Understanding Polysubstance Dependence

Polysubstance dependence was previously its own diagnosis but is now included in the diagnosis of substance use disorder. It refers to being dependent on multiple drugs without having a preferred drug and is distinct from co-occurring dependency on specific drugs. Treatment for dependence on a group of drugs requires a personalized approach that accounts for the full spectrum of the dependency.

Dependence on a substance happens when a person’s mind and body gets used to needing a substance to function normally. When the person stops using the drug, withdrawal symptoms can present themselves until the body readjusts to functioning without the use of the substance. Dependence happens because of ongoing substance use or using high amounts of an addictive substance.

Many people have dependence on a specific substance, such as alcohol or cocaine. Or they could have dependence on more than one substance at the same time.

Alternatively, there are people who are dependent on substance use rather than on any substance(s) in particular. This is known as polysubstance dependence, or at least it was until it was included in the overarching diagnosis of substance use disorder.

The Polysubstance Dependence Diagnosis


To help with understanding polysubstance dependence, it’s useful to understand the criteria for diagnosis.

Mental health and addiction professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a tool to help them make diagnoses and provide effective treatment. In the previous version, the DSM-4, polysubstance dependence was listed as its own diagnosis. It was used for people who fit diagnostic criteria for multiple substances without meeting the criteria for any one substance alone. An individual wouldn’t rely on a specific drug but would interchange drugs.

To be diagnosed with polysubstance dependence in the DSM-4, someone would need to use and meet dependence criteria for three or more substance classes randomly within a period of a year. He or she would not prefer a specific drug or meet a diagnosis of dependence on one drug or specific drugs. Also, the individual would need to meet three or more of these criteria:

  • Tolerance to the effects of the substances
  • Withdrawal symptoms when stopping substance use
  • A significant amount of time devoted to using substances and substance-related activities, such as obtaining a drug
  • Time taken away from previous activities, such as hobbies and spending time with loved ones, to put toward substance use
  • A loss of control over the amount of substances used or the frequency of use
  • An inability to cut back or stop substance use despite trying or a desire to stop
  • A continuation of drug use despite harm caused or worsened by the substance use

Polysubstance Dependence and Substance Use Disorder


The polysubstance dependence diagnosis was included in the DSM-4 but removed as its own disorder from the current DSM version, the DSM-5. The removal does not mean the problem no longer exists but that it was encompassed by the new diagnosis of substance use disorder. The criteria for substance use disorders in the DSM-5 made polysubstance dependence unnecessary as its own diagnosis.

Also, the previous diagnosis was often misunderstood and ineffective. Professionals tended to use it when a person was dependent on more than one specific substance, which should have been considered co-occurring dependence diagnoses. For instance, an individual could have co-occurring cocaine dependence and alcohol dependence. This is not the same as polysubstance dependence, which is dependence on a group of substances that the person uses indiscriminately.

Currently, the proper diagnosis is substance use disorder, which includes a spectrum of dependence, abuse, and addiction. The diagnosis tends to be broken down by the type of substance a person uses; for example, an individual could have alcohol use disorder or opioid use disorder, or both. In the case of polysubstance dependence, the diagnosis would stay under the broader substance use disorder term.

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Polysubstance Dependence Treatment


The most effective substance use disorder treatment is tailored to the individual. Therapy, such as cognitive behavioral therapy (CBT) and group therapy, is likely to help, as can medication-assisted treatment (MAT) that combines therapy with medication. A person with a dependence on multiple substances may benefit from a residential treatment program, which provides more intensive treatment that includes individual therapy, group therapy, family therapy, medication, and other forms of support all under one roof. The person has the opportunity to get away from substances and triggers while focusing on treatment and recovery.

Polysubstance dependence is now included within the diagnosis of substance use disorder. Rather than being dependent on specific substances, the person is dependent on a group of substances without favoring any specific ones. A quality treatment program can identify this problem and provide a customized treatment plan that targets the full range of the dependency.