Can You Go to Rehab for Multiple Addictions?

Addiction takes many forms. For some people, it means relying on a particular drug. But it’s not always that simple. If you’re consistently taking more than one drug at a time, or switching between drugs, you might have polysubstance use disorder.

This condition looks a little different for everyone. You might feel like it’s safer to take more types of drugs, so you don’t start depending on any of them. Or, you might be mixing substances to get a certain result. But this behavior doesn’t protect you from addiction.

If you’re ready to make a change, there are several ways to approach recovery and rehab. And in treatment, your care team can help you understand the nuances of this complex issue.

Can You Have More Than One Addiction?

The CCD defines polysubstance use as “the use of more than one drug,” adding that “this includes when two or more are taken together or within a short time period, either intentionally or unintentionally.” Often, this behavior is socially acceptable. Have you ever smoked a cigarette while drinking a beer? If so, you’ve engaged in polysubstance use.

Addiction is, among other things, a behavioral issue. In other words, you can have addiction even in the absence of physical symptoms like cravings or withdrawal. And at first, you might not even notice. It’s all too easy to use multiple drugs at the same time, especially if you’re taking illicit substances. Street drugs like heroin and cocaine aren’t regulated, and might be mixed with other things.

Addiction Can Sneak Up On You

Stigma plays a complex role in many types of addiction. Because drinking is so socially acceptable, it can be hard to know when you have alcohol addiction. On the other hand, meth addiction is so stigmatized that it’s easier to recognize the problem—even if it’s still hard to get help.

When you’re switching between substances, this metric can work against you. For instance, you might not be doing enough of any single drug to be worried about addiction. But are you taking drugs every day? This behavior can quickly become a slippery slope.

Legality makes some substances seem safer, but mixing any drugs has unpredictable results. Think of alcohol, marijuana, and nicotine. In many U.S. states, all 3 are both legal and socially acceptable. It makes sense that people mix these substances without thinking twice. But taking substances together can have unintended, even dangerous, effects.

The Effects of Combining Drugs

Combining drugs can be unpredictable. That’s especially true when you’re taking illegal, untested drugs, but it can even be an issue with prescriptions. For example, taking MDMA along with certain antidepressants can lead to serotonin syndrome. This condition is rare, but extremely dangerous. And it’s just one of several drug combinations to watch out for.

The following combinations can also put you at risk of serious side effects:

  • Drinking with benzodiazepines, like Xanax, makes it easier for your body to process the benzos. This can exponentially raise the concentration of drugs in your bloodstream. And because you can’t control or measure that increase, you might increase your risk of overdose.
  • Cocaine and alcohol heighten the risk of cardiotoxicity, or heart damage.
  • Mixing opioids and stimulants—or “speedballing”—is dangerous and unpredictable. If the 2 drugs effectively cancel each other out, you might even feel sober. And if you respond by taking more, then you risk overdosing. Speedballing can also cause serious heart problems.
  • Mixing multiple opioids is easy to do by mistake. Many sources mix drugs like heroin with fentanyl, a cheaper synthetic opioid. Because fentanyl is stronger than other similar drugs, this makes it difficult to dose properly—especially if you don’t know you’re taking it. And even accidental use of fentanyl can increase your risk of addiction.
  • Mixing alcohol with any drug can have a direct impact on your mental health. This can cause anxiety and increase drug cravings, making it harder to begin recovery.

Numerous Ways to Treat Multiple Addictions

Recovering from even one addiction can be a complex process. And if you’ve been taking several different substances, you may need highly specialized treatment. Your care team can help you decide which types of therapy are most appropriate. A comprehensive treatment program might include therapies like the following:

Prescribed Medications

When taken under a doctor’s supervision, certain medications can support your recovery from multiple addictions. However, this may not be appropriate for all patients. For instance, if you have a history of misusing prescription drugs, talk therapy may be a safer treatment.

