A Review of Terms: What Constitutes Polydrug Use?
Before tackling polydrug use, it is imperative to know and understand what is considered a “drug” and to define drug abuse. According to the FDA, drugs are substances that are intended to be used “in the diagnosis, cure, mitigation, treatment or prevention of disease.” Drug abuse is then defined as the use of drugs that deviates from socially or medically appropriate patterns.
Polydrug use is a broad term loosely defined as the use of multiple—usually medically prescribed but also sometimes illegal—drugs at the same time. It is usually performed to enhance and augment the desired physiologic or psychoactive effects of each individual drug. When done properly, polydrug use is not likely to result in addiction or abuse. However, it is also precisely because of its ability to produce beneficial and rewarding effects in the body that polydrug use can cause drug addiction.
How Does Polydrug Use Cause Addiction?
All drugs, when taken excessively, directly activates the part of the brain that is responsible for what is called the “reward system”—that is, the part of the brain that is capable of producing feelings of euphoria or being high. And because psychologically, euphoria is a positive feeling, the body will seek more of it, leading to unnecessarily frequent and excessive intake of multiple drugs. This causes drug addiction.
What are the reasons for polydrug use?
Polydrug use is common among groups of young people, especially those who go to nightclubs or rave parties where alcohol and other substances such as cocaine and methamphetamine are easily available. Polydrug use is considered “normal” in these situations, as the users tend to take these drugs to further increase their “high.”
To Reduce the Side Effects of Other Drugs
People who take depressant drugs such as benzodiazepines may want to decrease the sedative effects of these drugs by taking stimulants such as cocaine. On the other hand, the after effects of some drugs such as ecstasy can be toned down by taking other drugs such cannabis.
To Manage Chronic Pain
Non-prescribed over-the-counter medications can be taken on top of prescribed pain relievers by patients who do not get enough relief from their pain medications. For example, patients who take morphine for the alleviation of their pain can take alcohol or other over-the-counter drugs to enhance the pain-relieving effects of morphine.
To Manage Sleeping Problems
People who have a difficult time falling asleep can take multiple sedative substances such as alcohol, cannabis, and benzodiazepines to help them get to sleep faster.
What Are the Potential Adverse Effects of Polydrug Use?
While polydrug use can enhance the beneficial effects of each drug, it can also cumulatively amplify its adverse effects, making polydrug use a highly dangerous and potentially fatal drug use disorder. The type of drug, frequency of use, and dosage all contribute to the health risks of polydrug use.
Certain drug interactions among various drugs can lead to increased toxicity in the body through various mechanisms. For one, some psychoactive drugs have the potential to slow down the body’s metabolism, causing accumulation of the drugs in the body. Another is through the production of metabolites or breakdown products derived from drug metabolism which may be toxic to the body.
Increased Risk-Taking Behavior
Some psychoactive substances, like alcohol, have the ability to impair judgment and decrease cognition. This leads to a reduced capacity of the patient to determine the appropriate amount of other substances to be taken which may cause substance intoxication. It can also activate their risk-taking behavior, which can further result in more negative outcomes such as accidents and injuries.
General Medical Problems
Because most drugs are metabolized either in the liver or kidneys, the excessive use of multiple drugs can greatly damage these organs, which can lead to severe organ dysfunction. These causes a lot of medical problems such as hypertension, hepatitis, and cardiovascular risk.
Patients who use multiple psychoactive drugs at the same time are more prone to drug overdose because the ability of the drugs to produce euphoric feelings increases the patient’s likelihood of taking the drugs more frequently than necessary. Drug overdose is one of the most serious consequences of polydrug use as it rapidly alters the body’s physiologic state which can lead to severe complications such as arrhythmias, increase in blood carbon dioxide, and coma. Drug overdose is a potentially fatal condition.
Signs and Symptoms of Polydrug Use
Polydrug use has a lot of negative side effects because of their ability to alter physiologic mechanisms in the body. Common signs and symptoms of polydrug use include headache, dizziness, drowsiness, nausea and vomiting, gastrointestinal disturbances, decreased cognition, memory deficits, and impaired sensation.
