Polysubstance abuse means using two or more substances, such as alcohol, opioids, benzodiazepines, or stimulants, at the same time or within a short period. Many people who misuse substances use more than one, which makes treatment more complex and the health risks significantly higher than with a single drug.
Laguna Shores Recovery, located in Dana Point, California, in Orange County, provides treatment for polysubstance abuse across multiple levels of care, from medical detox through residential and outpatient programs. If you or someone you care about is using more than one substance, understanding what polysubstance abuse is and how it is treated is an important first step. Learn more about detox and early treatment options as you consider next steps.
What is Polysubstance Abuse?
Polysubstance abuse occurs when a person regularly uses multiple drugs or combines substances like alcohol with prescription medications or illicit drugs. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include a single polysubstance diagnosis; instead, clinicians assess a separate substance use disorder for each substance involved, which complicates both diagnosis and treatment.
According to SAMHSA’s 2025 National Survey on Drug Use and Health, about 7.1 million people aged 12 and older had both an alcohol use disorder and a drug use disorder in the past year. This pattern is not rare, and it is not simply a matter of using more drugs. The substances interact in the body in ways that multiply risk.
Why Do People Mix Drugs and Alcohol?
People mix substances for a range of reasons, and the behavior is rarely random. Common motivations include managing withdrawal symptoms from one drug by using another, intensifying a high, or reducing unwanted side effects.
Some people combine substances to self-medicate untreated mental health conditions like anxiety, depression, or trauma. According to NIDA, individuals with co-occurring mental health disorders are significantly more likely to develop substance use disorders, and the two conditions often reinforce each other over time.
What Drug Combinations Are Most Common?
Some combinations appear far more often than others, and each carries its own set of risks. The most frequently reported combinations include:
- Alcohol and benzodiazepines (such as Xanax or Valium)
- Opioids and benzodiazepines
- Alcohol and opioids
- Cocaine and alcohol, which the body converts into a third substance called cocaethylene
- Stimulants and depressants, sometimes called “speedballing”
- Marijuana combined with alcohol or other drugs
According to NIDA, which draws on CDC data, there were 10,870 overdose deaths involving benzodiazepines in 2023, and nearly 70% of them also involved illicitly manufactured fentanyl. When two central nervous system depressants are combined, they slow breathing in ways that neither drug would cause alone, which is why this combination is especially deadly.
What Are the Health Risks of Mixing Substances?
Mixing substances increases the risk of overdose, organ damage, and death beyond what any single substance would cause. The body processes each drug differently, and when multiple substances compete for the same metabolic pathways, toxic levels can build up quickly.
Short-term risks include:
- Respiratory depression, particularly with opioids, alcohol, or benzodiazepines
- Irregular heart rate or cardiac arrest
- Seizures during or after use
- Loss of consciousness
- Impaired judgment leading to accidents or injury
Long-term risks include liver damage, cognitive decline, increased tolerance requiring higher doses, and a significantly harder withdrawal process. Polysubstance use is also associated with more severe health problems and poorer treatment outcomes than single-substance use disorders.
What Are the Warning Signs of Polysubstance Abuse?
Warning signs of polysubstance abuse often overlap with those of single-substance use, but certain patterns stand out. A person may show signs of intoxication that do not match the substance they are known to use, or they may experience withdrawal symptoms that are unusually severe or unpredictable.
Other signs include:
- Using one substance to manage the effects of another
- Keeping multiple substances on hand or hidden
- Rapid changes in mood, energy, or behavior
- Increasing secrecy around drug or alcohol use
- Continued use despite visible health consequences
If several of these patterns are present, a clinical assessment by a licensed professional is the appropriate next step.
How Is Polysubstance Abuse Treated?
Treating polysubstance abuse requires addressing each substance involved, along with any underlying mental health conditions. A single-substance treatment plan is not sufficient when multiple dependencies are present. Effective care typically combines medical management, behavioral therapy, and structured support across an appropriate level of care.
Medication-assisted treatment (MAT) uses FDA-approved medications alongside counseling to reduce cravings, manage withdrawal, and lower the risk of relapse. MAT is an evidence-based approach that can improve treatment retention and reduce the risk of overdose mortality.