Even if you find meds helpful, they’re just one part of recovery. It’s important to combine this approach with other therapies, and with healthy lifestyle choices.

Exercise and Movement

Physical fitness has a huge impact on mental health. That makes it important for everyone. But data suggests it matters even more if you’re healing from addiction.

For people with multiple addictions, exercise decreases cravings and improves your mood. Experts say physical fitness might even guard against relapse. And best of all, you can put this data to work for you in any stage of recovery. During treatment, you might benefit from a form of movement that gets your blood pumping. And after you return home, you can take up yoga, go swimming, or just jog around the block.

Fitness can also aid in recovery by helping you build a healthy routine. Doing things you genuinely enjoy is an important part of long-term healing. Sustainable habits, like exercise, can give you the strength you need to stay on track.

Contingency Management

Contingency management (CM) activates your internal reward system. In treatment, patients get material rewards for achieving specific goals. For example, you might get free movie tickets after your 5th negative drug test in a row.

Data shows that CM can effectively treat patients with multiple addictions. This therapy can protect against relapse both during and after inpatient rehab. It even works as a virtual treatment.

Finding the Right Tools for Recovery

Multiple addictions are a complex issue. So when you start recovery, you’ll need a treatment approach that covers all your bases.

Talk to your care team about which combination of therapies will work best for you. The act of designing your treatment plan is the first step toward a healthier future. And that future can be as multifaceted and exciting as your past, even if the details are different.

Browse our list of rehab centers to learn about their locations, treatments offered, and insurance options, and to start planning your recovery.

Reviewed by Lisa Misquith

Alcohol Withdrawal

Safety Note: Alcohol withdrawal can be life-threatening. Seek medical support and supervision to withdraw safely from alcohol.

Alcohol alters the chemicals in the body to produce its effects, such as relaxation and euphoria. Our bodies are designed to maintain balance, or homeostasis or equilibrium. These two facts will help you understand why alcohol withdrawal happens. 

What is alcohol withdrawal?

Alcohol withdrawal describes the set of symptoms a person experiences when they stop drinking alcohol after they have been drinking regularly, often heavily or for extensive periods of time. Alcohol withdrawal symptoms are normal, but can be life-threatening, so it’s important to seek medical support. 

Over time of regular use, the brain and body adapts to alcohol being in the system and depends on it for maintaining balance (also known as homeostasis or equilibrium). When someone stops drinking, it takes time for the body to change back to normal levels. Withdrawal symptoms happen during this transition of regaining homeostasis.  

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms manifest in physical and psychological ways. Symptoms occur when, for example, the brain has become dependent on the release of dopamine from alcohol consumption and the person has not consumed alcohol in at least 6-8 hours.

Alcohol Withdrawal symptoms include, but are not limited to the following:

Physical symptomsPsychological symptoms
Disorientation
Fast heart rate
Headache
Loss of appetite
Nausea or vomiting
Shakiness
Sweating
Tremors 
Seizures
Delirium Tremens
Anxiety
Agitation
Depression
Irritability
Nervousness
Restlessness

Alcohol Withdrawal versus Hangover

Alcohol withdrawal and a hangover from drinking alcohol are separate things. Alcohol withdrawal symptoms occur when alcohol is not being consumed, while a hangover occurs when too much alcohol is consumed during one drinking period.

Hangover Symptoms

  • Decreased concentration
  • Decreased sleep
  • Dehydration
  • Fatigue
  • Headache
  • Increased appetite
  • Increased pulse
  • Irritability
  • Muscle aches
  • Nausea
  • Sensitivity to light and sound
  • Weakness

Here is a quiz that can help distinguish if you might be having alcohol withdrawal symptoms verses a hangover from alcohol.

Alcohol Withdrawal Timeline

Alcohol withdrawal symptoms that occur after the last drink are usually divided into 3 stages: Mild, Moderate, and Severe. All the stages are serious and should have supervision with a mental health professional. Not everyone will experience severe withdrawal symptoms, but grand mal seizures and delirium tremens can happen, particularly for those who drank for long periods of time and heavily.

