While alcohol is a drug, its ubiquity, legality, and nature as a ‘social lubricant’ often sets it apart from other substances, yet we often forget how dangerous alcohol is – especially in conjunction with other drugs.
While alcohol is one of the more commonly abused drugs in the country, many who abuse it also use a second, third, or even fourth substance – and while they might not be addicted to all the substances they use, there is a considerable and unique challenge in polysubstance drug use, and subsequent dependence.
For one, using more than one drug makes it difficult for health professionals to determine a cause for the many potential physical and mental effects of drug use, in no small part due to the way illicit drugs and alcohol often interact in dangerous and volatile ways. Another issue is the matter of addiction treatment, and the dangers that can arise during withdrawal as a result of polysubstance use.
Polysubstance Dependence – How Common Is It?
An estimated 9.4 percent of Americans struggle with substance use disorder. A study among 10th graders found that marijuana abuse and alcohol use was most prevalent, with the second-most common illicit drug being prescription medication, followed by other illicit drugs. 14 percent identified as polysubstance users, using three substances. In other age groups and studies, higher numbers were found.
Among adults aged 18 and older, an estimated 2.3 million use both alcohol and an illicit drug. That accounts for about one in nine persons with substance use disorder (addiction).
Reasons for polysubstance use may vary. Alcohol is the most commonly abused drug because it is typically the most commonly used drug, and heavy use increases the risk for substance use disorder.
Alcohol is readily available for purchase in many different forms, and alcohol use is not heavily stigmatized, and has even come to the accepted or expected under certain circumstances. The history behind alcohol use is ancient, tracing back to the precivilization era. Alcohol’s abundance in nature is such that it is one of few drugs that other mammals indulge in.
In part due to its legalization, lasting subculture, and the popularity of the drug for its potential medicinal use, marijuana is the most used illicit drug among Americans. The combination of alcohol and marijuana is the most common.
Behind marijuana is prescription medication, particularly opioids and stimulants. Opioid abuse began to explode in the 1990s, especially after aggressive lobbying and marketing from the pharmaceutical industry led to an increased demand for pain medication, and a steep increase in prescriptions. At the time, it was not commonly known that opioid medication could be as dangerous as heroin.
One particular scandal with repercussions to this day is Purdue’s push for OxyContin, which led to the greatest abuse of prescription medication in the world. As a result, America consumes the majority of the world’s opioid supply.
While the opioid crisis continues to rage on, more stringent policies have led to prescription medication use to decline. Instead, a new concern is fentanyl-laced heroin, which is cheaper to produce and leads to far more overdose deaths. Many who began using prescription opioids have since moved on to using heroin, because it has become more expensive and more difficult to find prescription painkillers.
Polysubstance Use Is More Dangerous Than Single Substance Use
While single substance use has a substantial list of risks and potential long-term side effects, including dependence, the use of more than one drug heavily compounds potential issues.
The most obvious risk is the increased risk of dependence. The more a drug is used, the more likely a person is to trigger or develop an addiction. Addiction is a physical disease of the brain, a condition caused by a series of internal (genetic) and external (environmental) factors. Unlike heavy use or binge use, addiction is determined not by the extent or amount of a person’s drug use, but their dependence on a drug, and their ability (or lack thereof) to function without the drug.
Another risk is the fact that alcohol interacts with other substances. The most dangerous of these are anti-anxiety drugs, which include uncommonly prescribed as well as outlawed tranquilizers and barbiturates, and more recent anti-anxiety medication such as benzodiazepine (Xanax, Valium). Because these drugs are depressants, just like alcohol, their combined use can lead to deadly consequences including overdose and death. Opioids from heroin to codeine elicit a similar effect in combination with alcohol.
Alcohol’s combined use with other drugs also leads to an increased amount of stress on the body and organs, potentially accelerating damage dealt to the liver, kidneys, heart, and brain. Side effects can include strokes, heart attacks, liver cirrhosis, and a variety of cancers from the throat to the pancreas.
Drugs and Alcohol Are Equally Dangerous
Because alcohol is ubiquitous and more widely consumed, there is potentially the thought that it is not as dangerous as other drugs. But as mentioned previously, it can be deadly in combination with other drugs, particularly prescription medication and heroin.
Withdrawal symptoms kick in when the brain and body begin to develop a tolerance to a drug, leading to decreased effectiveness per dose. The body effectively metabolized the drug faster, and its effects become less obvious.
Once this process begins, abruptly quitting can potentially cause the body to exhibit withdrawal symptoms as the drug has become ‘expected’.
Withdrawal symptoms are often more severe when the body begins to form a physical dependence to more than one substance. Typical withdrawal symptoms depend on the drug used and range from nausea and vomiting to flu-like symptoms, mood swings, psychosis, and pain. When alcohol is combined with other drugs, withdrawal symptoms can be potentially more severe. Alcohol and other depressants are also unique among most drugs in that they can produce fatal withdrawal symptoms in very serious cases of long-term substance use.
Treating a withdrawal should ideally always include medical supervision. While these symptoms can be weathered at home in most cases, they often drive one to use again and relapse due to intense cravings, and when multiple drugs are used, it’s difficult to predict the outcome of the withdrawal.
Drug use is never safe. But polysubstance use is particularly dangerous and presents a unique set of challenges due to a variety of factors, including the increase physical and mental risk associated with the combining of substances.