within the past twelve months. there is a distinct difference between a person having three separate dependence issues and having polysubstance dependence the main difference is polysubstance dependence means that they are not specifically addicted to one particular substance. this is often confused with multiple specific dependences present at the same time. to elaborate, if a person is addicted to three separate substance such as cocaine, methamphetamines and alcohol and is dependent on all three then they would be diagnosed with three separate dependence disorders existing together (cocaine dependence, methamphetamine dependence and alcohol dependence,) not polysubstance dependence. in addition to using three different substances without a preference to one, there has to be a certain level of dysfunction in a person's life to qualify for a diagnosis of polysubstance dependence. one of the bigger challenges that often occurs when trying to diagnose is the fact that people don't always report what they are taking because they are afraid of getting into legal trouble. when coding polysubstance dependence in a dsm-iv it would be a multiaxial diagnosis 304.80- polysubstance dependence", next to the classification, it is accompanied by a list of other types of substance dependence (e.g. "305.00 alcohol abuse" or "305.60 cocaine abuse"). the dsm-iv requires at least three of the following symptoms present during a 12-month period for a diagnoses of polysubstance dependence. tolerance: use of increasingly high amounts of a substance or they find the same amount less and less effective ( the amount has to be at least 50% more of the original amount needed.) withdrawal: either withdrawal symptoms when the substance stops being used or the substance is used to prevent withdrawal symptoms. loss of control: repeated use of more substance than was initially planned or use of the substances over longer periods of time than was planned. inability to stop using: either unsuccessfully attempted to cut down or stop using the substances or a persistent desire to stop using. time: spending a lot of time studying substances, obtaining substances, using substances, being under the influence of substances, and recovering from the effects of substances. interference with activities: give up or reduce the amount of time involved in recreational activities, social activities, and/or occupational activities because of the use of substances. harm to self: continuous use of substances despite having a physical or psychological problem caused by or made worse by the use of substances. dsm-5 eliminated polysubstance disorder; there the substances must be specified, among other related changes. treatment treatment for polysubstance dependence has many critical aspects. substance rehabilitation is a lengthy and difficult process. treatment must be individualized and last a sufficient amount of time to ensure the patient has kicked the addictions and to ensure the prevention of relapse. the most common forms of treatment for polysubstance dependence include: inpatient and outpatient treatment centers, counseling and behavioral treatments, and medications. it is important that treatments be carried on throughout the patient's life in order to prevent relapse. it is a good idea that recovering addicts continue to attend social support groups or meet with counselors to ensure they do not relapse. inpatient treatment center inpatient treatment centers are treatment centers where addicts move to the facility while they are undergoing treatment. inpatient treatment centers offer a safe environment where patients will not be exposed to potentially harmful situations during their treatments as they would on the outside. inpatients usually undergo the process of detoxification. detox involves withdrawing the user (usually medically) from all substances of concern. during their stay in the treatment facility, patients often are learning to manage and identify their substance addictions and to find alternate ways to cope with whatever is the cause of their addiction. outpatient treatments outpatient treatments include many of the same activities offered in an inpatient treatment facility, but the patient is not protected by the secure and safe environment of an inpatient treatment center. for this reason, they are significantly less effective. the patient usually continues to hold a job and goes to treatment nightly. twelve-step programs both in-patient and out-patient treatments can offer introductions to 12-step programs. suggested 12-step programs are alcoholics anonymous (aa) and narcotics anonymous (na). they offer regular meetings where members can discuss their experiences in a non-judgmental and supportive place. cognitive behavioral therapy also offered to patients are one-on-one counseling sessions and cognitive behavioral therapy(cbt). when looked at through a cognitive-behavioral perspective, addictions are the result of learned behaviors developed through positive experiences. in other words, when an individual uses a substance and receives desired results (happiness, reduced stress, etc.) it may become the preferred way of attaining those results, leading to addictions. the goal of cbt is to identify the needs that the addictions are being used to meet and to develop skills and alternative ways of meeting those needs. the therapist will work with the patient to educate them on their addictions and give them the skills they need to change their cognition's and behaviors.addicts will learn to identify and correct problematic behavior. they will be taught how to identify harmful thoughts and substance cravings. cbt is an effective treatment for addictions. medications medications can be very helpful in the long-term treatment of polysubstance dependence. medications are a useful aid in helping to prevent or reducing substance cravings. another benefit of medications is helping to preventing relapse. since substance use disorders affect brain functioning, medications assist in returning to normal brain functioning. people who use multiple substances require medications for each substance they use, as the current medications do not treat all substance use disorders simultaneously. medications are a useful aid in treatments, but are not effective when they are the sole treatment method. substance use disorder medications methadone treatment for heroin addiction. 'naltrexone: reduces opiates and alcohol cravings. disulfiram: induces intense nausea after drinking alcohol. acamprosate: normalizes brain chemistry disrupted by alcohol withdrawal and aids alcohol abstinence. buprenorphine/naloxone: the two medications together reduce cravings and block the pleasure from opiates. epidemiology there are not very many studies that have examined how often polysubstance dependence occurs or how many people are dependent on multiple substances. however, according to a study that analyzed the results from the national epidemiological survey on alcohol and related conditions, approximately 215.5 out of a total of 43,093 individuals in the united states (0.5%) met the requirements for polysubstance use disorder. another study suggested that the number of new cases of polysubstance dependence has been going up. this idea was supported by a study that took place in munich, germany. a group of researchers chose to look at responses to a survey using the m-composite international diagnostic interview (m-cidi). the m-cidi is a version of the composite international diagnostic interview (cidi). the researchers collected data from 3,021 participants, all between the ages of 14 and 24, to estimate the prevalence, or total number of cases, of substance use and of polysubstance use/dependence. the results of this study indicated that of the 17.3% who said that they regularly used substances, 40% said that they used more than one substance, but 3.9% specifically reported using three or more substances, indicating that there is a lot of overlap in the use of different substances. the researchers compared their results to earlier german studies and found that substance dependence seems to be increasing, at least in germany. gender differences women and men differ in various ways when it comes to addictions. research has shown that women are more likely to be polysubstance dependent. it has been noted that a larger percentage of women use licit (legal) substances such as tranquilizers, sedatives, and stimulants. on the other hand, men are more likely to use illicit (illegal) substances such as cocaine, methamphetamine, and other illicit substances. research suggests that women addicts more frequently have a family history of substance use. when asked to describe their onset of addictions, women more frequently describe their addiction as sudden where as men describe them as gradual. females have a higher percentage of fatty tissues and a lower percentage of body water than men. therefore, women absorb substances more slowly. this means these substances are at a higher concentration in a woman's bloodstream. female addicts are known to be at greater risk for fatty liver disease, hypertension, anemia, and other disorders.