Stage 1 – MildStage 2 – ModerateStage 3 – Severe
Occurs 6-8 hours after the last drinkOccurs 12-48 hours after the last drinkOccurs 48-72 hours after the last drink
Craving for alcohol
Dilated pupils
Headaches
Loss of appetite
Minor hand tremors
Nausea
Unclear thinking
Vomiting
Breathing difficulties
Hallucinations
Increased blood pressure
Irregular heartbeat
Mental confusion
Seizures
Agitation
Disorientation
Excessive sweating
Fever
Hallucinations
Rapid heartbeat

Withdrawal

We often joke about going through withdrawal from a specific person, food, or TV show. While withdrawal describes something being removed or taken away, it also specifically refers to a set of symptoms a person can experience upon stopping an addictive substance or behavior, such as drugs, alcohol, and gambling. 

What is drug / alcohol withdrawal?

Drug and alcohol withdrawal occurs when a person stops using drugs or drinking after a period of regular use. 

Withdrawal is one of the diagnostic criteria for a substance or alcohol use disorder since it is a sign that a person has become physically and/or psychologically dependent. Withdrawal is often what keeps a person trapped in addiction because one of the quickest ways to relieve withdrawal is to use or drink again. Many will continue drugs and alcohol not for the positive, pleasurable effects, but for avoiding the negative effects of withdrawal.

A person does not necessarily have to be an “addict” or “alcoholic” to experience withdrawal and not everyone will experience withdrawal symptoms. 

Common Withdrawal Symptoms

Symptoms can be both physical and psychological. Symptoms and intensity of symptoms vary from person to person. Age, how long someone has been using drugs or alcohol, how much and how frequently, and more are factors for withdrawal.

  • Nausea
  • Vomiting
  • Sleep Disturbances (e.g. insomnia)
  • Agitation, irritability
  • Anxiety
  • Depression
  • Discomfort (malaise)
  • Muscle aches

Why is withdrawal so uncomfortable?

Withdrawal is so uncomfortable because the body adapts to the drug being present and it takes time for the body to readjust when the drug is no longer present. Withdrawal symptoms typically are the exact opposite of symptoms felt from the drug. For example, if a drug relaxes your system, you may feel anxiety and irritability upon stopping the drug.

Can you die from withdrawal?

The short answer is yes, you can die from withdrawal. However, most substances produce uncomfortable, non life-threatening symptoms. Alcohol and benzodiazepines are substances that can be very dangerous to stop “cold turkey” or abruptly, so it’s important to be under medical supervision for alcohol and benzodiazepine detox.

Resources

https://www.who.int/substance_abuse/terminology/withdrawal/en/

How Do I Know If I Have a Drug Problem

A person may know they have a drug problem if they have become dependent on a drug and feel like the drug is needed for functioning. Another way an individual can tell if their drug use is causing a problem is if they are experiencing negative consequences in their home, work, or personal relationships.

When does using drugs become a problem?

Drug usage in someone’s life becomes a problem when it negatively affects an individual’s mental, emotional, and physical health. This may manifest as an addiction, withdrawal symptoms, illegal activity, or other negative consequences in their life or the lives of family and friends.

Drugs can also become a problem in someone’s life when they depend on the drug for achieving personal fulfillment at the expense of themselves and/or others.

DSM-V and ICD-10 criteria for Substance Use Disorders

The table below features the DSM-V and ICD-10 which can be used as a guide to determine if drug usage may be a problem in your life or your loved ones life. 

This table is not to be used for a self-diagnosis. Please seek help from a mental health professional for a real diagnosis if you feel like you or your loved one may be experiencing a drug problem.

