Many people use more than one substance. Some might drink alcohol while using marijuana, or combine prescription medications with other drugs.
When this pattern becomes problematic—when it starts affecting health, relationships, work, or daily life—it may be considered polysubstance use disorder.
Treatment for polysubstance use looks different than treatment for a single substance. It often involves addressing multiple dependencies simultaneously while recognizing how different substances interact in the body and brain.
According to research from the National Institute on Drug Abuse, polysubstance use is quite common among people with substance use disorders.
For example, among people with cocaine use disorder, many also meet criteria for other substance use disorders (including alcohol, nicotine, or cannabis). Among people with heroin use disorder, co-occurring nicotine, alcohol, and cocaine use disorders are also common.
These aren’t separate problems happening to the same person by coincidence. Substance use disorders often overlap because of shared genetic vulnerabilities, common environmental triggers, and the way substances affect similar brain pathways.
Treating multiple substance dependencies isn’t as simple as addressing each one separately. Substances can interact with each other in complex ways, both in how they affect the body and in how withdrawal presents itself.
Some combinations can increase medical risk. Someone dependent on both alcohol and benzodiazepines faces potentially dangerous withdrawal that requires medical supervision.
Someone using opioids and stimulants together may experience competing effects that complicate stabilization and treatment planning.
Alcohol combined with cocaine can create a toxic metabolite called cocaethylene, which can be more dangerous than either substance alone.
Beyond the physical complexities, people using multiple substances often have more severe symptoms and face more barriers to care than those with single-substance dependencies. That’s why carefully coordinated care (medical, behavioral health, peer support, and mental health) can be especially important.
Eleanor Health provides outpatient treatment specifically designed to address polysubstance use through integrated, whole-person care. Instead of treating each substance in isolation, treatment addresses the full picture—medical needs, mental health, behavior patterns, and daily-life stability.
Treatment often starts with understanding the scope of someone’s substance use. Medical providers may assess which substances are being used, how often, in what combinations, overall health status, any existing medical conditions, and mental health symptoms.
This assessment informs every aspect of the treatment plan and helps the care team prioritize safety and next steps.
Therapy for polysubstance can address multiple substances together rather than focusing on one substance at a time. Common approaches include cognitive behavioral therapy (CBT), relapse prevention therapy, and trauma-informed care (depending on need).
Cognitive-behavioral approaches help identify triggers across different substances, develop coping strategies that work regardless of which substance is involved, and a better understanding of the role each substance plays (stress relief, sleep, energy, social confidence, etc.).
Group therapy connects people with others facing similar challenges. Hearing how someone else manages cravings for alcohol while staying away from cocaine, or learning what helped another person stop using multiple substances, provides practical insights that complement individual therapy.
Medications can play an important role in polysubstance treatment, but they must be carefully individualized.
For example, for opioid use disorder, options may include buprenorphine or naltrexone. For alcohol use disorder, medications such as naltrexone or acamprosate may be considered. For someone managing stimulant use alongside depression or anxiety, psychiatric medications may help stabilize mood and reduce the urge to self-medicate.
Medical providers carefully consider medication interactions, risks, and benefits, and monitor how treatment affects overall wellbeing.
The goal isn’t only to reduce substance use; it’s to help people feel genuinely better and more stable over time.
Depression, anxiety, PTSD, bipolar disorder, and other mental health conditions frequently co-occur with polysubstance use.
Sometimes mental health symptoms came first and substances became a way to cope. Other times, prolonged substance use triggered or worsened mental health issues. Often, it’s complicated to sort out which came first.
What’s clear is that addressing mental health alongside substance use improves outcomes for many people. Someone struggling with severe anxiety may have a much harder time maintaining recovery without also getting support for anxiety.
Eleanor Health’s therapists and providers support both substance use recovery and co-occurring mental health needs as part of integrated care.
Peer recovery specialists bring lived experience that complements clinical expertise. They’ve navigated their own recovery journeys and understand both the clinical side and the day-to-day reality of building a life without substances.
Peer specialists provide practical guidance on managing cravings, building routines, finding recovery-friendly social supports, and accessing community resources like housing assistance or job training.
Peer support can also help people stay connected between appointments—especially when motivation dips or stress spikes.
Treatment provides tools and support, but recovery unfolds in daily life.
People often build recovery by creating new routines, finding purpose, developing healthy relationships, and learning to handle stress without substances.
This might look like:
Treatment at Eleanor Health can include helping people identify and access these kinds of supports. Peer recovery specialists can connect members to community resources. Therapists work with people to develop daily practices that support sobriety. Medical providers ensure physical health doesn’t become a barrier to building this new life.
There’s no standard timeline for polysubstance use disorder treatment. Some people make meaningful progress in a few months. Others need ongoing support for years. Many people find that some level of continued care, whether that’s monthly check-ins, ongoing medication management, or regular therapy, helps maintain stability long-term.
The Centers for Disease Control notes that polysubstance use is a growing factor in health risks related to substance use, including fatal overdose. This underscores why comprehensive, coordinated treatment matters so much. It’s not just about stopping substance use. It’s about reducing harm, improving health, and building sustainable recovery.
Eleanor Health’s outpatient model can be flexible over time. Appointments may become less frequent as stability improves, and increase again if challenges arise.
Starting treatment begins with calling or submitting our contact form. Staff discuss substance use, health concerns, and insurance. First appointments may be available quickly depending on location and provider availability. A medical provider can help create an initial plan and connect you with therapy and peer recovery support as appropriate.
Eleanor Health operates in many states with virtual treatment available throughout. Recovery from polysubstance use disorder is challenging but absolutely possible. Thousands successfully build lives where substances no longer control their reality.
CDC. “Polysubstance Overdose.” Overdose Prevention, 8 May 2024, www.cdc.gov/overdose-prevention/about/polysubstance-overdose.html.
National Institutes on Drug Abuse. “Common Comorbidities with Substance Use Disorders Research Report.” PubMed, National Institutes on Drug Abuse (US), 2020, www.ncbi.nlm.nih.gov/books/NBK571451/.
Andrews P. (1997). Cocaethylene toxicity. Journal of addictive diseases, 16(3), 75–84. https://doi.org/10.1300/J069v16n03_08