What Are the Common Substances Used together?
Alcohol and Cannabis
Alcohol and cannabis are two of the most widely available substances in the United States, which is why they are also one of the most common combinations of polydrug use. When taken together, alcohol and cannabis become more potent in producing hallucinogenic effects, which can increase the risk-taking behavior of its users, resulting in injuries, accidents, and other harmful consequences.
Alcohol and Cocaine
Alcohol has the ability to produce cocaethylene, an active breakdown product of cocaine that stays longer in the blood. Cocaethylene has a lot of adverse side effects, including increase in heart rate and blood pressure which in turn increases the risk for stroke and heart attack, making it a more toxic substance than cocaine itself. Alcohol also has the potential to increase the levels of cocaine in the blood by as much as 30%, which can result in drug overdose when not taken with caution. Because cocaine has the ability to impair cognition, it also enables increased alcohol consumption among its users by decreasing their sensitivity to alcohol intoxication, leading to increased risk-taking behavior.
Heroin and Benzodiazepines
Heroin is a highly addictive opioid drug which helps in pain relief and produces feelings of calmness and relaxation. Benzodiazepines are another psychoactive class of drugs which have essentially the same effect as heroin. Patients usually take them together, either by ingestion or injection, to augment their ‘calming’ or ‘sedative’ effects. Both drugs are capable of slowing down heartbeat and breathing, thus taking them together can lead to potentially harmful consequences such as coma and drug overdose.
Opioids and Cocaine
Opioids are a broad class of drugs used mainly for pain alleviation. High doses of opioids can depress the central nervous system, slowing down both breathing and heart rate. Cocaine, on the other hand, are stimulant drugs that induce an increase in heart rate. When used in combination, opioids and cocaine amplify each other’s negative cardiovascular effects that can result in respiratory depression, and without intervention, this can cause death.
Amphetamines and Ecstasy
These are the two most popular drugs used in rave parties and nightclubs, and the combined effects of these stimulants on the body’s sympathetic activity can lead to fatal consequences. When used simultaneously, these drugs can overstimulate the body and can cause rapid alterations in heart rate, blood pressure, and body temperature. Over time and without proper interventions, these physiologic alterations can result in serious complications such as cardiovascular injuries and kidney failure.
How Is Polydrug Use Treated?
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The approach to the treatment of polydrug use is similar to that of other substance use disorders, with psychotherapy being the cornerstone of management. Individual psychotherapy, behavioral psychotherapy, family therapy, and support groups are just some of the most beneficial modalities of treatment in polydrug use. Helping the patients to recognize their own destructive behavior and the consequences that come with it is central to this treatment approach, as this will empower the patients to seek recovery for themselves.
It is also critical for the patient to be able to identify their possible reasons for engaging in polydrug use. These can include poor quality of sleep, mental health problems or other personal issues. By doing so, their doctors can help them become more proactive in seeking appropriate ways of addressing these problems.
Also, a key aspect of treatment is to help the patient identify the particular drugs and substances that cause their symptoms and other unwanted side effects. It is also crucial to help the patient acknowledge the specific aspects of their life that are negatively affected by their excessive and frequent use of these drugs because these will help reinforce their desire to be treated.
Pharmacotherapy is mostly used as an adjunct to psychotherapy, but specific substances such as methadone (for opioid dependence) and naltrexone (for alcohol dependence) are available to keep drug use to a minimum or to avoid relapses. A successful pharmacologic treatment, however, cannot occur without effective psychotherapy because constant reinforcement is needed to attain optimal compliance to these medications.
Referral to Other Services
While polydrug use is a psychiatric problem, a holistic approach to treatment must always be recommended to address the underlying problems that lead the patient to polydrug use, or in contrast, problems that have arisen from polydrug use. Because polydrug use can cause various general medical problems, a referral to an internist may be suggested for an overall evaluation of the patient. Polydrug use patients can also benefit from social services such as housing or employment assistance.
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