shopping” or going to more than one doctor to get prescription drugs.
    • Spending a lot of time thinking about drugs, getting drugs, using them, or recovering from use.
    • Losing interest in regular hobbies or activities due to drug abuse.
    • Having trouble completing normal daily tasks like cooking or going to work.
    • Trying to hide the physical effects the drugs have on you.
    • Borrowing or stealing money or valuables to fund your drug habit.
    • Having relationship problems due to the way your drug abuse affects your behavior and lifestyle.
    • Stealing medications from other people’s medicine cabinets.

    Polydrug Combinations: What Are Dangerous Drug Combinations?

    Alcohol, cocaine, and marijuana are the most commonly abused drugs, both alone and in conjunction with other substances. Alcohol, in particular, is frequently abused with cocaine, marijuana, and opioids.6 Other common polydrug combinations include:

    • This combination is very common but also very dangerous. Benzodiazepines like Ativan, Xanax, and Klonopin are dangerous when misused on their own, but when combined with prescription opioids like OxyContin, Vicodin, and hydrocodone, the result can be life-threatening.
    • Abusing alcohol and any kind of prescription drug simultaneously can cause alcohol poisoning, loss of consciousness, breathing problems, and sometimes death. Risky behaviors like drunk driving or unplanned sex are also common.
    • This is a particularly dangerous combo. Ecstasy (also referred to as molly) raises body temperature and alcohol dehydrates the body, which can easily lead to heatstroke, water poisoning, or heart failure. Long-term effects include liver damage, brain damage, cognitive problems, and clinical depression that can last long after the drug use has ended.
    • Although many drug users combine heroin with other sedatives because of the complementary effects the two drugs provide, when they are used together, the side effects can be dangerously intensified. The user may experience difficulty breathing, decreased heart rate, coma, cardiac arrest, or even death.
    • Using amphetamines (illegal or prescription forms) with other sedatives such as alcohol can easily cause accidents or overdose, which may result in seizures, heart failure, stroke, or death.

    Slang Terms for Drug Combinations

    People who abuse drugs may use slang terms to disguise their behavior or hide it from friends and loved ones. Below are some common slang terms for drug combinations that polydrug addicts may use:7

