When families are concerned about a loved one’s substance use, they may naturally focus on one particular drug or substance. In reality, substance use does not always involve just one substance. A person may use multiple substances together, use different substances at different times, or unknowingly be exposed to another substance through the illicit drug supply.
This is known as polysubstance use, and understanding what it means can help loved ones become more informed about the risks and complexities surrounding substance use.
For families, the goal is not to determine exactly what substances someone has taken or to diagnose an addiction themselves. Instead, learning about polysubstance use can provide helpful context for concerning changes in a loved one’s behavior, health, relationships, or responsibilities and help families recognize when it may be appropriate to seek professional guidance.
What Is Polysubstance Use?
Polysubstance use generally refers to the use of more than one drug or substance, either at the same time or within a relatively short period.
This can occur intentionally. For example, someone may knowingly combine two or more substances. It can also happen unintentionally when one substance contains another drug that the person did not expect.
Polysubstance use may involve different combinations of substances, including alcohol, opioids, stimulants, sedatives, or other drugs.
Because substances affect the body differently, combining them can make their effects less predictable. This is one reason families should understand that substance use may be more complicated than identifying a single drug.
Why Do People Use Multiple Substances?
There is no single reason someone may engage in polysubstance use.
Some people may intentionally combine substances because they are seeking particular effects. Others may use different substances at different times depending on availability, circumstances, or how they are feeling.
Substance use may also become part of someone’s attempts to cope with stress, difficult emotions, trauma, or other challenges.
In other situations, the individual may not know they are using multiple substances at all.
Illicitly manufactured drugs can contain unexpected substances, including fentanyl. Counterfeit pills may also resemble legitimate prescription medications while containing ingredients the person does not anticipate.
For families, this uncertainty is an important part of understanding polysubstance use. A loved one may not always be able to accurately identify everything they have taken.
Why Combining Substances Can Increase Risks
Different substances affect the body and brain in different ways. When substances are combined, their effects can interact and become difficult to predict.
Some substances slow activity in the central nervous system, while others increase it. Using multiple substances can create additional risks depending on what was taken, how much was used, and the individual’s health and circumstances.
The Centers for Disease Control and Prevention (CDC) notes that mixing drugs can be particularly dangerous because the effects may be stronger, more unpredictable, or even deadly.
These risks can be especially concerning when substances with similar effects are combined. For example, opioids and other substances that can slow breathing may create serious dangers when used together.
For loved ones, understanding the risks of polysubstance use is not about memorizing every possible drug interaction. The more important takeaway is that combining substances can create unpredictable and potentially serious situations that deserve attention.
Polysubstance Use Can Be Intentional or Unintentional
One of the most important things for families to understand is that polysubstance use does not always mean someone intentionally decided to combine several drugs.
The illicit drug supply can be unpredictable. Substances may be mixed or contaminated without the person using them knowing what is present.
This is particularly relevant to fentanyl. Illicitly manufactured fentanyl may be found in other drugs or counterfeit pills, creating the possibility of exposure even when someone did not knowingly seek fentanyl.
This uncertainty is one reason it may be difficult for family members to determine exactly what is happening based solely on what a loved one tells them they have taken.
Rather than trying to identify every possible substance, it can be more helpful to pay attention to broader patterns and concerning changes.
What Signs Might Loved Ones Notice?
There is no single set of warning signs that confirms polysubstance use. Different substances can produce different effects, and behavioral or physical changes may also have causes unrelated to substance use.
However, families may notice patterns such as:
- Significant or unpredictable mood changes
- Increased secrecy or isolation
- Changes in sleeping habits
- Difficulty maintaining work, school, or household responsibilities
- Changes in appearance or personal hygiene
- Unexplained financial problems
- Increasing conflict with family or friends
- Changes in social circles
- Loss of interest in previously enjoyed activities
- Periods of unusual energy followed by extreme fatigue
- Continuing substance use despite negative consequences
These signs should not be used to diagnose someone. Instead, they can provide a reason to check in with a loved one and consider whether professional guidance could be beneficial.
For a broader look at behavioral, emotional, and physical changes families may notice, read our article Signs a Loved One May Be Struggling With Addiction.
The Illicit Drug Supply Adds Another Layer of Concern
Today’s illicit drug supply makes conversations about polysubstance use particularly important.
People may believe they know what they are taking based on how a substance looks, how it was described, or what they were told when obtaining it. However, appearance alone cannot reliably identify everything an illicit substance contains.
Counterfeit pills can also create additional uncertainty because they may be designed to resemble prescription medications.
This does not mean families should attempt to inspect, identify, or test unknown substances themselves. Instead, awareness of the unpredictable drug supply can help loved ones understand why substance-related risks may extend beyond the drug a person believes they are using.
Talking to Someone You’re Concerned About
If you are worried about a loved one’s substance use, it can be tempting to begin the conversation by asking exactly which drugs they are taking. While understanding what someone has used can be important for healthcare professionals, families may have more productive conversations by beginning with what they have personally observed.
For example, you might express concern about changes in behavior, increased isolation, missed responsibilities, or other patterns that have caused you to worry.
Try to approach the conversation when everyone is calm and able to talk privately. Focus on concern rather than accusations, and give your loved one an opportunity to speak without immediately interrupting or trying to solve the problem.
A person may not be ready to discuss their substance use, or may not be aware of the level of severity.
The goal of the conversation does not have to be getting every answer immediately. Sometimes, expressing concern and letting someone know that support is available can be an important starting point.
When Substance Use Becomes an Emergency
Because polysubstance use can involve unpredictable effects, families should take signs of a possible overdose or other serious reaction seriously.
If someone is unresponsive, cannot be awakened, is experiencing serious difficulty breathing, or appears to be experiencing another life-threatening emergency, seek emergency medical assistance immediately.
Families do not need to determine which substance caused the reaction before seeking emergency help.
The CDC provides additional educational information about the risks associated with combining substances through its Polysubstance Use Facts resource.
Seeking Guidance for Families
You do not have to know exactly what substances a loved one is using before asking for professional guidance.
In fact, uncertainty is often one of the main reasons families reach out.
A healthcare or addiction professional may help families better understand concerns related to:
- Changes in a loved one’s behavior
- Patterns of substance use
- How to begin difficult conversations
- Addiction treatment and support resources
- Healthy family boundaries
- Ways to support someone without taking responsibility for their decisions
Seeking guidance is not the same as diagnosing your loved one. It is an opportunity to ask questions, learn more about the situation, and understand what resources may be available.
Understanding Polysubstance Use Can Help Families Stay Informed
Polysubstance use can make an already complicated issue even more difficult for families to understand. A person may knowingly combine substances, use different drugs at different times, or unknowingly encounter additional substances through an unpredictable illicit drug supply.
Families cannot always know exactly what someone has taken. What they can do is become informed, pay attention to concerning changes, maintain open communication when possible, and recognize when a situation may require additional guidance.
At Medical Care Clinic, we understand how challenging it can be to watch someone you care about struggle with substance use. Our team provides compassionate addiction care, education, and guidance for individuals and the families supporting them.
If you are concerned about a loved one’s substance use, speaking with a qualified professional may help you better understand your concerns and learn more about the support options available.