Polysubstance Use Defines Substance Disorders Now
Vulnerability and compulsive reward-seeking change forms across substances.
By Mark S Gold M.D.
Published by Psychology Today on May 11, 2026
Key points
• Polysubstance use is no longer the exception; it’s the clearest expression of a single addictive disease.
• Most overdoses involve multiple substances—opioids, psychostimulants, Benzos, alcohol, and cannabis.
• Substance use before age 18 is strongly associated with a chronic and relapsing polysubstance use disorder.
Addiction medicine is in the midst of a conceptual tectonic shift. Recent work by Director Nora Volkow and her National Institute on Drug Abuse (NIDA) colleagues is crystallizing the direction of the change. What clinicians have historically labeled as separate conditions—alcohol use disorder, opioid use disorder, and cocaine use disorder—are now better understood as different expressions of one common vulnerability.
