Many people who seek help for drinking are also struggling with another substance. In 2024, about 7.7 million people in the United States had both an alcohol use disorder and a drug use disorder, that's roughly one in six people with any substance use disorder (SUD) [1].
When more than one substance is involved, the risks change, and so does the care a person needs. This article explores polysubstance addiction, why it requires a specialized treatment approach, and how Alta Mira Recovery Programs works to address each substance involved.
Polysubstance use means taking two or more substances together or within a short time [2]. Sometimes this is on purpose. A person may drink to calm down after using cocaine, or take a sleeping pill after heavy drinking. Sometimes it is not on purpose. Drugs bought outside a pharmacy can be mixed with other substances, such as fentanyl, without the buyer knowing [2].
Polysubstance addiction goes a step further. It describes a pattern in which a person has lost control over more than one substance. For example, someone can have an SUD involving alcohol, cannabis, and tobacco at the same time [3].
Alcohol is often paired with prescription sedatives such as benzodiazepines (anti-anxiety medications like Xanax or Valium), opioid painkillers, stimulants such as cocaine, and cannabis.
Often, yes. Alcohol is a depressant, which means it slows the body down, including breathing. Opioids and benzodiazepines are also depressants. Combining alcohol with other drugs can increase the risk of overdose and serious damage to the brain, heart, and other organs [2].
Mixing alcohol with a stimulant does not cancel out the effects. Stimulants can hide how intoxicated a person is, which makes it easier to take too much. In 2022, nearly half of all drug overdose deaths in the U.S. involved more than one drug [2].
When drinking is the most visible problem, other substances can go unnoticed by family, doctors, and sometimes by the person themselves. An individual may see a daily sleeping pill or occasional cocaine use as separate from their drinking. Others may avoid mentioning it because they feel embarrassed or ashamed.
Diagnosing more than one condition at once is complex because symptoms overlap, and a thorough assessment lowers the chance that something is missed [3]. Treatment that focuses only on alcohol can leave the other substance use unaddressed.
Because it directly affects your safety. Alcohol withdrawal can range from shaky hands and nausea to delirium tremens, a severe form of withdrawal that can cause sudden confusion, hallucinations, fever, and seizures [4]. Each substance can cause different withdrawal symptoms, so the medical team needs a complete understanding of a person's substance use to develop a safe detox plan.
Being open about substance use is about ensuring proper care, not passing judgment. A treatment team cannot plan for what it does not know, and a complete history is what makes a personalized plan possible.
At Alta Mira, treatment starts with understanding the whole person, not just the substance that brought them in. Personalized care follows a few connected steps.
A coordinated sequence, not separate tracks for each substance.
Alta Mira's 10-Day Detoxification and Assessment Service gives people a place to stop using while the medical team monitors withdrawal and manages symptoms. People with moderate to severe alcohol withdrawal may need care in a facility where vital signs such as blood pressure and body temperature are checked closely [4]. When multiple substances are involved, the medical team tailors the detox plan to address the withdrawal risks associated with each one.
During the same period, the clinical team gathers a complete history: which substances a person uses, how much, how often, and in what combinations. When a diagnosis is unclear, psychological testing may be used to clarify what is going on and guide the treatment plan.
Many people who struggle with substances also live with anxiety, depression, trauma, or another mental health condition. These issues are usually best treated together rather than separately, which can make all the treatments more effective [3]. Alta Mira integrates treatment for substance use and co-occurring mental health conditions into a coordinated care plan — the same integrated model described in our guide to dual-diagnosis treatment.
Treatment for alcohol use disorder can include behavioral therapies, mutual-support groups, and, for some people, medication [5]. Alta Mira uses evidence-based therapies, including Motivational Enhancement, which helps individuals identify and build on their personal motivation for recovery. Therapy also explores the role each substance plays in a person's life, whether it helps with sleep, eases stress, or supports work demands, while introducing healthier ways to address those needs.
Family programming helps loved ones understand polysubstance addiction and how to support recovery at home. Before discharge, each person collaborates with the care team to develop a plan for ongoing support and recovery. Many people with alcohol use disorder recover, but setbacks are common, and ongoing support helps people handle triggers such as stress [5].
For some substances, yes. Three medications are approved in the U.S. to help people reduce or stop drinking: naltrexone, acamprosate, and disulfiram. None of them is addictive [5]. Effective medications also exist for opioid use disorder [3].
Medication options depend on the substances involved and the individual's overall health, making a comprehensive assessment an essential first step in treatment.
Signs that more than one substance may be involved include missing or unfamiliar prescription bottles, drowsiness that seems out of proportion to how much someone drank, and long periods of alertness during heavy drinking. Stimulants can mask how drunk someone is, so a person who drinks a lot but still seems wide awake may be using something else [2].
Call 911 if the person has slowed breathing, a seizure, a high fever, severe confusion, hallucinations, or an irregular heartbeat [4]. Stay with them and tell responders everything you know about what was taken. Even if you're unsure which substances were taken, it's safest to seek emergency medical care immediately.
If you or a loved one is struggling with alcohol and other substances, Alta Mira Recovery Programs offers residential care in the San Francisco Bay Area for substance use disorders and complex co-occurring mental health conditions.
Our credentialed clinical team takes the time to understand every substance involved, providing diagnostic services and care tailored to your needs.
[1] Substance Abuse and Mental Health Services Administration. 2025, Jul. 28. Key Substance Use and Mental Health Indicators in the United States: Results From the 2024 National Survey on Drug Use and Health. NSDUH Series H-60. Center for Behavioral Health Statistics and Quality.
[2] Centers for Disease Control and Prevention. 2024, Apr. 2. Polysubstance Use Facts. U.S. Department of Health and Human Services.
[3] National Institute on Drug Abuse. 2024, Sep. 30. Co-Occurring Disorders and Health Conditions. U.S. Department of Health and Human Services.
[4] MedlinePlus. 2025. Alcohol Withdrawal. National Library of Medicine.
[5] National Institute on Alcohol Abuse and Alcoholism. 2025. Understanding Alcohol Use Disorder. U.S. Department of Health and Human Services.
Supervised detox and coordinated care for alcohol and whatever else is part of the picture.
