Multiple substance use

Multiple substance use , also known colloquially as mixed use , is a form of drug use that involves two or more psychotropic substances .

Spread and examples

Figures on the frequency of mixed use, especially in combination with illegal drugs, are only available sporadically. However, it can be assumed that in very many cases in which drugs are consumed, more than one substance is included. Even the simultaneous use of alcohol and tobacco is mixed consumption. A study published in Germany in 2004 showed that 87.8% of those questioned who had experience with alcohol or cannabis had also tried the combination of both (see table on mixed consumption).

Reasons for multiple substance use can be complex. On the one hand, the use of a certain drug can spontaneously create a “desire” for other substances, on the other hand, there is also targeted mixed consumption in the hope of achieving a special effect. For some combinations, users have developed their own terms, for example for the simultaneous use of MDMA and LSD , which is known as candy flip , or the combination of cocaine and heroin , which is called speedball .

Drug counseling centers usually advise against mixed consumption of any kind, since in most cases the individual risks of the drugs add up, but sometimes also increase.

Substance combination	Possible mixed consumption-specific effects	Mixed use experience among respective users of the single drugs (study 2004)	Rating by consumers as "good" (2004 study)	swell
Alcohol and tobacco	increasing risk of cancer higher risk of cardiovascular disease Erectile dysfunction and menstrual disorders	no information	no information
Alcohol and cannabis	Nausea and vomiting The ability to react and orientate yourself decline Hallucinations higher accident risk Tendency to overdose more intense alcohol intoxication	87.8%	36.6%
Alcohol and MDMA (Ecstasy)	Tendency to overdose Excessive stress on the liver is more likely to lead to alcohol poisoning and liver damage Heat build-up and signs of overheating higher accident risk higher risk of long-term memory impairment harder "comedown"	80.1%	37.9%
Alcohol and LSD	The effect of the alcohol is not perceived, risk of an alcohol overdose	78.6%	24.3%
Alcohol and amphetamine (speed)	The effect of the alcohol is not perceived, risk of an alcohol overdose reduced ability to react despite a feeling of sobriety great strain on the liver and kidneys Dehydration Heat build-up, overheating	77.6%	49.8%
Alcohol and cocaine	The effect of the alcohol is not perceived, risk of an alcohol overdose reduced ability to react despite a feeling of sobriety Overconfidence, aggressive behavior with long-term and high-dose mixed consumption, emotional hardening For cocaine use after alcohol use: Formation of cocaine: this significantly increases the original cocaine effect	75.6%	55.2%
Alcohol and heroin	Potentiation of the side effects: comatose state and paralysis of breathing and cardiac activity possible	69.5%	9.2%
Cannabis and MDMA (Ecstasy)	mutual reinforcement temporary impairment of memory high circulatory stress	47.1%	79%
Cannabis and amphetamine (speed)	Anxiety or panic high circulatory stress with long-term consumption risk of psychosis and / or anxiety disorders	25.9%	62%
Cannabis and methamphetamine (crystal)	Anxiety or panic high circulatory stress with long-term consumption risk of psychosis and / or anxiety disorders	no information	no information
Cannabis and cocaine	Anxiety or panic high circulatory stress additive increase in heart rate and blood pressure under stressful conditions with long-term consumption risk of psychosis and / or anxiety disorders For cocaine use after cannabis use: slightly increased and prolonged euphoria, increased blood levels	28.8%	72%
MDMA (Ecstasy) and LSD ("Candyflip")	The effect of MDMA (Ecstasy) is increased Increase in body temperature Heat stroke / collapse Anxiety and panic strong hallucinations	27.9%	46%
MDMA (Ecstasy) and Amphetamine (Speed)	Effect of MDMA (Ecstasy) is partially reduced, tendency to overdose The stimulating effect of both substances is retained, which means that the cardiovascular system is heavily stressed Heat stroke / collapse increased fluid loss increased likelihood of brain damage	28.4%	69%
Amphetamine (Speed) and LSD	The LSD trip becomes “unpredictable”: This can mean that the user does not feel any LSD effects at all, or that they are overwhelmed by the effects, with all the associated risks.	17.1%	20%

