The Misuse of the DSM-5-TR Diagnosis of Polysubstance Use Disorder

October 5, 2026

Sandy Rivers, Author & Founder, Authentic Trainings

Tom O'Connor, Publisher

KEY POINTS

DSM-5-TR does not list polysubstance use disorder as a standalone diagnosis; clinicians diagnose substance-specific use disorders, although the older umbrella term remains common in some settings.

Sandy argues that an imprecise label can hide why a person uses different substances, including trauma, mental health symptoms, pain, work demands, and other life circumstances.

Broad labeling may increase stigma and lead treatment teams to miss the substances, risks, medications, therapies, and supports that require individual attention.

The article calls for substance-specific assessment, person-first language, co-occurring mental health care, and a fuller understanding of the individual behind the diagnosis.

DSM-5-TR is the guide that many doctors, therapists, and mental health professionals use to diagnose mental health and substance-related conditions. One issue that continues to create confusion and controversy is the diagnosis often referred to as "polysubstance use disorder," which generally means a person is using more than one drug or substance at the same time. While the DSM-5-TR no longer officially lists "polysubstance dependence" as its own disorder, the term is still commonly used in treatment settings. Unfortunately, the label is sometimes misused in ways that can hurt people rather than help them.

Polysubstance Use Disorder: An Oversimplification

One of the biggest problems with this diagnosis is that it can oversimplify a person's situation. My previous medical director would say it was a lazy way to diagnose a complex case. People use substances for many different reasons, and those reasons are often deeply connected to stress, trauma, mental health struggles, or physical pain. For example, someone might drink alcohol to deal with anxiety, take stimulants to stay awake during long work shifts, and use prescription pain medication for chronic pain. Simply labeling that person as having a "polysubstance use disorder" can ignore the real reasons behind their behavior. Instead of understanding the person's life and struggles, the diagnosis can become a shortcut that places everyone into the same category.

Stigma

Another major issue is stigma. Challenges related to substance use already carry a great deal of judgment in society, and being labeled as someone who uses "multiple substances" can make that judgment even worse. People may assume the individual is reckless, dangerous, or beyond help. In my experience, these individuals were often the most severely traumatized. Sadly, this stigma can come not only from the public but also from healthcare workers, employers, and even family members. When people feel judged or shamed, they are less likely to seek help or remain in treatment. A diagnosis meant to guide care can sometimes leave a person feeling hopeless or misunderstood.

Misusing the diagnosis can also lead to poor treatment. Recovery from harmful substance use is not one-size-fits-all. Different substances affect the body and mind in different ways, and each person's situation is unique. Someone struggling with opioid use may need medication-assisted treatment, while someone misusing stimulants may benefit more from therapy and behavioral support. If a person is broadly labeled as having a polysubstance problem without looking closely at which substances are most harmful or why they are being used, treatment may miss the mark. This can lead to frustration, relapse, and the feeling that recovery is impossible.

Mental Health Problems

Mental health problems are another important part of the conversation. Many people who struggle with substance use are also dealing with depression, anxiety, trauma, or other emotional difficulties. In some cases, drugs or alcohol become a way to numb emotional pain or escape overwhelming feelings. If professionals focus only on the substance use itself, they may overlook the deeper issues underneath it. A person who has experienced trauma, for example, may need counseling and emotional support just as much as treatment for substance use. Ignoring those root causes can keep people trapped in a cycle of harmful behavior and repeated relapse.

Concerns also exist about unfair treatment and bias. Research has shown that people from poorer communities or minority backgrounds are often diagnosed more harshly than others. Two people may have similar patterns of substance use, but the one from a disadvantaged background may be more likely to receive a severe diagnosis. Meanwhile, someone from a wealthier or more privileged background might be described as simply "experimenting" or "going through a difficult time." This double standard shows how personal opinions and social bias can influence mental health diagnoses, even when professionals are supposed to follow the same guidelines for everyone.

Other Consequences of Using Polysubstance Use Disorder as a Diagnosis

An inaccurate diagnosis can extend far beyond healthcare. Being labeled with multiple substance use disorders can affect someone's ability to find a job, maintain custody of their children, or receive fair treatment in court. In some situations, people with these diagnoses are automatically seen as irresponsible or high-risk. This can lead to punishment instead of support. For example, someone in recovery may struggle to receive pain medication for a legitimate medical issue because healthcare providers fear misuse. These situations can make recovery even harder and leave people feeling trapped by a label.

The DSM-5-TR attempted to address this issue by removing "polysubstance dependence" as an official, standalone diagnosis. Instead, clinicians are encouraged to diagnose each substance use disorder separately. This change recognizes that challenges related to substance use are complex and that every substance affects people differently. However, old habits remain, and many professionals still use the term informally because it is quicker or more familiar. As a result, the same problems can continue despite changes in the official guidelines.

What Providers Need to Do

To reduce the misuse of this diagnosis, healthcare providers need to take a more personal and compassionate approach. Instead of focusing only on the substances someone uses, they should try to understand the person behind the behavior. Asking questions about trauma, stress, relationships, mental health, and life experiences can provide a clearer picture of what is really happening. Language also matters. Referring to someone as "a person with a substance use disorder" rather than calling them an "addict" can help reduce shame and promote dignity.

In the end, challenges related to substance use are not simply about drugs or alcohol. They are often connected to pain, isolation, mental health struggles, and difficult life experiences. When diagnoses like polysubstance use disorder are used carelessly, they can reduce a complex human experience to a simple label. While diagnostic tools are important, they should never replace empathy, understanding, and individualized care. People struggling with substance use deserve treatment that sees them as human beings, not just as a diagnosis.

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Read Sandy's bio by clicking her icon at the start of this article.

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