Polydrug use: the risks of mixing substances

Rarely does a person who comes to us talk about a single substance. What we hear far more often are stories in which alcohol goes hand in hand with cocaine, where anti-anxiety medication accompanies nights out, or where cannabis is used to «come down» after taking stimulants. This pattern of using several substances, whether at the same time or alternating them over the same period, is what we call polydrug use, and it is far more common than the popular image of addiction would suggest.

At Reconectar, in Las Palmas de Gran Canaria, we support many people who do not fit the idea of «being addicted to one specific thing». Their relationship with substance use is more complex, more chameleon-like and, precisely for that reason, harder to understand and to address. Grasping what polydrug use is, why it happens and what additional risks it carries is an important first step, both for the person using and for the families who look on with worry without quite knowing what is going on.

What polydrug use is

Polydrug use means that the same person uses more than one psychoactive substance, either simultaneously (taking two or more at once in search of a combined effect) or sequentially (using one to achieve an effect and another afterwards to counteract it or prolong the night). The term covers very different combinations: alcohol and tobacco, alcohol and cocaine, cannabis and alcohol, stimulants with sedatives, or mixtures that include medicines once prescribed by a doctor.

It is worth stressing that polydrug use is not necessarily a sign of «more extreme» consumption or of a particular personality. It often appears gradually, almost without the person consciously deciding on it: one substance leads to another, the setting makes certain combinations easy, and what began as something occasional ends up becoming a stable pattern. Understanding this without judgement is essential if it is to be worked on.

Why it is so common

If polydrug use is so widespread, it is because it responds to very human and understandable reasons, even though its consequences are serious. Among the motives we see most often are:

• Boosting or shaping effects. Some people combine substances looking for a more intense or longer-lasting experience, or one different from what a single substance offers.
• Counteracting the «comedown». It is very common to use one substance to soften the unpleasant effects of another: calming the activation of a stimulant with a depressant, or trying to «perk up» after taking something sedating.
• Availability and cost. What is at hand, what is accessible at a given moment or what the group is sharing has a strong influence on what gets used.
• Social context. Certain environments and celebrations normalise particular mixtures, so combining stops being perceived as risky and comes to feel like part of the night.

Understanding these motivations does not mean playing down the risks. On the contrary: it helps explain why a simple warning is rarely enough, and why therapeutic support needs to go beyond «just stop doing it».

Common and especially delicate combinations

Although any mixture introduces uncertainty, some combinations deserve particular attention because of the kind of reactions they can trigger in the body. We describe them in general terms, with no intention whatsoever of giving guidance on use, but to explain why they are a cause for concern.

Alcohol and cocaine. When both substances are present in the body at the same time, the liver produces a compound called cocaethylene. This metabolite prolongs certain effects and places an additional burden on the cardiovascular system, so the combination is more demanding on the heart than either substance on its own. It is one of the mixtures that comes up most often in the stories we hear in our sessions.

Several depressants at once. Combining substances that share the effect of «slowing down» the central nervous system (such as alcohol, benzodiazepines or opioids) adds their effects together in a way that is hard to predict. The most serious risk is respiratory depression: breathing becomes slower and shallower, something that can become very grave. What is more, the person often does not perceive the danger, because the sedation interferes with their own ability to notice.

Stimulants and depressants together. Mixing substances that speed things up with others that slow them down creates a kind of internal tug-of-war. The body receives contradictory signals, the effect of one can mask that of the other, and this makes it harder to recognise how much has actually been consumed, with the consequent risk of going past one's own limits without realising.

Why it multiplies the risks

The key to polydrug use is that its risks do not simply add up, they multiply in unpredictable ways. When two or more substances come into play, factors appear that do not exist with a single substance:

• Unpredictable interactions. The way two substances combine in a particular body depends on many variables, so the response is hard to anticipate even for someone with experience.
• Greater risk of overdose. When some effects mask others, it becomes easier to lose track of how much has been taken and to cross a dangerous threshold.
• More damage to the body. Combining substances increases the wear on organs that are already working at their limit, with consequences that build up over time.
• A heavier load on the heart and liver. These are the two organs that suffer most: the heart from the added cardiovascular stress, and the liver from having to metabolise several substances and their by-products at once.

There is also an important psychological factor: the sense of control. Many people believe they handle «their mixture» well because they have been repeating it for a long time, and that confidence can make them lower their guard in the face of precisely what is most dangerous.

Why it complicates diagnosis and treatment

From a clinical point of view, polydrug use poses added challenges. When a person uses several substances, the symptoms overlap and it becomes harder to tell what is causing what: a low mood, sleep problems or episodes of anxiety may be due to one substance, to another, to the combination, or to withdrawal from one of them.

This has practical consequences. Focusing only on the «most visible» substance, or on the one the person considers their main problem, usually leaves out important pieces of the puzzle. If we work only with alcohol and ignore the use of anti-anxiety medication, or address the cocaine without looking at the role cannabis plays, the risk of relapse stays high because the full pattern remains intact. That is why at Reconectar we insist on looking at the whole picture, not an isolated part.

The link with mental health

Polydrug use and mental health are closely intertwined. Substances often serve a function: to ease anxiety, soften sadness, make sleep possible, switch off from difficult thoughts or get through situations that feel overwhelming. In these cases, use is not just a habit but a way (costly and, in the long run, ineffective) of managing a distress that needs to be heard.

When several substances are used in this way, there is usually an underlying suffering that has not been able to be addressed in any other manner. Treating only the use without attending to that underlying layer leaves the person without real resources, because we take away what they were turning to without offering them something different. This is why good support always combines work on the substance use with care for emotional life and for the circumstances surrounding each person.

How it is approached in therapy

Addressing polydrug use calls for treating the full pattern of use and, above all, the person behind it, not one substance in isolation. Rather than «putting out fires» one by one, the therapeutic work seeks to understand what function each substance serves, at what moments it appears, which needs it tries to meet, and what alternatives can gradually be built.

This means looking at several levels at once: the physiological (how the body is and what care it needs), the psychological (which emotions and thoughts sustain the use), the relational (what role the people around the person play) and the existential (what meaning, routines and projects can gradually fill the space that use had taken up). It is a gradual process, with no shortcuts, that respects each person's own pace.

The Reconectar approach

At Reconectar we work with an open method, without residential admission. We believe recovery is more solid when the person builds it from within their own everyday life, with their relationships, their work and their responsibilities, rather than apart from all of that. This is why the process fits into daily life and does not require putting it on hold.

Care is provided directly by the therapists, with no intermediaries: the person works with professionals who know their case and accompany them throughout the whole process. We offer sessions in person in Las Palmas de Gran Canaria or by video call, so that distance or scheduling are not an obstacle, and all the support is confidential. When there is polydrug use, this close and personalised approach is especially valuable, because it allows the work to be adapted to a pattern that is almost never linear.

A step that can be taken with support

If you have recognised yourself in these lines, or recognised someone you love, you are not facing a dead end. Polydrug use can be treated, and asking for help is not a sign of weakness but the first act of care towards oneself. You do not need to have everything figured out, or to have hit any kind of rock bottom, to begin talking.

At Reconectar, in Las Palmas de Gran Canaria, we are here to listen without judging and to help you understand what is happening and what path might open up. If you wish, you can get in touch with us and take that first step, without rushing, but without having to do it alone.