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Polysubstance Use Disorder

Medically reviewed by Last updated on Sep 3, 2023.

What is polysubstance use disorder (PUD)?

PUD is a medical condition that develops from long-term use or misuse of 2 or more substances. You are not able to stop even though it causes physical or social problems. PUD includes use of a drug such as cocaine or misuse of alcohol, tobacco, or a prescription medicine such as opioids. This disorder is also called polysubstance abuse.

What are the signs and symptoms of PUD?

Signs and symptoms include at least 2 of the following in a 12-month period:

  • You take a prescription medicine in a way it was not intended. This is also called misuse. For example, your prescription is for anxiety relief, but you take it to feel good instead. You take more than prescribed or for longer than recommended. Misuse can also mean you take a medicine even though you do not have a prescription for it.
  • You have a strong urge or craving for the substances. This is also called addiction. You are not able to control when or how much you use. You spend large amounts of time trying to get, use, or recover from the substances. In between uses, you think about when you will get to use it again.
  • You become tolerant to the substances. This means the amount you have been taking no longer has the effects you want. You need higher amounts to feel the effects.
  • You become dependent on the substances. This means your body becomes used to the substances. You have withdrawal symptoms when you do not use the substances for a short amount of time. You have to take them to stop or prevent withdrawal symptoms, such as shaky hands.
  • You are not able to decrease or stop the substances. You start again when you try to quit. You try to use lower amounts, but you are not able.
  • You continue the substances even though it causes problems or is dangerous. For example, you drive after you use a substance that causes drowsiness. You may try to make the effect stronger by mixing a substance with alcohol, a medicine, or a drug. You have problems at school, work, or home. You spend less time doing important or enjoyable activities.

How is PUD diagnosed and treated?

Your healthcare provider will ask about the substances, and how much you take. Blood or urine tests may be used to check the levels in your system. The tests can also check for physical problems the substances may cause. Treatment may be offered in a hospital, outpatient facility, or drug rehabilitation center. Healthcare providers can help you make decisions about treatment programs. The goal is to help you decrease or stop taking the substances.

  • A detox program includes medicine and treatment to reduce withdrawal symptoms and anxiety when you stop taking the substances. You will be in the hospital with close monitoring and care.
  • Your dose will be gradually decreased by your healthcare provider to help prevent withdrawal symptoms.
  • Cognitive behavioral therapy (CBT) can help you manage depression and anxiety caused by PUD. CBT can be done with you and a talk therapist or in a group with others.
  • Motivational enhancement therapy can help you set and reach healthy, positive goals.
  • Twelve-step facilitation (TSF) is a short, structured approach to reach early recovery. It is done one-to-one with a therapist in 12 to 15 sessions.

What are safety guidelines to follow?

  • Do not combine medicines, drugs, or alcohol. The combination can cause an overdose, or cause you to stop breathing.
  • Learn about the signs of an overdose so you know how to respond. Signs depend on the substances. Your heartbeat or breathing may be faster or slower than usual. You may have heavy sweating, vomiting, trouble sleeping, or sleeping too much. Your skin may be pale or clammy. You may have slurred or slow speech. Tell others about signs of an overdose so they will know what to do if needed. Talk to your healthcare provider about naloxone. You may be able to keep naloxone at home in case of an overdose. Your family and friends can also be trained on how to give it to you if needed. Get immediate help or call your local emergency number (911 in the US) for signs of an overdose.
  • Take prescribed medicines exactly as directed. Do not take more than the recommended amount. Do not take it more often than recommended. If you use a pain patch, be sure to remove the old patch before you place a new one. Make sure the patch is not exposed to sunlight. Sunlight speeds up the opioid release from the patch.
  • Keep substances out of the reach of children. Store substances in a locked cabinet or in a location that children cannot get to.
    Common Childproofing Latches

Where can I go for support and more information?

  • Alcoholics Anonymous
    Web Address:
  • Substance Abuse and Mental Health Services Administration
    PO Box 2345
    Rockville , MD 20847-2345
    Web Address:

Call your local emergency number (911 in the US) or have someone call if:

  • You have chest pain and your heart is beating faster than usual.
  • You have a seizure.
  • You feel you might harm yourself or others.
  • You have new shortness of breath.

When should I seek immediate care?

  • You are dizzy and lightheaded.

When should I call my doctor?

  • You know or think you are pregnant.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.