Multiple drug use: a dangerous trend.

The pattern of drug abuse across the United States appears to be taking a turn for the worse. Rather than latching on to one "drug of choice," people are increasingly ingesting several drugs at once in combinations that pose serious health dangers and create hazards for detoxification programs, say researchers at the national 800-COCAINE Helpline in Summit, N.J.

A random survey of 300 helpline callers during May revealed that 87 percent of them abuse several drugs at the same time, says psychiatrist Mark S. Gold, founder of the telephone advice and treatment referral service. The number of "polydrug" abusers has increased 19 percent since the helpline began to survey callers in May 1983.

The sample only includes people seeking help for drug abuse, notes helpline research direcotr Arnold M. Washton, but the reported increase has prompted the service to install additional telephone lines and train its counselors more extensively.

"Multiple substance abuse is becoming the norm for people heavily involved in drugs," says Washton. Survey respondents report combining alcohol, cocaine, marijuana, tranquilizers, prescription narcotics and sleeping pills. They are often addicted to two or more drugs.

The greatest portion of callers--63 percent--said they were addicted to cocaine; 31 percent reported alcohol addiction, 23 percent said they were addicted to tranquilizers and prescription narcotics and 17 percent were addicted to sleeping pills.

Polydrug abusers seek out additional drugs to increase, balance or maintain the effects of drugs they are already taking, says Gold. "Cocaine addicts often use other substances to soften the crashing effects of the cocaine high," he explains. "Cocaine users are especially prone to alcohol abuse during withdrawal from cocaine."

Mixing drugs apparently leads to increased helath problems, adds Gold. Nearly half of the polydrug abusers in the survey reported a progressive worsening of medical symptoms, particularly stomach ailments and liver problems. Data collected by the National Institute on Drug Abuse indicate that about two-thirds of hospital emergency room cases admitted for drug abuse involve combinations of drugs.

"The polydrug abusers we spoke to do not match the description of street addicts one usually associates with drug abuse," says Washton. Multiple drug abusers in the survey are fairly young, with an average age of 29. Nearly three-quarters are employed, and another 15 percent are students. About half the sample reported family, social and job prolems related to drug abuse.

Diagnosis of polydrug abuse is difficult, cautions Washton. During intoxication and withdrawal, multiple substance abusers may exhibit symptoms that mimic psychiatric disorders. In addition, since most treatment programs require patients to be drug free, polydrug abusers often admit only to using one drug.

Even with the proper diagnosis, says Gold, detoxification of multiple-substance abusers is complicated. "People who mix alcohol, for example, and tranquilizers are in danger of having brain seizures during withdrawal unless treatment is tailored to the individual's condition."

There is no uniform approach to polydrug abuse treatment, explains Gold, but because of the dangerous reactions during withdrawal, detoxification should take place in a hospital or residential center. The mix of multiple drug use, medical disorders and family problems then requires individually designed treatment.

Adds Gold: "Drug abuse specialists are unprepared to deal with polydrug abuse. Treatment centers, and the medical community in general, are only experienced at treating single-drug addictions."

800-COCAINE counselors are linked to a network of treatment centers and hospitals, "but there aren't many facilities that are experienced at treating polydrug abusers," says Washton. "This problem simply hasn't been well studied."