Alternative definition of terms and classification

Classification according to ICD-10
F19.-	Mental and behavioral disorders due to multiple substance use and consumption of other psychotropic substances
F19.0	Acute intoxication (acute intoxication)
F19.1	Harmful use
F19.2	Addiction syndrome
F19.3	Withdrawal syndrome
F19.4	Withdrawal syndrome with delirium
F19.5	Psychotic disorder
F19.6	Amnestic syndrome
F19.7	Residual and delayed psychotic disorder
F19.8	Other mental and behavioral disorders
F19.9	Unspecified mental and behavioral disorder
ICD-10 online (WHO version 2019)

• According to ICD-10 , multiple substance use is a form of drug use in which two or more psychotropic substances are consumed and no substance alone dominates the use or only one or none of the substances is known. At the same time, no statement is made about the presence or extent of health disorders or a specific clinical appearance.

• "Multiple substance use occurs when the substance is absorbed in a chaotic and indiscriminate manner, without a particular substance or group of substances predominating."

With negative connotation and stigmatizing , polytoxicomania (from the Greek: μανία manía = frenzy) and multiple substance abuse are sometimes spoken of. In contrast, multiple dependence describes an existing dependency syndrome when several psychotropic substances are taken. The DSM-IV calls for the repeated use of substances from at least three substance groups (excluding caffeine and nicotine ) over a period of at least twelve months (for the diagnosis of polysubstance dependence ) , whereby the dependency criteria apply to all substances, but not to a specific group, must be met. A renaming to Polysubstance Use-Disorder is currently being discussed.

Particular dangers during pregnancy

If mothers with multiple addictions also consume multiple substances during pregnancy , there is a high probability that the child will be born with physical and / or mental disabilities . In Germany, three out of every 1000 children born are children of women with multiple addictions. Through the use of heroin, cocaine and alcohol, for example, the following faults may occur in children: delayed crawling stage , delayed walker age , delayed language development , ADD / ADHD , dyscalculia , dyslexia . In addition, the following was observed with multiple substance use during pregnancy: congenital malformations , increased susceptibility to infection , developmental delay , learning disorders , sudden infant death syndrome and consequences of obstetric complications.

Individual evidence

1. ↑ ^{a b c d} Federal Center for Health Education (BZgA): Beware of mixed consumption , accessed on October 13, 2015
2. ↑ ^{a b c d e f g h i j k l m n} Gundula Barsch, Joachim Eul, Tibor Harrach (2004): Understanding mixed drug use differently - prevalences and consumption ratings , in: and Wiener Zeitschrift für Suchtforschung, vol. 27, 2004 No. 4 , Pp. 49–6 and in: Konturen, issue 6-2006, pp. 8–15, accessed online on October 13, 2015
3. ↑ ^{a b c d e f g} Landescaritasverband Bayern eV: Mixed consumption , accessed on October 13, 2015
4. ↑ ^{a b} SZL Suchtzentrum gGmbH: Substance information LSD , accessed on October 13, 2015
5. ↑ SSL addiction gGmbH: substance information Speed , accessed on 13 October 2015
6. ↑ SZL Suchtzentrum gGmbH: Substance information cocaine , accessed on October 13, 2015
7. ↑ SSL addiction gGmbH: Substance Information heroin , accessed on 13 October 2015
8. ↑ ^{a b c d} SZL Suchtzentrum gGmbH: Substance information cannabis , accessed on October 13, 2015
9. ↑ Federal Center for Health Education (BZgA): Description of consumption for the combinations of consumption: cannabis - cocaine - alcohol , accessed on October 14, 2015
10. ↑ SSL addiction gGmbH: Substance Information MDMA , accessed on 13 October 2015
11. ^ Landescaritasverband Bayern eV: Substance information LSD , accessed on October 14, 2015
12. ↑ Berger, Mathias (Ed.): Mental Illnesses - Clinic and Therapy , p. 382; Elsevier, 3rd edition 2009
13. ↑ American Psychiatric Association, DSM-5 Development, 2010: Polysubstance-Use Disorder ( Memento of October 19, 2012 in the Internet Archive )
14. ↑ Ruthard Stachowske  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. . Retrieved May 29, 2014  

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !