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Polysubstance dependence

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A person with polysubstance dependence is psychologically addicted to being in an intoxicated state, but because no single drug predominates, the person does not develop symptoms of physical dependence (tolerance, physical withdrawal upon cessation, etc.) in relation to any of the abused substances.[1]


Commonalities in Polysubstance Dependence

The results of a longitudinal study on substance use led the researchers to observe that excessively using or relying on one drug increased the probability of excessively using or relying on another drug.[2] When discussing polysubstance dependence, any combination of three drugs can be used, but studies have shown that alcohol is commonly used with another substance.[3] This is supported by one study on polysubstance use that separated participants who used multiple substances into groups based on their preferred drug. The three substances were cocaine, alcohol, and heroin, which implies that those three are very popular.[4] Other studies have found that opiates, cannabis, amphetamines, hallucinogens, inhalants and benzodiazepines are often used in combination as well.[5]

Polysubstance dependence happens more often than was previously thought, according to a study that analyzed the results from the National Epidemiological Survey on Alcohol and Related Conditions, approximately 215.5 out of a total of 43,093 individuals in the United States (0.5%) met the requirements for polysubstance abuse/dependence.[6] In Munich, Germany, a group of researchers chose to look at responses to a survey using the M-Composite International Diagnostic Interview (M-CIDI). Data was collected from 3,021 participants, all between the ages of fourteen and twenty-four, regarding the prevalence of drug abuse/dependence and of polysubstance abuse/dependence.[7] The results of this study indicated that of the 17.3% who said that they regularly used drugs, 40% said that they used more than one substance, but 3.9% specifically reported using three or more substances, indicating that there is a lot of overlap in the use of different substances.[8]

Studies That Have Been Done on Polysubstance Dependence

Gender and Polysubstance dependence studies

One study of polysubstance dependent men showed that neuropsychological ability did not improve with increases in the length of time abstinent. This suggests that polysubstance dependence leads to serious impairment which cannot be recovered much over the span of a year. [9]

Another study, involving 63 polysubstance dependent women and 46 controls, showed that in polysubstance dependent women, verbal learning ability is significantly decreased, though visual memory is not affected. In addition, alcohol and cocaine use led to more severe issues with verbal learning, recall, and recognition. [10]

Women and men differ in various ways when it comes to addictions. Research has shown that women are more likely to be polysubstant dependent. It has been noted that a larger percentage of women abuse licit (legal) drugs such as tranquilizers, sedatives, and stimulants. On the other hand, men are more likely to abuse illicit (illegal) drugs such as cocaine, meth, and other street drugs. It is also interesting to note, as research suggests, that women addicts more frequently have a family history of drug abuse. When asked to describe their onset of addictions, women more frequently describe their addiction as sudden where as men describe them as gradual. Females have a higher percentage of fatty tissues and a lower percentage of body water than men. Therefore, women have slower absorption rates of drug substances. This means these substances are at a higher concentration in a women’s bloodstream. Women addicts are known to be at greater risk for fatty liver disease, hypertension, anemia, and other disorders. [11]

Cognition and Polysubstance dependence studies

Cognition refers to what happens in the mind, such as mental functions like "perception, attention, memory, language, problem solving, reasoning, and decision making."[12] One study decided to test the cognitive abilities of participants in rave parties who used multiple substances. To do this, they compared twenty-five rave party attenders with twenty-seven control participants who were not using drugs. The results of this study indicated that in general, the rave attender group did not perform as well on tasks that tested speed of information processing, working memory, knowledge of similarities between words, ability to attend while something is interfering with attention, and decision making. Certain drugs were associated with particular mental functions, but the researchers suggested that the impairments for working memory and reasoning were caused by the misuse of multiple substances.[13]

Another study that tried to find differences between the effects of particular drugs focused on polysubstance users who were seeking treatment for addictions to cannabis, cocaine, and heroin. They studied a group of polysubstance users and a group that was not dependent on any drugs. Because alcohol was a common co-substance for nearly all of the polysubstance user group, it was difficult to tell exactly which drugs were affecting certain cognitive functions. The researchers found that the difference in the two groups' performance levels on executive function tasks were consistently different, with the polysubstance group scoring lower than the control group. In general, this meant that multiple substances negatively affected the polysubstance group's cognitive functioning, but more specifically, the researchers found that the amount of cannabis and cocaine affected the verbal part of working memory, the reasoning task, and decision making, while cocaine and heroin had a similar negative effect on visual and spatial tasks, but cannabis particularly affected visual and spatial working memory.[14] These results suggest that the combined use of cannabis, cocaine, and heroin impair more cognitive functions more severely than if used separately.[15]

One study decided to try to determine if polysubstance users who also abused alcohol would display poorer performance on a verbal learning and memory test in comparison to those who abused alcohol specifically.[16] The California Verbal Learning Test (CVLT) was used due to its ability to "quantify small changes in verbal learning and memory" by evaluating errors made during the test and the strategies used to make those errors.[17] The results of this study showed that the group of polysubstance and alcohol abusers did perform poorly on the CVLT recall and recognition tests in comparison to the group of alcohol abusers only, which implies that alcohol and drug abuse combined impaired the memory and learning of the group of polysubstance and alcohol abusers in a different way than the effects of alcohol alone can explain.[18]

Genetics and Polysubstance dependence studies

It has been shown that depression and posysubstance are often comorbid of each other, meaning they are both present at the same time. If a person is genetically predisposed to be depressed then they are at a higher risk of having polysubstance dependance. [19]. There is data to support that there are some genes that contribute to substantial dependance, although there are not many. [20]

Depression and Polysubstance dependence

Scientists have hypothesized that drug use either causes, or at least attributes to, the mood disorder, depression, or the drugs that sufferers of depression take is a method they use to manage it; a type of self medication.[21]

It is difficult to find the cause of polysubstance abuse; particularly when taking into consideration the abuse is often a form of self medication to those who suffer from an untreated and undiagnosed mental disorder; such as, depression. So the underlying mental illness, which causes judgement impairment by itself, needs to be identified and treated in conjunction with treating the polysubstance abuse, or the likelihood of success with treating the polysubstance abuse and preventing relapses is minimal. .[22] Alcohol and depression are very commonly inter related to each other and researchers have discovered that depression continuous for several weeks after a patient had been rehabilitated. The results of this study showed that , the onset of depression happens after alcohol dependence occurs .[23]

How Polysubstance is Diagnosed

The DSM- IV is a book that is well known in the psychology field. It is full of all the mental disorders that have been accepted by the scientific community. The DSM-IV also includes all the requirements/symptoms a person must have to be diagnosed with a certain disorder. According to the DSM-IV, if a person uses three or more substances, while not being dependent on a specific one , within a twelve month period they qualify for a diagnosis of Poly substance abuse. [24]. When coding Polysubstance Dependence in a DSM-IV-TR multiaxial diagnosis, " 304.80- Polysubstance Dependence" is accompanied by a list of the substances abused (e.g. "305.00 Alcohol Abuse", "305.60 Cocaine Abuse"). [25].

There is a distinct difference between a person having three, separate dependence issues and having Polysubstance dependence. To clarify if a person is addicted to three separate narcotics such as cocaine, meth and alcohol and is dependent on all three then they would be diagnosed with three separate dependence disorders( cocaine dependence, methamphetamine dependence and alcohol dependence), not polysubstance dependence..[26]

Symptoms

The DSM requires at least three of the following symptoms present during a 12 month period for a diagnoses of polysubstance dependence. [27].

  • Tolerance: Use of increasingly high amounts of a substance or they find the same amount less and less effective ( the amount has to be at least 50% more

of the origional ammount needed)

  • Withdrawal: Either withdrawal symptoms when drug stops being used or the drug is used to prevent withdrawal symptoms.
  • Loss of control: repeated use of more drugs than planned or use of the drugs over longer periods of time than planned.
  • Inability to stop using: either unsuccessfully attempted to cut down or stop using the drugs or a persistent desire to stop using.
  • Time: Spending a lot of time obtaining drugs, using drugs, being under the influence of drugs, and recovering from the effects of drugs.
  • Interference with activities: give up or reduce the amount of time involved in recreational activities, social activities, and/or occupational activities because of the use of drugs.
  • Harm to self: continuous use of drugs despite having a physical or psychological problem caused by or made worse by the use of drugs. [28].

Treatment

Treatment for Polysubstance dependence is much like that of other addictions- only on a multiple scale. Treatment for polysubstance dependence has many critical aspects. It needs to be a sufficient period of time in treatment, the treatment needs to be individualized, and it needs to be continued to prevent relapse. The most common forms of treatment for polysubstance dependence include: in and outpatient treatment centers, counseling and behavioral treatments, and medications. [29]

In-patient treatment centers are treatment centers where addicts move to the facility while they are undergoing their treatment. In-patient treatment centers offer a safe environment where patients will not be exposed to potentially harmful situations during their treatments as they would on the outside. In-patient treatment centers see much higher success rates than the alternative out-patient treatments. In-patients usually undergo the process of detox. Detox involves the removal (usually medically) of all drug substances from the body. Once detox is complete, the withdrawal symptoms kick in (2-3 days later). These symptoms include, but are not limited to: nausea, depression, anxiety, panic attacks, restlessness, and drug cravings. [30] Out-patient treatments include many of the same activities offered in an in-patient treatment facility, but the patient is not protected by the secure and safe environment of an in-patient treatment center. For this reason, they are significantly less effective. [31]

Both in and out treatments can offer a 12-step program. These organizations and programs are much like Alcoholics Anonymous (AA). They offer regular meetings where members can discuss their experiences in a non-judgmental and supportive place. In one study, conducted on 12-step outpatients, 1 in 5 reported abstinence from drug abuse 1 year post treatment. 12 Step programs and other social support groups are a good way to prevent relapse. [32]

Also offered to patients are one-on-one counseling sessions and cognitive behavioral therapy(CBT). [33] When looked at through a cognitive-behavioral perspective, addictions are the result of learned behaviors developed through positive experiences. In other words, when an individual uses a drug and receives desired results (happiness, reduced stress, etc.) it may become the preferred way of attaining those results, leading to addictions. The goal of CBT is to identify the needs that the addictions are being used to meet and to develop skills and alternative ways of meeting those needs. The therapist will work with the patient to educate them on their addictions and give them the skills they need to change their cognitions and behaviors. CBT is an effective treatment for addictions. [34]

Medications can be very helpful in the long term treatment of polysubstance dependence. Medications are a useful aid in helping to prevent or reducing drug cravings. Another benefit of Medications is helping to preventing relapse. Since drug addictions effect brain functioning, medications assist in returning to normal brain functioning. Polysubstance abusers require medications for each substance they are addicted to, as the medications we currently have, do not treat all addictions simultaneously. Medications are a useful aid in treatments, but are not effective when they are the sole treatment method. [35]

It is important that treatments be carried on through-out the patient’s life in order to prevent relapse. It is a good idea that recovering addicts continue to attend social support groups or meet with counselors to ensure they do not relapse.[citation needed]