DSM-VICD-10
The presence of at least 2 of the symptoms in the chart below indicates an individual may have a Substance Use Disorder. The severity is defined as: Mild: 2-3 symptoms, Moderate 4-5 symptoms, and Severe 6+ symptoms.The presence of 3 or more of the following should be present together for at least 1 month, or repeatedly during a 1 year period.
In the past year, have you?Have you had?
Had times when you ended up taking the substance more, or longer, than you intended?A strong desire or sense of compulsion to take the psychoactive substance?
More than once wanted to cut down or stop taking the substance, or tried to, but couldn’t?Difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use?
Spent a lot of time taking the substance? Or being sick or getting over other aftereffects?A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms? 
Wanted the substance so badly you couldn’t think of anything else?Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses?
Found that taking the substance interfered with taking care of your home or family? Or caused job troubles? Or school problems?Progressive neglect of alternative pleasures or interests because of psychoactive substance use?
Continued to take the substance even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to take the substance?
More than once gotten into situations while or after taking the substance that increase your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area?)
Continued to take the substance even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to take more of the substance much more than you once did to get the effect you want? Or found that your usual drug dose had much less effect than before?
Found that when the effects of drugs were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating or racing heart?

DSM-V contains a list of criteria that helps determine if an individual may have a Substance Use Disorder. The DSM-V is the Diagnostic and Statistical Manual of Mental Disorders developed by the American Psychiatric Association in 1952. As research and data continues, the APA updates the DSM with current information which is why there is the letter V for the 5th edition.

ICD-10 contains a  list of criteria that helps determine if an individual may have a Substance Use Disorder. The ICD-10 is the International Classification of Diseases developed by the United States National Center for Health Statistics (NCHS) in 1893. As research and data continues, the APA reviews and updates the ICD with current information which is why there is the number 10 for the 10th revision.

How Can You Find Out?

Many will say if you’re questioning, then that means you have a drug problem and should seek help. Here are a few other ways you can find out if you have a drug problem.

Talk to Your GP

Talk to your general practitioner about your drug use and be honest. GPs can conduct an assessment and refer you to another health professional or level of care if needed.

Get an Assessment with a Mental Health Professional

The best and recommended way to know if you have a drug problem is to get an assessment with a mental health professional. Since they’re experts, they’ll be able to assess the severity of a substance use disorder and recommend the level of treatment you need. You can talk to your GP about a mental health assessment or find other providers who can give one.

Try Minimizing or Stopping Drugs

Note: this is not safe if you consistently take drugs, as drug withdrawal can be life-threatening. If you have not become dependent on drugs though and think you may have a problem, see if you can go without the drug or significantly reduce your drug intake. Does it cause anxiety? Are you struggling to stop? 

Take an Online Quiz

Here are a few common online quizzes regarding drugs. The general quizzes below are not meant to be a diagnosis, but more of a spectrum guide of your drug usage.

Keep Learning 

Understanding the Basics of Addiction  >> | Withdrawal >>

How Do I Know If I Have an Alcohol Problem

Alcohol is a substance that may become a problem in someone’s life regardless of how much alcohol one drinks or how frequently (although regular and heavy use generally indicate a problem). Alcohol misuse may mean drinking over the recommended guidelines, becoming physically dependent on alcohol, or drinking for emotional reasons. 

Alcohol use disorders are determined through an assessment by a health professional who has gone through training to diagnose based on standards provided by credited research.

What makes alcohol a problem?

Alcohol is so common and seemingly everyone drinks alcohol, so at what point can it become a problem?

A person may notice they have an alcohol problem if they start neglecting life responsibilities to consume alcohol. They may notice alcohol has become a problem in their life when they feel the need to drink alcohol to do daily functions, cope, grieve, or numb their emotions.

Another way someone may notice that alcohol has become a problem is if their behavior causes negative consequences in their life or the lives of others.

It is important to note that someone does not have to be an “alcoholic” to have a problem with alcohol. Alcohol use disorders are based on the individual’s assessment.