For polysubstance cases, MAT may involve buprenorphine or naltrexone for opioid dependence, alongside medical monitoring for other substances. Laguna Shores Recovery offers MAT with both buprenorphine and naltrexone as part of its treatment options.
Behavioral therapies address the thought patterns and behaviors that drive substance use. Cognitive behavioral therapy (CBT) helps people identify triggers and develop coping strategies. Dialectical behavior therapy (DBT) and motivational interviewing are also used, particularly when emotional regulation or ambivalence about change is part of the picture.
According to NIDA, combining medication with behavioral therapy works best for many patients. Laguna Shores Recovery offers a range of evidence-based addiction therapies, including CBT, DBT, trauma therapy, and motivational interviewing.
The right level of care depends on the severity of use, the substances involved, and whether medical detox is needed. Under the ASAM Criteria, level of care is based on a multidimensional assessment, including withdrawal risk, medical and mental health needs, and the stability of a person’s living environment. Because withdrawal from multiple substances can be medically complex, people who use more than one substance may be assessed for a higher level of care, such as medically supervised detox or residential treatment.
Outpatient programs, including partial hospitalization (PHP) and intensive outpatient (IOP), are appropriate for people who have completed detox and have a stable living environment. Residential treatment provides 24-hour structure and medical oversight, which is often necessary when multiple substances are involved.
How Can Polysubstance Abuse be Prevented?
Prevention focuses on education, early intervention, and addressing risk factors before dependence develops. According to NIDA, early exposure to substances, untreated mental health conditions, and a family history of addiction are among the risk factors for polysubstance use disorder.
Effective prevention strategies include:
- Screening for substance use in primary care and mental health settings
- Educating young people about the specific risks of combining substances
- Treating co-occurring mental health conditions early
- Reducing access to prescription medications that carry high misuse potential
Polysubstance Abuse FAQs
Yes. Both combinations suppress the central nervous system, slowing breathing to potentially fatal levels. According to NIDA, citing CDC data, nearly 70% of the 10,870 overdose deaths involving benzodiazepines in 2023 also involved illicitly manufactured fentanyl, making this one of the most dangerous drug combinations documented.
Signs include intoxication that does not match a known substance, unusually severe or unpredictable withdrawal, keeping multiple substances on hand, and rapid mood or behavior changes. A formal assessment by a licensed clinician is the most reliable way to identify polysubstance use.
No. Withdrawal from multiple substances, particularly combinations involving alcohol, benzodiazepines, or opioids, can be medically dangerous and in some cases life-threatening. Medical detox in a supervised setting is strongly recommended for anyone dependent on more than one substance.
Many commercial insurance plans cover substance use disorder treatment, including polysubstance abuse, under the Mental Health Parity and Addiction Equity Act. Coverage varies by plan, so it is important to verify your specific benefits before beginning treatment. Our admissions team can help you verify your insurance and explain treatment costs.
Treatment length depends on the substances involved, the severity of dependence, and whether co-occurring mental health conditions are present. According to NIDA, treatment lasting 90 days or longer is generally associated with better outcomes, though the appropriate duration should be determined through a clinical assessment.
Recovery Is Possible at Laguna Shores Recovery in Dana Point, CA
Using more than one substance can make recovery feel more complicated, but it doesn’t put recovery out of reach. Laguna Shores Recovery, located in Dana Point in Orange County, California, treats polysubstance abuse across a full range of care, from medical detox and residential treatment to partial hospitalization, intensive outpatient, and aftercare. Our facility is accredited by The Joint Commission and licensed by the State Department of Health Care Services and the State Substance Use Treatment Agency.
Because many people who use multiple substances are also managing anxiety, depression, trauma, or other mental health conditions, our treatment includes dual diagnosis care that addresses both at the same time. We also understand that recovery looks different for everyone, which is why we serve young adults, women, men, seniors, and members of the LGBTQ community, each with care tailored to their needs.
If you or someone you love is struggling with more than one substance, you don’t have to figure out the next step alone. Contact Laguna Shores Recovery today to speak with our admissions team, verify your insurance, and learn which level of care is right for you.
Matthew Beck B.A, M.A, LMFT 