See also

References

  1. ^ Polysubstance Dependence. (2011). Encyclopedia of Mental Disorders. Retrieved from http://www.minddisorders.com/Ob-Ps/Polysubstance-dependence.html
  2. ^ Newcomb, M.D., Galaif, E.R., & Locke, T.F. (2001, June). Substance Use Diagnosis Within a Community Sample of Adults: Distinction, Comorbidity, and Progression Over Time. Professional Psychology: Research and Practice, 32(3), 239-247. doi:10.1037/0735-7028.32.3.239
  3. ^ Malcolm, B., Hesselbrock, M., & Segal, B. (2006). Multiple Substance Dependence and Course of Alcoholism among Alaska Men and Women. Substance Use & Misuse, 41(5), 729-741. doi:10.1080/10826080500391803
  4. ^ Verdejo-Garcaia, A. & Perez-Garcaia, M. (2007, March). Profile of Executive Deficits in Cocaine and Heroin Polysubstance Users: Common and Differential Effects on Separate Executive Components. Psychopharmacology, 190 (4), 517-530. doi:10.1007/s00213-006-0632-8
  5. ^ Kornreich, C., Delle-Vigne, D., Campanella, S., Noel, X., Papageorgiou, C., Brown, O., Verbanck, P., & Ermer, E. (2011, October). Conditional Reasoning Difficulties in Polysubstance-Dependent Patients. Psychology of Addictive Behaviors, 3-7. doi:10.1037/a0025841
  6. ^ Agrawal, A., Lynskey, M.T., Madden, P.A., Bucholz, K.K., & Heath, A. (2007, January). A Latent Class Analysis of Illicit Drug Abuse/Dependence: Results from the National Epidemiological Survey on Alcohol and Related Conditions. Addiction, 102(1), 94-104. doi: 10.1111/j1360-0443.2006.01630.x
  7. ^ Perkonigg, A., Lieb, R., & Wittchen, H. (1998, March). Prevalence of Use, Abuse, and Dependence of Illicit Drugs Among Adolescents and Young Adults in a Community Sample. European Addiction Research, 4(1/2), 58-66. doi:10.1159/000018923
  8. ^ Perkonigg, A., Lieb, R., & Wittchen, H. (1998, March). Prevalence of Use, Abuse, and Dependence of Illicit Drugs Among Adolescents and Young Adults in a Community Sample. European Addiction Research, 4(1/2), 58-66. doi:10.1159/000018923
  9. ^ Medina, K.L., Shear, P.K., Schafer, J., Armstrong, T.G., & Dyer, P. (2003, January). Cognitive functioning and length of abstinence in polysubstance dependent men. Archives of Clinical Neuropsychology, 19(2), 245-258. Retrieved from www.sciencedirect.com
  10. ^ Medina, K.L., Shear, P.K., Schafer, J. (2006, October). Memory functioning in polysubstance dependent women. Drug and Alcohol Dependence, 84(3), 248-255. Retrieved from www.sciencedirect.com
  11. ^ Nelson- Zlupko, L. Kauffman, E. Morrison Dore, M (1995, January). Retrieved from http://web.ebscohost.com.ezproxy.linfield.edu:2048/ehost/pdfviewer/pdfviewer?sid=c8ea01e2-d96d-4482-8272-c9305ed50084@sessionmgr4&vid=6&hid=24
  12. ^ Goldstein, B. (2011). Cognitive Psychology: Connecting Mind, Research, and Everyday Experience--with coglab manual. (3rd ed.). Belmont, CA: Wadsworth.
  13. ^ Verdejo-Garcia, A., Del Mar Sanchez-Fernandez, M., Alonso-Maroto, L.M., Fernandez-Calderon, F., Perales, J.C., Lozano, O., & Perez-Garcia, M. (2010, June). Impulsivity and Executive Functions in Polysubstance-Using Rave Attenders. Psychopharmacology, 210(3), 377-392. doi:10.1007/s00213-010-1833-8
  14. ^ Fernandez-Serrano, M.J., Perez-Garcia, M., Rio-Valle, J.S., & Verdejo-Garcia, A. (2010, September). Neuropsychological Consequences of Alcohol and Drug Abuse on Different Components of Executive Functions. Journal of Psychopharmacology, 24(9), 1317-1332. doi:10.1177/0269881149841
  15. ^ Fernandez-Serrano, M.J., Perez-Garcia, M., Rio-Valle, J.S., & Verdejo-Garcia, A. (2010, September). Neuropsychological Consequences of Alcohol and Drug Abuse on Different Components of Executive Functions. Journal of Psychopharmacology, 24(9), 1317-1332. doi:10.1177/0269881149841