DSM-V and ICD-10 criteria for Alcohol Use Disorders

The table below features the DSM-V and ICD-10 criteria for an alcohol use disorder; both are beneficial to use as a guide for if alcohol may be a problem in your life or your loved one’s life. 

This table is not to be used as a self-diagnosis. Please seek help from a health professional for more detailed information and for a diagnosis about a possible alcohol use disorder that you or your loved one may be experiencing.

DSM-VICD-10
The presence of at least 2 of the symptoms in the chart below indicates an individual may have an Alcohol Use Disorder (AUD). The severity of the AUD is defined as: Mild: 2-3 symptoms, Moderate 4-5 symptoms, and Severe 6+ symptoms.The presence of 3 or more of the following should be present together for at least 1 month, or repeatedly during a 1 year period.
In the past year, have you?Have you had?
Had times when you ended up drinking more, or longer, than you intended?A strong desire or sense of compulsion to take the psychoactive substance (alcohol)?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?Difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use?
Spent a lot of time drinking? Or being sick or getting over other aftereffects?A physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms? 
Wanted a drink so badly you couldn’t think of anything else?Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses?
Found that drinking-or being sick from drinking-after interfered with taking care of your home or family? Or caused job troubles? Or school problems?Progressive neglect of alternative pleasures or interests because of psychoactive substance use?
Continued to drink even though it was causing trouble with your family or friends?Persistent substance use despite clear evidence of overtly harmful consequences (mental and/or physical?)
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
More than once gotten into situations while or after drinking that increase your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area?)
Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to drink much more than you once did to get the effect you want? Or found that your usual number of rinks had much less effect than before?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating or racing heart?

DSM-V is a list of criteria that helps determine if an individual may have an Alcohol Use Disorder. The DSM-V is the Diagnostic and Statistical Manual of Mental Disorders developed by the American Psychiatric Association in 1952. As research and data continues, the APA updates the DSM with current information which is why there is the letter V for the 5th edition.

ICD-10 is a list of criteria that helps determine if an individual may have an Alcohol Use Disorder. The ICD-10 is the International Classification of Diseases developed by the United States National Center for Health Statistics (NCHS) in 1893. As research and data continues, the APA reviews and updates the ICD with current information which is why there is the number 10 for the 10th revision.

How Can You Find Out?

Many will say if you’re questioning, then that means you have an alcohol problem and should seek help. Here are a few other ways you can find out if you have an alcohol problem.

Talk to Your GP

Perhaps one of the best and easiest ways to find out if you have an alcohol problem is to candidly talk to your general practitioner about your alcohol use. GPs can conduct an assessment and refer you to another health professional or level of care if needed.

Get an Assessment with a Mental Health Professional

Another recommended way to know if you have an alcohol problem is to get an assessment with a mental health professional. Since they’re experts, they’ll be able to assess the severity of an alcohol use disorder and recommend the level of treatment you need. You can talk to your GP about an assessment or find other providers who can give one.

Try Minimizing or Stopping Alcohol

Note: this is NOT safe for everyone, especially if you consistently drink, as alcohol withdrawal can be life-threatening. If you casually drink though and think you may have a problem, see if you can go without alcohol or significantly reduce your alcohol intake. Does it cause anxiety? Are you struggling to stop? 

Take an Online Quiz

Here are a few common online quizzes regarding alcohol consumption. The general quizzes below are not meant to be a diagnosis, but a guide for alcohol use.

  • A 10 question quiz that helps determine if alcohol use in your life is causing you to be at low risk, medium-risk, or high risk for having an Alcohol Use Disorder. alcohol.org
  • A 15 question quiz that helps determine if alcohol use is a problem in your life. All questions are either true or false. allthetests.com
  • A 11 question quiz that uses the DSM-V approach to determine if you may have an alcohol use disorder. This quiz has the results of the answered questions on a spectrum of mild, moderate, or severe. menshealth.com