Woman in polka dot dress holding a wine glass that alcohol and being poured into and smoking, new study shows polysubstance users have poorer addiction treatment outcomes

New Study Suggests Polysubstance Use may be Associated with Poorer Addiction Treatment Outcomes

Just have a problem with alcohol or drugs? A new study shows you have a better chance of successfully completing addiction treatment and a reduced re-admission rate versus those who abuse both.

The addiction treatment center client study measured treatment outcomes by looking at whether treatment was successfully completed and whether its clients readmitted within the 2019 calendar year. (Baksh, 2021)

Those who had been using both drugs and alcohol had poorer outcomes than those that used one or the other. The study did not distinguish between those who used multiple drugs and those who used a single drug, however.

A follow-up study is planned that will examine whether using just one drug was associated with a better treatment completion and lower re-admission rate compared to polysubstance use.

black and white spiral, new study shows polysubstance users have poorer treatment outcomes

What is Polysubstance Use… and Why Should We Care?

“Sick… mentally, physically and spiritually. That is exactly what I was before finally reaching out and asking for help. For the longest time, I didn’t consider myself an alcoholic or an addict because, in my twisted delusions, I thought I had it all under control. I was wrong… and everyone around me could see it, but I couldn’t myself. For years, I would drink to not remember the past and I would use to numb any emotions in the present. Drugs and alcohol were my coping method to escape mentally from events that happened during overseas deployments.”

– Tyler, former polysubstance user  (Addiction rehab before and after, 2021)

Polysubstance use disorder was once an official diagnosis. Individuals meeting this criteria generally:

  • Lacked a clear drug of choice
  • Used three or more substances
  • Were using multiple substances in an effort to stay high continuously

While polysubstance use disorder was removed by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), studies in the field have shown some distinctions between single and polysubstance users.

A 2014 review, for example, found that those using a wider range of substances had a higher risk of co-occurring disorders – along with health issues and cognitive functioning problems. (Connor, Gullo, White, & Kelly, 2014)

Similarly, in a National Epidemiological Survey on Alcohol and Related Conditions participant study, individual use profiles were analyzed and classified into five groups, from no abuse to polysubstance use.

Major findings of the study were:

  • Major depressive disorder was most strongly associated with polysubstance use.
  • Anxiety was most strong associated with prescription drug abuse/dependence.
  • Alcohol and anti-social personality disorder (ASPD) were more strongly associated individuals in all groups of users versus those with no substance abuse

A particular polysubstance abuse pattern of use – sedatives, opiates and tranquilizers – was also associated with anxiety disorder. The study also identified a “high-risk group” that had an increased rate of all psychological disorders on one side of the spectrum and a “milder” group using cannabis only on the other. (Agrawal, Lynskey, Madden, Bucholz, & Heath, 2006)

Woman in polka dot dress holding a wine glass that alcohol and being poured into and smoking, new study shows polysubstance users have poorer addiction treatment outcomesWho is the Typical Polysubstance User?

Of course, substance users come from all demographics.

However, the National Epidemiological Survey on Alcohol and Related Conditions participant study found certain factors to be more prevalent in polysubstance users versus those with a single drug of choice.

These included people who were:

  • Male
  • Younger
  • Socioeconomically disadvantaged
  • Attained a lower educational level
  • Had a history of childhood abuse/maltreatment

(Bhalia, Stefanovics, & Rosenheck, 2017)

In terms of clinical outcomes and life consequences, polysubstance use is also associated with higher rates of:

  • Depression
  • Suicide attempts
  • Deviant behaviors, arrests and incarceration
  • Infection and other medical problems
  • Financial trouble

(Bhalia, Stefanovics, & Rosenheck, 2017)

Polysubstance Use on the Severity Spectrum

“I was at the very lowest point I could get and didn’t want to BE anymore. The pain and the guilt that the enemy kept taunting me with was the open sore and my drugs and alcohol were the balm I needed to soothe the constant ache.”

– Christy, former polysubstance user (Addiction Rehab Before and After, 2021)

Given the greater propensity of co-occurring issues, childhood history and worsening outcomes, a tendency toward polysubstance use could be an indicator of more severe underlying issues.

This can be particularly true in light of the self-medication hypothesis of addiction. This hypothesis postulates that substance use is an attempt to fix unaddressed psychological issues.

Similarly, polysubstance use results in more severe psychiatric and medical issues as well. Individuals are also more likely to indulge in “risky social behaviors,” according to the National Epidemiological Survey on Alcohol and Related Conditions participant study. (Bhalia, Stefanovics, & Rosenheck, 2017)

Other research backs this up. Case in point: A national VHA study found that veterans with two or more substance use disorders had not only more co-morbidities as compared to those with one, but had more serious ones as well.

They also used services such as the emergency department, substance abuse and mental health programs more frequently than those with a single substance use disorder.

Polysubstance use disorder was also associated with personality disorder, bipolar disorder, schizophrenia and depressive disorders. Those with polysubstance use disorder were also frequently taking antipsychotic and antidepressant medications.

Study authors noted that, the higher the level of polysubstance use, the more “pronounced” these markers were. (Bhalia, Stefanovics, & Rosenheck, 2017)

Where does all of this lead? At a minimum, it shows that polysubstance use may also need to be a factor considered in clinical assessment and practice.

two golden butterflies on a pink flowering plant amid greenery with a blurred background, new study finds polysubstance users have poorer addiction treatment outcomes

Clinical Implications of Polysubstance Use

Of course, we must consider that polysubstance use may be driving co-occurring diagnoses, in at least some cases. But, rather than sussing out the chicken-and-egg relationship between the two, its arguably more important to figure out the clinical implications.

Research supports the fact that you can’t treat conditions in a vacuum… especially addiction.

This is not a new message, however.

The best addiction treatment centers already incorporate co-occurring diagnosis treatment into their programs and services.

They also have medical practitioners and treatments, including psychotropic medications, available to those who need it.

Cutting edge drug and alcohol rehab facilities even have brain mapping and neurofeedback available to retrain the brain. These treatments show promise in treating everything from anxiety to PTSD and depression to addiction.

Finally, to reinforce these clinical gains, the best addiction treatment centers also aid clients in re-integrating with the real world, finding gainful employment and building a social ecosystem that supports lifetime sobriety.

It’s a holistic approach to addiction, mental health and total wellness that is proven to work.

All is Not Lost

“I have regained care and compassion for others… Before I could do that, I had to learn how to care about and love myself. Today, I have rebuilt genuine relationships with my family, newfound friends and my higher power. I have gained these things by being honest, getting a sponsor and living through my Higher Power the 12 steps and traditions. These are the things I’ve learned through the support of Foundations and all the staff in order to live a happy, healthy life.”

– Tyler, former polysubstance user (Addiction Rehab Before and After, 2021)

“This past year has been such a beautiful new experience. It hasn’t been an easy road in the sense that… I left behind wreckage and chaos from blazing a trail in active addiction. But guess what? I submitted to my Lord and allowed Him to show me how to act and react through the team at Foundations. They taught me how to get a proper perspective on life… I have a passion for life, and even when life gets tough, I have true joy.”

Christy, former polysubstance user (Addiction Rehab Before and After, 2021)

If you are a polysubstance user, you should not give up hope. Just like their single user counterparts, those without a clear drug of choice still get clean every day.

Perhaps there are more – or more severe – issues to address, however, successful addiction treatment is out there for you.

With the right help from the right drug and alcohol rehab, you can achieve sobriety. You can also stack the deck in your favor by taking any prescribed medications and continuing your treatment (even once a week, on a fully outpatient basis) as long as you need.

You can also build mitigating factors into your life to support your recovery. Even while receiving addiction treatment (especially if it’s an outpatient facility), you can build a circle of friends who don’t use drugs, for example. You can also look for a new career.

You are not the first to walk this path… and you most likely won’t be the last, either. Seek help from a qualified addiction treatment center that can show you the way out, as they have for many others before you.

RELATED: Do you have an addictive personality?
What is an addictive personality?
How do you overcome addiction?


Addiction rehab before and after. (2021, February 23). Retrieved March 10, 2021, from Foundations Wellness Center

Agrawal, A., Lynskey, M., Madden, P., Bucholz, K., & Heath, A. (2006, October 20). A latent class analysis of illicit DRUG abuse/dependence: Results from the NATIONAL epidemiological survey on alcohol and related conditions. Retrieved March 10, 2021, from Wiley Online Library

Baksh, J., MCAP, LMHC. (2021, January 27). Florida drug and alcohol Rehab CLIENT Study 2019. Retrieved March 10, 2021, from Foundations Wellness Center

Bhalia, I. P., MD, Stefanovics, E. A., PhD, & Rosenheck, R. A., MD. (2017, September). Clinical epidemiology of single versus multiple substance… : Medical care. Retrieved March 17, 2021, from Lippincott Research

Connor, J.P., Gullo, M.J., White A., & Kelly, A.B. (2014). Polysubstance use: Diagnostic challenges, patterns of use and health. Current Opinion in Psychiatry. Retrieved March 10, 2021, from PubMed.gov


Justin Baksh, LMHC, MCAP, Chief Clinical Officer

Chief Clinical Officer
Foundations Wellness Center

Meet author Justin Baksh, LMHC, MCAP, the Chief Clinical Officer of Foundations Wellness Center. A former United States Marine, Justin holds a Master’s in Mental Health Counseling and has also attained the Certified Master’s Level Addiction Professional credential.

Justin has over 10 years of experience working with substance use and polysubstance use disorders, as well as anxiety, depression, life stressors, life transitions, trauma, PTSD, ADHD, ADD, OCD, and a variety of other disorders using cognitive behavioral therapy, DBT, biofeedback, strength-based and solution-based modalities. Read Full Bio

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