    • 3M – Mescaline, mushrooms (psilocybin), and Molly
    • A-bomb – Marijuana cigarette with heroin or opium
    • Amp joint – Marijuana cigarette laced with some form of narcotic
    • Atom bomb – Marijuana mixed with heroin
    • B-40 – Cigar laced with marijuana and dipped in malt liquor
    • Back breakers – LSD and strychnine
    • Back to back – Smoking crack after injecting heroin or using heroin after smoking crack
    • Bad seed – marijuana combined with peyote
    • Banana split – 2C-B (Nexus) with other drugs (commonly LSD)
    • Banano – marijuana or tobacco cigarettes laced with cocaine
    • Bars – heroin and alprazolam
    • Batman – cocaine and heroin
    • Bazooka – crack and marijuana, crack and tobacco combined in a joint, coca paste and marijuana
    • Beam me up Scotty(ie) – PCP and crack
    • Beast – heroin and LSD
    • Bikers coffee – methamphetamine and coffee
    • Bipping – snorting heroin and cocaine
    • Black hash or black Russian – opium mixed with hashish
    • Blanco (Spanish) – heroin and cocaine
    • Blunt – marijuana inside a cigar or cocaine and marijuana inside a cigar
    • Boy-girl – heroin mixed with cocaine
    • C & M – cocaine and morphine
    • Candy flipping on a string – combining LSD with MDMA or mixing LSD, MDMA and cocaine
    • Candy-flipping – LSD and ecstasy
    • Caviar – cocaine and marijuana
    • Cheese – heroin and Tylenol
    • China white  – heroin and fentanyl
    • Chips – tobacco or marijuana cigarettes laced with PCP
    • Chocolate chip cookies – MDMA and heroin or methadone
    • Chocolate rock – crack smoked with heroin
    • Chronic – marijuana mixed with crack
    • Cigamos – crack cocaine and tobacco
    • Clicker – crack and PCP
    • Cocktail – crack and marijuana; cigarette laced with cocaine or crack; to smoke cocaine in a cigarette
    • Cocoa puff – to smoke cocaine and marijuana
    • Cooler  – cigarette laced with a drug
    • Coolie – cigarette laced with cocaine
    • Cotton brothers – cocaine, heroin, and morphine
    • Crack back – marijuana and crack
    • Crack bash – crack cocaine and marijuana 
    • Crack cooler – crack soaked in wine cooler
    • Crackers – Talwin and Ritalin
    • Crangbustin – chewing tobacco with heroin
    • Crimmie – cigarette laced with crack
    • Croak – cocaine mixed with methamphetamine
    • Diablito (Spanish) – crack cocaine and marijuana in a joint
    • Dirty joints – crack cocaine and marijuana
    • Domex – PCP and MDMA
    • Donk – marijuana and PCP
    • Dors and 4’s – Doriden and Tylenol 4
    • Dragon rock – heroin and crack
    • Dust – marijuana mixed with various chemicals
    • Dynamite – cocaine and heroin
    • El diablito (Spanish) – cocaine, marijuana, heroin, and PCP
    • El diablo (Spanish) – cocaine, marijuana, and heroin
    • Elephant flipping – PCP and MDMA
    • Ethan – acid mixed with cocaine
    • Five-way – snorting heroin, cocaine, meth, ground-up flunitrazepam pills, and drinking alcohol
    • Flamethrowers – cigarette laced with cocaine and heroin
    • Flat chunks – crack cut with benzocaine
    • Flower flipping – MDMA and mushrooms
    • Frios (marijuana laced with PCP) – marijuana laced with PCP
    • Frisco special – cocaine, heroin, and LSD
    • Frisco speedball – cocaine, heroin, LSD
    • Fry – marijuana cigarettes dipped in embalming fluid or laced with PCP
    • Fuel – marijuana and insecticides
    • Geek – crack and marijuana
    • Goma (Spanish) – black tar heroin and opium
    • Goofball – cocaine and heroin
    • Greek – marijuana and powder cocaine
    • Gremmies – cocaine and marijuana
    • H & C – heroin and cocaine
    • H-bomb – MDMA mixed with heroin
    • Handlebars – crack cocaine and alprazolam
    • Happy stick – marijuana and PCP
    • He-she – heroin and cocaine
    • Herb and al – marijuana and alcohol
    • Hugs and kisses – methamphetamine and MDMA
    • Illies/illing – marijuana dipped in PCP
    • Illy – marijuana cigarettes soaked in embalming fluid
    • Jim jones – marijuana laced with cocaine and PCP
    • Juice joint – marijuana cigarette sprinkled with crack
    • Karachi – heroin, phenobarbital, and methaqualone
    • Kitty flipping – ketamine and MDMA
    • Lace – cocaine and marijuana
    • Ibj – heroin, LSD, and PCP
    • Leak – marijuana and PCP
    • Love flipping – mescaline and MDMA
    • Loveboat or lovelies – PCP and marijuana
    • Mexican speedballs – crack and methamphetamine
    • Missile basing – crack liquid and PCP
    • Moonrock – crack and heroin
    • New jack swing – heroin and morphine
    • One and ones – Talwin and Ritalin
    • One-fifty-one – crack sprinkled on tobacco
    • Oolies – marijuana cigarettes laced with crack
    • Outerlimits – crack and LSD
    • Ozone – PCP and crack cigarette
    • P-dogs – cocaine and marijuana
    • Pancakes and syrup – glutethimide and codeine cough syrup
    • Parachute – crack and PCP smoked
    • Parsley – marijuana and PCP
    • Party pack – 2C-B and MDMA (or other illegal drugs)
    • Pharming – mixture of prescription drugs
    • Pikachu – PCP and Ecstasy
    • Poro – heroin and PCP
    • Primo – marijuana mixed with cocaine; crack and heroin; cocaine and tobacco
    • Primo square – marijuana joint laced with crack
    • Primo turbo – crack cocaine and marijuana
    • Primos – Cigarette laced with cocaine and heroin
    • Pseudocaine – crack cocaine cut with phenylpropanolamine
    • Red rum – Heroin, barbital, strychnine, and caffeine
    • Red stuff – Heroin, barbital, strychnine, and caffeine
    • Ritz and ts – Ritalin and Talwin injected
    • Sleeper and red devil – heroin with a depressant
    • Smoking gun – heroin and cocaine
    • Snowball – cocaine and heroin
    • Snow seals – cocaine and amphetamine
    • Space base – crack dipped in PCP
    • Speedball – cocaine mixed with heroin; crack and heroin smoked together; Ritalin mixed with heroin
    • Speedies – MDMA with amphetamine
    • Squirrel – PCP and marijuana sprinkled with cocaine and smoked; marijuana, PCP, and crack combined and smoked
    • Stacks – MDMA with heroin or crack
    • Super X – methamphetamine and MDMA
    • Syrup – marijuana and cough syrup
    • Tar – crack and heroin smoked together
    • Thirty-eight – crack sprinkled on marijuana
    • Tio – cocaine-laced marijuana cigarette
    • Tnt – heroin and fentanyl
    • Torpedo – marijuana and crack
    • Tragic magic – crack dipped in PCP
    • Turbo – marijuana and crack
    • Twisters – crack and methamphetamine
    • Wac – PCP on marijuana
    • Waffle dust – MDMA and amphetamine
    • Water-water – marijuana laced with PCP or dipped in embalming fluid
    • Wet sticks – marijuana, PCP, and formaldehyde
    • Whiz bang – heroin and cocaine
    • Wicky – powder cocaine, PCP, and marijuana
    • Wicky stick – PCP, marijuana, and crack
    • Wild cat – Methcathinone mixed with cocaine
    • Wollie – Rocks of crack rolled into a marijuana cigarette or in a cigar
    • Woo blunts – marijuana and cocaine
    • Woola blunt – marijuana and heroin
    • Yeola – marijuana and crack
    • Zoom – marijuana laced with PCP
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      Who Has the Highest Rate of Polysubstance Abuse?