  16. ^ Bondi, M.I., Drake, A., & Grant, I. (1998). Verbal Learning and Memory in Alcohol Abusers and Polysubstance Abusers with Concurrent Alcohol Abuse. Journal of the International Neuropsychological Society, 4(4), 319-328. Retrieved from journals.cambridge.org
  17. ^ Bondi, M.I., Drake, A., & Grant, I. (1998). Verbal Learning and Memory in Alcohol Abusers and Polysubstance Abusers with Concurrent Alcohol Abuse. Journal of the International Neuropsychological Society, 4(4), 319-328. Retrieved from journals.cambridge.org
  18. ^ Bondi, M.I., Drake, A., & Grant, I. (1998). Verbal Learning and Memory in Alcohol Abusers and Polysubstance Abusers with Concurrent Alcohol Abuse. Journal of the International Neuropsychological Society, 4(4), 319-328. Retrieved from journals.cambridge.org
  19. ^ (136), In Scopus. "ScienceDirect - Clinical Psychology Review : The Comorbidity of Depression and Substance Use Disorders." ScienceDirect - Home. Mar. 2000. Web.
  20. ^ Uhl, George R., Qing -Rong Liu, Donna Walter, Judith Hess, and Daniel Naiman. "Polysubstance Abuse–Vulnerability Genes: Genome Scans for Association, Using 1,004 Subjects and 1,494 Single-Nucleotide Polymorphisms." American Journel of Human Genetics. Pubmed Centrial, 6 Nov. 2001. Web. 04 Nov. 2011.
  21. ^ Abraham, Henry David, and Maurizio Fava. "Order of Onset of Substance Abuse and Depression in a Sample of Depressed Outpatients." Comprehensive Psychiatry 40.1 (1999): 44-50. Print.
  22. ^ Joel D Swendsen, Kathleen R Merikangas, The comorbidity of depression and substance use disorders, Clinical Psychology Review, Volume 20, Issue 2, March 2000, Pages 173-189, ISSN 0272-7358, 10.1016/S0272-7358(99)00026-4.
  23. ^ Joel D Swendsen, Kathleen R Merikangas, The comorbidity of depression and substance use disorders, Clinical Psychology Review, Volume 20, Issue 2, March 2000, Pages 173-189, ISSN 0272-7358, 10.1016/S0272-7358(99)00026-4.
  24. ^ "Clarification of Concept of Polysubstance Dependence." American Psychiatric Association. American Psychiatric Association. Web. 21 Oct. 2011.
  25. ^ Skodol, M.D., Andrew E., John M. Oldham, M.D., and Peggy E. Gallaher, Ph.D. "Axis II Comorbidity of Substance Use Disorders Among Patients Referred for Treatment of Personality Disorders -- Skodol Et Al. 156 (5): 733 -- Am J Psychiatry." The American Journal of Psychiatry. American Psychiatric Publishing Inc. Web. 21 Oct. 2011.
  26. ^ "Clarification of Concept of Polysubstance Dependence." American Psychiatric Association. American Psychiatric Association. Web. 21 Oct. 2011.
  27. ^ "Polysubstance Dependence - Causes, DSM, Effects, Therapy, Adults, Withdrawal, Drug, Person." Encyclopedia of Mental Disorders. Advameg Inc. Web. 07 Nov. 2011.
  28. ^ "Polysubstance Dependence - Causes, DSM, Effects, Therapy, Adults, Withdrawal, Drug, Person." Encyclopedia of Mental Disorders. Advameg Inc. Web. 07 Nov. 2011.
  29. ^ September 2009. "NIDA InfoFacts: Treatment Approaches for Drug Addiction." http://www.nida.nih.gov/infofacts/treatmeth.html
  30. ^ “What is Drug rehab?” drugrehab.org
  31. ^ “What is Drug rehab?” drugrehab.org
  32. ^ Laudet, Alexandre, Stankick, Virginia, and Sands, Brian. "An Exploration of the Effect of On-site 12-step meetings On Post Treatment Outcomes among Polyubstance-Dependent Outpatient Clients." Evaluation Review 31.6(2007): 613-646. ArticleFirst. 16 October 2011.
  33. ^ “What is Drug rehab?” drugrehab.org
  34. ^ Kadden, Ronald M. (9 October 2002). Cognitive-Behavior Therapy for Substance Dependence: Coping Skills Training Retrieved 24 October 2011. http://www.bhrm.org/guidelines/CBT-Kadden.pdf
  35. ^ September 2009. "NIDA InfoFacts: Treatment Approaches for Drug Addiction." http://www.nida.nih.gov/infofacts/treatmeth.html

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