One Is Not Enough: Understanding and Modeling Polysubstance Use

Polydrug use with alcohol produces synergistic effects throughout the C-BG-T, likely as a result of alcohol’s unique pharmacological profile. For example, chronic pretreatment with nicotine enhances acute alcohol-induced DA release in the NAc (Johnson et al., 1995; Blomqvist et al., 1996), and elevated levels of DA, DOPAC, and HVA persist for over an hour (Tizabi et al., 2002, 2007; Ding et al., 2012). Additionally, alcohol and nicotine co-administration acutely increase production of BDNF and GDNF in the NAc (Truitt et al., 2015), along with increases in glutamatergic signaling in the VTA and PFC (Deehan et al., 2015; Engle et al., 2015). Notably, this wide activation of the C-BG-T network is absent following administration of either drug alone, demonstrating a unique mechanism of action for alcohol and nicotine polydrug use. Finally, people with mental health disorders have been found to have higher rates of substance use and substance use disorders versus the general population.

Symptoms and Diagnosis

It is estimated that 188 million individuals 12 years substance use disorder or older use cannabis worldwide (United Nations Office on Drugs and Crime, 2019), including 43.5 million individuals in the US (Substance Abuse and Mental Health Services Administration, 2019). Beginning in 2012 with Washington and Colorado, 11 states and the District of Columbia have legalized recreational cannabis, making it legally accessible to ∼328 million people. The number of cannabis users in the US has risen with its gradual decriminalization and legalization, from 4.1% in 2002, to 9.9% in 2007, to 15.9% in 2018 (Hasin et al., 2015; Substance Abuse and Mental Health Services Administration, 2019). Frequency of cannabis use is also high, with reports of 40% of individuals being daily or near-daily users (Substance Abuse and Mental Health Services Administration, 2019). Therefore, the best treatment for polysubstance use is optimizing and focusing treatment efforts on the substances we have the most effective treatments for, as opposed to focusing on substances we have less effective treatments for, like benzodiazepines and stimulants.

How can family members support a loved one in recovery from poly substance use disorder?

Intentional polysubstance use occurs when a person takes a drug to increase or decrease the effects of a different drug or wants to experience the effects of the combination. The use of more than one drug, also known as polysubstance use, is common.1 This includes when two or more are taken together or within a short time period, either intentionally or unintentionally. Their encouragement could be the motivation you need to contact a healthcare provider. You may need to try different treatment options to find one that works best for you.

Flexible, Personalized Care Plans

Long-term nicotine use also produces a persistent increase in mPFC pyramidal cell and NAc MSN dendritic branching (Brown and Kolb, 2001; Hamilton and Kolb, 2005; Ehlinger et al., 2016), similar to psychostimulants. Moreover, adolescent nicotine use enhances synaptic pruning, microglial activation, and inflammatory cytokine expression throughout the C-BG-T via a D2 receptor-mediated mechanism (Linker et al., 2020). Repeated co-administration of psychostimulants and nicotine augments long-term potentiation (LTP) induction and ΔFosB in the NAc core (Levine et al., 2011; Mello et al., 2014). Interestingly, these effects are absent following sequential administration of these drugs (Levine et al., 2011), indicating a unique pharmacological profile for concurrent nicotine and psychostimulant administration. Psychostimulants produce long-term disruptions in glutamate homeostasis and alterations in neuronal morphology throughout the C-BG-T network (Kalivas, 2009; Badiani et al., 2011). Repeated cocaine administration weakens GABAA-mediated inhibition of prelimbic (PrL) pyramidal neurons, increasing their excitability and augmenting excitatory drive to the NAc (Nasif et al., 2005; Huang et al., 2007).

• This comprehensive guide provides essential tips and strategies to help you stay sober during the 4th of July celebrations.
• Some of the more commonly studied polydrug combinations include administration of cocaine with other drugs (Francesco et al., 2003; Leri et al., 2003b; Substance Abuse and Mental Health Services Administration, 2016).
• Someone dependent on both alcohol and benzodiazepines faces potentially dangerous withdrawal that requires medical supervision.
• This over-representation may be due to consequential medical problems and other negative sequelae of substance use for which primary care treatment is sought (Cherpitel and Ye, 2008).

BTMPS Prevalence in the U.S. Drug Supply

• It’s important to turn to healthy coping mechanisms during these times of change, like exercising, meditating or learning a new hobby.
• They offer practical advice, accountability, and the kind of understanding that can only come from someone who’s been through similar struggles.
• It’s important to have a relapse prevention plan in place and seek support when needed.
• For more prevalent behaviors (polysubstance, cannabis), outcomes were past-month use frequency.
• For example, alcohol potentiates GABAA signaling both in cortical slices and neuronal cultures (Aguayo, 1990; Reynolds and Prasad, 1991; Reynolds et al., 1992; Tatebayashi et al., 1998).

While it may be one of the most difficult things to do, it’s OK to ask for help when you need it. Many find success through support groups (like Narcotics Anonymous) and ongoing therapy. You might need different types of treatment at different times during your recovery. Several types of treatment settings, including inpatient and outpatient settings, as well as short-term care and long-term therapeutic communities, are available. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must have at least two signs in the symptoms section over 12 months to be diagnosed with substance use disorder.