How To Get Training in Polysubstance Abuse: The Hidden Trend Within the Opioid Epidemic

In the classroom or in the news, addiction is often treated as an issue with distinctive roots and boundaries:

It’s the opioid epidemic, a flood of heroin and synthetic opioids washing through America’s streets
It’s marijuana and THC, available legally in many states but often used illegally or in forms like edibles or vapes that are attractive to teens and children
It’s methamphetamines, cooked up in trailers and destroying rural communities
It’s alcoholism, silently killing thousands each year through liver disease and car accidents

Every once in a while, you’ll see someone acknowledge that, of course, the addiction problem is all of the above. But outside of the ranks of professional substance use disorder counselors or psychology professionals, you don’t often hear about the actual reality out on the streets: it’s often all of the above even in a single patient.

This is polysubstance abuse. It’s the most dangerous factor of substance use disorder patients in the United States today… and it’s a condition you’ll have to learn to treat if you want to help them.

A Problem Hidden in Plain Sight Defies Easy Resolution

Of course, polysubstance abuse isn’t exactly a new phenomenon; anyone you know who smokes and drinks to excess simultaneously is engaging in the practice. And the classic speedball, mixing amphetamines with opioids to sustain the euphoria while reducing anxiety and nervousness, has been around since at least the early 1980s and probably before.

It also has a long history of being exceptionally dangerous; speedball overdoses are what killed Chris Farley, DJ Rashad, and River Phoenix.

Some users have even attempted to use polysubstance doses in an attempt to self-treat addiction, similar to the way that methadone is used to medically treat opioid addiction.

Polysubstance abuse can also occur with prescription medications, particularly when used contrary to medical direction. Blends of adderall and xanax are often done to achieve an effect similar to combing coke and heroin.

The inadvertent mixing of various drugs, as in nicotine and alcohol, can be dangerous as well, but the biggest threats today are intentional efforts like mixing uppers and downers to try to tune a high. And with newer and more powerful drugs on both sides of that spectrum, that danger is greater than ever.

Why Polysubstance Abuse Is So Dangerous

The risks in serious polysubstance abuse are twofold:

These are both reasons why it’s critical for substance abuse counselors to understand the latest trends in polysubstance use and abuse in general, and in their area specifically.

Polysubstance abuse tends to fall into certain specific patterns, such as alcohol and cocaine, cocaine and opioids, or opioids and benzodiazepines. Each has their own key risk factors.

In general, however, studies consistently find that polysubstance abusers are at higher risk for:

The combination of how common this is with the elevated danger shows just how important it is to master treating this condition for even new addiction counselors.

A Formal College Education in Substance Use Disorders Is the Best Grounding for Future Studies of Polysubstance Abuse

Naturally, the basis for your understanding of polysubstance abuse will come out of your formal education in addiction counseling. The ground floor of figuring out these complex chemical, physiological, and psychological interactions is a firm understanding of each of the individual drugs that are going into the mix.

There aren’t a lot of courses in most SUD degree programs that explicitly address polysubstance use. You may run across it in diagnostic and assessment manuals, although polysubstance use disorder has been dropped from the DSM-5 as a formal and separate diagnosis. And it’s definitely something your professors have encountered in practice, and may discuss it in class even if it’s not on the syllabus.

Things open up a bit when you get to continuing education courses. Researchers who have done a deep dive into polysubstance abuse have been good about turning their papers and projects into courses available both online and in person. Most of them offer CEUs that will go toward maintaining your license or certifications.

Even NAADAC has gotten in on the game, with a webinar specific to the increase in polysubstance abuse involving opioids.

Street-Wise Teachers and Mentors May Be Your Best Resource For Current Trends in Polysubstance Use

Of course, the ultimate instruction comes through experience. The unique combinations of substances that are most common in your region will be evolving constantly. What you pick up in school will offer an introduction, but you’ll have to keep learning and improving your understanding to keep up with the changes.

This is where your supervised practice will be incredibly important. Mentorship from someone who is experienced practicing both in your area and with the specific combinations of drugs in use will build out your own knowledge as you pursue active cases.

Exploring Treatment Options for Polysubstance Abuse

Certain types of therapy may be more useful than others in approaching polysubstance addictions. For example, traditional methadone maintenance treatment for opioid addiction can have a limited effect when the opioid is only part of the addiction equation. Further, studies have shown that MMT can be less effective in patients who are also using other types of both legal and illegal substances.

On the other hand, the benefits of treating polysubstance abuse as a package deal is well proven. Studies have found that something as simple as dealing with tobacco dependence as part of treatment is associated with a 25 percent increase in long-term abstinence from alcohol and other substances.

There are also plenty of fairly generalized treatment methodologies that should be just as effective in polysubstance abuse treatment, since they aren’t substance-specific in the first place. MET, CBT, and relapse prevention techniques focus primarily on internal drivers and can cover multiple types of addictions simultaneously.

When Polysubstance Use Becomes a Sanctioned Course of Treatment for Addiction

There’s one other reason it is important for new substance abuse counselors to get up to speed on polysubstance use: it just could be part of your next successful treatment plan.

Just as the street finds its own uses for various substances designed for treating other conditions, it turns out that a certain subset of addiction patients have experimented with the use of hallucinogenic drugs to kick other substance use disorders. Ibogaine, in particular, a hallucinogen used in shamanic rituals in central Africa, has a reputation for helping people kick other habits.

They describe intensive trips that feel like undergoing years of therapy in a matter of hours, and a reduction in cravings afterward. But there is a considerable amount of debate in the field right now about the use of hallucinogens in the treatment of addiction.

As with most hallucinogens, individual experiences vary. At worst, ibogaine itself can case seizures or heart attacks.

Controlled studies of such substances are rare, since they are often tightly controlled Schedule I drugs themselves. Animal research has proven encouraging, however, and the underground rumor mill offers plenty of success stories from human users.

But scientists have begun to synthesize variants that may deliver recovery without hallucinations. Findings published by chemists at the University of California San Francisco in 2023 describe two potential new drugs modeled on ibogaine’s molecular makeup.

While these are years, if not decades from being actually trialed chemically, they may offer a drug that can be taken in tandem with others as a kind of cure. Like methadone for opioids, but with lower maintenance requirements and more applications, this kind of polysubstance use could completely revolutionize addiction therapy. You will want to be well-informed about all the pluses and minuses as you launch your career in addiction treatment.