New drugs and polydrug use: implications for clinical psychology.

Abstract

The abuse of legal and illegal drugs is a complex and constantly evolving phenomenon. In recent years the polydrug use, term that refers to the use of two or more psychoactive drugs in combination to achieve a particular effect, has been on the rise. In many cases, one drug (amphetamine, cocaine, or heroin) is used as a base, with additional drugs being added to compensate for the side effects of the primary drug and to make the experience more enjoyable. The traditional traffic of drugs, always cheaper and more often available on the Internet, is expanding to include medical prescription drugs that can be ordered without prescription, “smart” drugs (substances legally sold for other uses, such as fertilizers, bath salts, dietary supplements), and synthetic drugs (Cinosi et al., 2014). In Italy, in 2013, the Department of Drug Control Policy (DPA) has identified, made illegal, and seized more than 250 new substances, including synthetic cannabinoids, cathinones, phenethylamines, piperazines, and metossietamine (Dipartimento Politiche Antidroga Relazione annuale al Parlamento, 2013). With the change in substances, the methods of recruitment and their use have also changed. The assumption is that combination of drugs increases the health risk much more compared to a single drug, e.g., alcohol and cocaine increase cardiovascular toxicity (Snenghi et al., 2015); alcohol or depressant drugs, when taken with opioids, lead to an increased risk of overdose; opioids or cocaine taken with ecstasy or amphetamines also result in additional acute toxicity. Benzodiazepines are notorious for causing death when mixed with other depressant substances, such as opioids, alcohol, or barbiturates (Kelly et al., 2015). The unpredictability of the effect, due to the use of several substances randomly mixed, makes the substance use more attractive. Instead of looking for a specific effect, as was the case with the use of a single drug, polyusers seek the maximum alteration of consciousness and loosening of inhibitions (the so-called garbage head syndrome), which makes it much easier to achieve the euphoria. The new phenomenology of the “culture” of the buzz calls for a re-thinking by the therapists and experts in the field in order to promote various forms of integration between professionals and to calibrate new methods of intervention.