More social research into polydrug use

The growing range of psychoactive substances, greater availability of drugs and increased technical knowledge surrounding drug use have created opportunities for multiple ways of combining different substances. There are indications of a trend of increased use of multiple substances in recent decades. For example, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) has stated that “[p]olydrug use, including the combination of illicit drugs with alcohol, and sometimes, medicines and non-controlled substances, has become the dominant pattern of drug use in Europe” (EMCDDA, 2011, p. 13). This, naturally, leads to a growing need to further knowledge on the different patterns, meanings, attitudes and risks of polydrug use.

Although the increase in polydrug use has appeared challenging to study due to the lack of stable measurements (Karjalainen, Kuussaari, Kataja, Tigerstedt, & Hakkarainen, 2017), the volume of publications dealing with the theme has certainly increased to a significant degree. This is shown in Figure 1, which displays the number of publications retrieved in a search in the Web of Science from the 1970s up until 2017. This inquiry shows that the research literature has discussed polydrug use widely and increasingly ever since the late 20th century. A major part of this literature stems from natural sciences such as toxicology, pharmacy, neurosciences or psychiatry. In contrast, in the prevailing traditions of social research on alcohol and drugs, polydrug use has remained a “no man’s land” (Hakkarainen & Metso, 2009).

Figure 1.

The number of publications dealing with polydrug use found in Web of Science by the end of 2017. The search was conducted with the following search terms profile: (polydrug* OR polysubstance OR (“multiple substance abuse”) OR (“multiple drug* abuse”) OR (“multiple drug* use”) OR (“mixed drug* abuse”) OR (“mixed substance abuse”)).

As is the case with drug use in general, polydrug use is a phenomenon that also needs to be explained by means, measures and theories of the social sciences. In fact, some specific characteristics related to polydrug use are only possible to address by the help of social scientific approaches and tools. Not least because our understanding of the intentions, social meanings, control and the different patterns of combining substances is still very limited. Neither do we know much about the mechanisms or situational factors leading to polydrug use. More research from different angles is needed in order to answer questions like “How is polydrug use perceived?” “Who is a polydrug user?” “How prevalent is polydrug use today?” “Why do people combine different substances, and how do they perceive the risks and harms of use?” The theoretical and empirical knowledge of such issues continues to lag far behind the adoption of new and multifaceted consumption practices.

It is evident that the health-related and social harms and risks of polydrug use are considerable. For example, the simultaneous use of alcohol, illicit drugs and medicines produces unpredictable effects that increase substantially the number of deaths caused by overdose, and other detrimental consequences (e.g., Karjalainen, et al., 2010; Salasuo, Vuori, Piispa, & Hakkarainen, 2009). These risks are significant especially at the more severe and hard-use end of the drug use spectrum which is particularly based on uncontrolled polydrug use. This sort of problematic severe drug use often includes alcohol and pharmaceuticals as important ingredients (e.g., EMCDDA, 2011; Tammi, Pitkänen, & Perälä, 2011). However, recent studies have shown that polydrug use is not always uncontrolled, but can involve intentional and conscious aspirations to produce, enhance or mediate certain effects and feelings (e.g., Quintero, 2009; Schensul, Convey, & Burkholder, 2005). According to some studies, polydrug use often takes place in recreational settings. Parker describes the situation in Britain:

A major difficulty in researching young people’s illicit drug use lies in the attempt to disentangle it from drinking episodes and careers, as a great deal of recreational drug use occurs during alcohol consumption and in venues where alcohol is available (e.g. parties, bars, and clubs). (Parker, 2005, p. 210)

Overall, the definition of the concept “polydrug use” is problematic. Research focusing on it easily slides into a repetition of themes associated with ill health, mental health problems and social disadvantages. This has led to a dominant formulation of polydrug use as a strongly stigmatised and marginalised behaviour when, in fact, simultaneous use of different drugs is a practice that is manifold, diverse and wide-ranging, and which manifests itself in myriad use patterns (Kataja, Hakkarainen, & Väyrynen, 2017; Lamy, 2014; O’Gorman, 2016). Particularly, it is important to recognise personal control of use as an integral part of polydrug-use patterns.

The increase in drug use patterns of combining substances may also be a result of increased knowledge-based technical control over emotions and cognitive features. The intentional production of certain feelings through drug use may represent new kinds of techniques of chemical mind altering (see Rose & Abi-Rached, 2013). Polydrug use is also entwined with intentions of enhancements of human capacities within different domains (studies, work, sex, sports, appearance). These topics are gaining more attention among researchers (Van de Ven, 2016). Furthermore, online environments provide new platforms for exchanging ideas and knowledge and for purchasing different substances (Barratt & Maddox, 2016). One significant factor of the new and increased polydrug use is also the demographic transition that is currently taking place in Western societies. The higher consumption of alcohol among older adults who use prescription medicines creates new patterns of polydrug use (Cousins et al., 2014). All of these social and cultural factors, and many more, affect patterns of polydrug use, including its new forms. Identifying these patterns and forms is worth a deeper exploration of the kind that does not forget the pleasure dimension that is the core motive of all substance use. Even though it is a sensitive topic, the intentions of combining different substances and a pursuit of pleasure from polydrug use should be more extensively considered in future research (Hautala, Hakkarainen, Kataja, Kailanto, & Tigerstedt, 2018).

To conclude, even though polydrug use is today increasingly acknowledged, theoretical and empirical knowledge of the different patterns of use, whether they take more traditional or trendy shapes, is still scarce and underdeveloped (e.g., Schensul et al., 2005).

In this thematic issue, polydrug use is approached from three different angles. To begin with, Katherine Karriker-Jaffe and colleagues (2018) draw attention to the contribution of simultaneous use of heavy drinking and drug use to diagnoses of alcohol use disorder and drug abuse, respectively. One of their important findings is that simultaneous drug and alcohol use is associated with a significantly elevated risk of drug abuse. Therefore, they suggest that screening and brief intervention should cover not only alcohol use but also about use of other drugs. This would be in line with recommendations to focus interventions on multiple risk behaviours and simultaneous use of different substances.

Second, Kati Kataja and colleagues (2018) explore discussions in an online context regarding simultaneous use of different substances. In the discussion fora under study, persons having first-hand experience of polydrug use share and circulate polydrug-use-related knowledge. According to the findings of the study, knowledge about the pleasures and risks of different drug combinations is under constant negotiation, sometimes even debated. According to this ongoing interaction the forum users position themselves either as beginners or masters in polydrug use practices. Thus, online discussions function as sites for learning how to make more pleasurable and safer drug combinations.

Third, in his debate paper, Axel Klein (2018) discusses the political use of the term polydrug use during the Nixon administration in the US in the 1970s. He argues that the origin of the term can be found in the early years of the war on drugs when the administration renewed the connection between marihuana use and heroin use by the gateway theory. Drug users were presented as “poly drug users” who would switch substances in accordance with availability and price. Klein concludes that due to conceptual problems and the political use of the term, “polydrug use” is still causing confusion among observers, laymen and policy makers.

This special issue of NAD leads the way towards a better understanding of the rather undiscovered world of the pleasures and problems of polydrug use, especially from the social sciences point of view.