Polysubstance abuse

When it comes to addiction in America, there’s no shortage of sources. There’s addiction to alcohol, to substances (illicit and prescription drugs used non-medically), gambling, spending, sex, work and eating disorders. It shouldn’t come as any surprise, then, that when someone seeks treatment for one addiction, they are often diagnosed with co-occurring and/or multiple addictions. In fact, there seems to be a thin line separating single and multiple addictions, also known as polysubstance abuse.

Substance abuse addiction has been defined as “uncontrollable, compulsive drug-seeking and use, even in the face of negative health and social consequences.” The Mayo Clinic says that drug addiction “is a dependence on a street drug or a medication,” that the addict may not be able to control drug use and continue using despite the harm it causes, and often suffers from intense cravings. In the classic sense of addiction, the same could be said of all types of addictive behavior. The addict is unable to control his or her actions, repeatedly seeks out and engages in the addictive behavior, suffers cravings and, more often than not, the addiction spills over into other areas. While a person may begin with an addiction to marijuana or alcohol, they may later develop a dependence on other illicit drugs, or experience problems with gambling, overwork, or sexual compulsions.

Dual Diagnosis

Substance abuse and mental health disorders, known as dual diagnosis or co-occurring disorders, are very common. According to statistics reported by the National Alliance on Mental Illness (NAMI), and taken from the Journal of the American Medical Association (JAMA) roughly 50 percent of persons with severe mental disorders are affected by substance abuse. Serious mental illness is present in some 37 percent of alcohol abusers and 53 percent of drug abusers. Perhaps most troubling is the JAMA’s estimate that 29 percent of all people diagnosed as mentally ill abuse either alcohol or drugs. Add to that the fact that dependence on certain drugs can lead to psychotic or severe mental illness, as well as the fact that mentally ill individuals may abuse substances in an effort to feel better and be able to function, and you have a clear correlation between the potential for single and multiple addictions. In fact, some addiction treatment centers estimate that some people have three or more diagnosable addiction or mental disorders occurring simultaneously.

How Big is the Problem of Multiple Addictions?

Getting a handle on just how prevalent single and multiple addictions are in the U.S. is not an easy task. Despite numerous studies on the subject of addiction, various types of addiction, treatment methods, medications and aftercare, no definitive study exists on how widespread multiple addictions are in this country. The consensus is, however, that the number is underreported, as many multiple- and dual-diagnosis addictions remain undiagnosed. In addition, what numbers are available are based upon individuals seeking treatment for substance or alcohol abuse or dependence and/or multiple co-occurring disorders, or dual diagnosis). Thus, the real numbers in the greater population of individuals who are addicted but do not seek treatment is probably much higher.

Statistics on Multiple Addictions

Let’s take a look at some recent statistics. According to findings from the 2008 National Survey on Drug Use and Health (NSDUH), prepared by the Office of Applied Studies (OAS) of the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 20.1 million Americans aged 12 and older were current (past month) illicit drug users. This represents 8.0 percent of the population aged 12 and older. Illicit drug use, in the report, includes marijuana/hashish, cocaine and crack cocaine, heroin, hallucinogens, inhalants, and prescription-type psychotherapeutics used for non-medical purposes.

In the same report, 51.6 percent of Americans aged 12 and older – or 129.0 million of the U.S. population – were current drinkers of alcohol.

Substance dependence or abuse accounted for an estimated 8.9 percent of the population aged 12 and older in 2008, some 22.8 million Americans. Of this number, 3.1 million had dual dependence for alcohol and illicit drugs. Interestingly, a previous (2005) SAMHSA survey, the National Survey of Substance Abuse Treatment Services, found that 47 percent of clients in treatment were addicted to both alcohol and illicit drugs.

Of concern is the fact that 20.8 million people in 2008 needed substance abuse treatment but did not receive it. The report also showed that, in 2008, there was an estimated 9.8 million adults (4.4 percent) with a serious mental illness. Of 2.5 million adults with a serious mental disorder and substance abuse or dependence, more than half (60.5 percent) received medical care or substance abuse treatment at a specialized facility, 11.4 percent received treatment for both mental illness and substance abuse, 45.2 percent received only treatment for mental health care, and 3.7 percent received only specialty substance abuse treatment.

Treatment for Multiple Addictions

To successfully treat multiple addictions, the patient must seek treatment from a facility or center (residential, inpatient hospital or outpatient) that specializes in each of the known or suspected addictions. It is important to note that not every treatment facility will accept or be able to treat patients with certain multiple addictions. The facility may not be equipped to deal with the addiction, and thus not accept the patient into treatment, or they may not diagnose an additional addiction (or more) right way and, therefore, not treat it.

This most commonly occurs with mental health illness and substance abuse. Either the patient is treated for substance abuse and nothing is done about the mental illness, or the patient undergoes care for the mental illness and the co-occurring substance abuse is left untreated.

Patients with dual diagnosis or multiple addictions are advised to seek treatment from licensed drug rehabilitation and treatment centers staffed with psychiatrists and/or master’s level clinical psychologists specifically trained to treat dual diagnosis clients. In addition, a licensed drug rehabilitation center is able to prescribe psych medications – either for the co-occurring mental illness or if they are needed to handle depression, anxiety, psychotic thoughts, suicidal thoughts and behavior, as well as manage acute withdrawal symptoms upon admission to the treatment program.

Not only are patients with a psychological disorder more likely to have other issues with drug abuse and addiction, individuals who abuse substances over long periods of time may exhibit brain changes that result in psychological disorders. It is estimated that 40 percent of patients treated for addiction and substance abuse are diagnosed with antisocial personality disorder, while 14 percent meet the diagnostic criteria for lifetime anxiety or depressive disorder. Men, twice as much as women, are likely to have antisocial personalities, while women are twice as likely as men to suffer major depression. The highest rates of antisocial personalities and generalized anxiety disorders are found among patients diagnosed with addiction to three or more substances.

Long-term abstinence – from drugs, alcohol and other addictive behaviors – is complicated by multiple addictions. As such, treatment for multiple addictions, as well as dual diagnosis disorders, must involve a multi-disciplinary and multi-dimensional approach. While most people entering treatment for a single addiction may see significant improvement in about 3 months (90 days), according to the National Institute on Drug Abuse (NIDA), those with multiple addictions will likely need much longer treatment, followed by intensive aftercare counseling and support.

Where to Find Treatment for Multiple Addictions

A good first step is to use the Substance Abuse Treatment Facility Locator, provided by SAMHSA, a searchable directory of more than 11,000 addiction treatment programs, updated weekly. There’s also the Mental Health Services Locator that SAMHSA maintains.

Check for facilities that specialize in treating the specific type of addictions you, or the person you’re inquiring about, have. Go to their websites and gain a thorough understanding of the treatment they offer. Make a list of questions and contact their representatives either by email or telephone. Definitely find out whether your insurance plan covers the treatment for multiple addictions, or if there are scholarships, federal, state or county funds available, pay-as-you-go, reduced-pay, payment based on ability or special financing available.

When you find a facility that meets all your requirements, make an appointment and tour the facility (if feasible). If everything is to your liking and you believe that the treatment facility offers you or the patient in question the best chance of recovery, make arrangements to have the individual undergo an initial assessment. Be sure that the treatment facility is aware of the specific multiple addictions or dual diagnosis disorders present (if fully known or suspected).

This will result in the development of a personalized treatment program to address the required addictions. For the spouse and/or family of the addict, it’s important to be supportive and involved in as much of the patient’s treatment program as recommended. In addition, spouse and family members can benefit from individual and group counseling and attendance at 12-step groups such as Al-Anon/Alateen, Co-Anon, Co-Dependents Anonymous (CODA), and Co-Dependents of Sex Addicts (COSA), among others. Here is a link to numerous links and resources.

Bottom line: whether you know or suspect that you or a loved one has multiple addictions, encourage them to get treatment now. The sooner they get help, the sooner they can be on their way to recovery.