      Research shows adolescents are much more likely to be polydrug users than middle age or older adults and polysubstance abuse declines greatly after age 25.7 One study also found that drug users in urban areas are more likely to be polydrug users than drug users in rural areas, although there is a general lack of research on that topic.6

      Drug users who regularly abuse certain substances may also be more likely to use several different drugs simultaneously. For example, one study conducted in 14 European countries found that 60 percent of cocaine users were polydrug users, and of those, 42 percent used alcohol, 28 percent used cannabis, and 16 percent used heroin.2

      Another study, which took place in the U.S., found that nearly 50 percent of treatment admissions were for polysubstance abuse, illustrating the likelihood that drug users may eventually use multiple substances simultaneously, even if they initially only start out with one primary substance of abuse.2

      How to Detox From Polysubstance Addiction

      Detox for polysubstance abuse poses several unique challenges that must be addressed before addicted individuals can reach a stable state of sobriety.8 Most often, inpatient detox is recommended, as polysubstance detox is much more complex and the side effects of withdrawal are very unpredictable.

      During inpatient polydrug detox, clients are monitored round-the-clock by a staff of nurses and a supervising physician. Depending on the severity of the client’s substance abuse and dependence, the treatment team can provide a period of safe, medical monitoring, or medication-assisted treatment to relieve physical and psychological symptoms of drug withdrawal.

      In some instances, opioid replacement therapy may be used to reduce the severity of opioid withdrawal. This may be achieved with drugs like methadone or Suboxone. Drug detox for polysubstance abuse involving benzodiazepines may also include a tapering method, to gradually wean the client off of the drugs and into a safe and stable state.

      Since detox for polysubstance abuse is so complex and unpredictable, a personalized medical detox program is the best and safest way to get sober. Continued care is also essential, as some withdrawal symptoms may linger for weeks or even months. A continued care program like inpatient or outpatient rehab can help clients learn how to cope with cravings, implement relapse prevention strategies, and resolve trauma or negative thoughts and behaviors that have contributed to their substance abuse.

      Find a Polysubstance Addiction Treatment Center

      Overcoming polydrug addiction can be a challenging endeavor but with the right support and treatment, long-lasting recovery and sobriety are possible. With individualized polysubstance abuse treatment, you can start over and reclaim your life. 

      If you or a loved one is abusing multiple substances simultaneously, it’s so important to seek medical help to detox. At Briarwood Detox Center, we can help you begin your recovery journey with a comfortable, safe, and effective medical detox program that addresses the complexities of polysubstance abuse. Call Briarwood Detox Center today to speak with an admissions specialist about our detox program options, including executive detox for professionals or clients who prefer additional discretion and privacy while they detox. 


      1. http://www.minddisorders.com/Ob-Ps/Polysubstance-dependence.html
      2. http://www.drugs.ie/resourcesfiles/ResearchDocs/Global/World_Drug_Report_2014_web.pdf
      3. https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis
      4. https://grants.nih.gov/grants/guide/pa-files/par-16-291.html
      5. https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
      6. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-2-33
      7. https://www.noslang.com/drugs/dictionary/
      8. https://archives.drugabuse.gov/news-events/nida-notes/2008/03/alcohol-abuse-makes-prescription-drug-abuse-more-likely

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