Treating Polysubstance Abuse in Oklahoma: A Guide

Here is something worth sitting with: when the Oklahoma State Department of Health counts overdose deaths, it counts substances “alone or in combination” ². That single choice of wording tells you how the state sees this crisis. Deaths rarely involve just one drug. The dashboard is built on the assumption that most cases involve a mix.

The fentanyl trajectory shows why. In 2020, Oklahoma recorded 127 fentanyl-involved overdose deaths. By 2023, that number climbed to 730 — nearly a six-fold increase in three years. In 2024, it dropped to 487, still almost four times the 2020 count ³. Fentanyl did not arrive alone. It arrived pressed into pills people thought were something else, mixed into powders sold as other drugs, showing up in toxicology reports next to methamphetamine, alcohol, benzodiazepines, and cocaine.

Overall unintentional overdose death rates rose 77% from 2020 to 2023 before easing 15% from 2023 to 2024 ³. The recent decline is real, and it matters. But it does not undo the pattern underneath: the substances driving deaths in Oklahoma travel together.

If you are using more than one thing, you are not the outlier the surveillance data is designed to flag as unusual. You are what the data is measuring. That reframe matters when you pick up the phone. You are not asking a program to make a rare exception for you. You are asking it to treat the population it is set up to serve.

Methamphetamine is the most common substance involved in Oklahoma overdose deaths — showing up in roughly two of every three drug overdose deaths in 2024 ³. Meth-involved deaths totaled 813 in 2023 and 760 in 2024 ³. Those numbers sit next to the fentanyl figures, and often on the same death certificate.

That combination — a stimulant and an opioid working on the body at the same time — is what clinicians now plan around. The CDC has documented the same trend nationally, with a large and growing share of overdose deaths involving both opioids and stimulants together ⁹. Oklahoma is not an odd corner of that map. It is one of the clearer examples of it.

Why does this matter for the plan a program builds for you? Because stimulants and opioids pull the body in opposite directions. One speeds you up, one slows you down. The withdrawal timelines are different. The cravings hit on different triggers. The medications that help with opioid use disorder do nothing for meth, and there is no FDA-approved medication for meth use disorder at all. A program that treats you as “an opioid case” and quietly ignores the meth is not building a plan for the person actually walking through the door.

The clinical question a good Oklahoma admissions team asks is not “which substance brought you here” but “which substances are in your life right now, and in what pattern.” If nobody asks the second question, that tells you something.

You may have heard some version of this before: “Let’s get you off the opioids, and then we’ll deal with the drinking.” Or, “We need you clean from meth for 30 days before we can really work on the alcohol piece.” It sounds reasonable at first. Focus. One thing at a time. Except that is not what the clinical evidence actually supports.

The VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders — the same guideline that shapes care for veterans across the country and informs civilian practice too — puts it plainly. Patients with more than one substance use disorder should be managed according to the recommendations for each of those individual disorders ¹. Not sequentially. Not after they “prove” they can handle the first one. Concurrently. If you have an opioid use disorder and an alcohol use disorder and a stimulant use disorder, the guideline expects each to be assessed and treated on its own evidence base, inside one coordinated plan.

That matters for you because it means the sequential model — the one that has probably felt like a locked door — is not the standard of care. It is a workaround that some programs default to because it is easier for them. It is not what the science says works, and it is not what a program building a real plan for your situation should be doing.

Here is a specific fear worth naming. Maybe you are on buprenorphine or methadone for opioid use disorder, or you have been prescribed naltrexone for alcohol. And you have also been using meth, or drinking on top of the medication, or something in between. You are afraid that being honest about that will get your medication taken away.

That does not mean nothing changes. A good clinical team will look at what you are using, ask why, adjust the plan, and add support around the substances the medication does not cover. But the reflex to punish honesty by taking away the one thing keeping you alive on the opioid side — that reflex is not evidence-based. If a program tells you that you have to stop your MOUD to be admitted, that is a signal about their protocol, not about what your body actually needs.

Almost nobody arrives at multiple substances by accident. Somewhere in the story there is usually pain that came first — a childhood that was not safe, a loss that never got grieved, an assault, a deployment, a body that hurts, a mind that will not quiet down. The substances started as a way to survive that. Then they became their own problem, sitting on top of the original one.

Any polysubstance plan that ignores what is underneath is building on sand. SAMHSA’s guidance on trauma-informed care is built around a simple idea: services should be organized so they do not retraumatize the client, and knowledge about trauma should be integrated into every aspect of care ¹⁰. That is not a soft add-on. It shapes how intake questions are asked, how groups are run, how staff respond when you are triggered, and how the treatment plan handles the mental health conditions — depression, anxiety, PTSD, bipolar disorder — that so often ride alongside heavy substance use.

When a program treats each substance separately and treats the trauma somewhere down the road, you end up carrying the weight of coordinating your own care while in withdrawal. That is not a plan. A real integrated plan puts the substances, the trauma, and the mental health conditions on the same page, with the same team.

A real polysubstance plan starts with a real polysubstance assessment. That means the intake conversation does not stop at the first substance you name. A good clinician keeps going — gently, without judgment — through the whole list. What are you using. How much. How often. What time of day. What are you mixing it with. What are you using to sleep. What are you using to wake up. What are you using when the cravings for the other thing get loud.

The reason this matters is simple: what does not get named does not get treated. If you tell an admissions team about the fentanyl but leave out the daily drinking because you do not think of yourself as an alcoholic, the plan they build has a hole in it. Withdrawal management, medication choices, and relapse-prevention work all shift when a second or third substance is on the list.

Assessment should also cover the mental health piece and the trauma history at the same time — SAMHSA’s trauma-informed framework calls for exactly this kind of integrated intake so the client is not asked to tell the worst parts of their story to three different strangers on three different days ¹⁰.

Once every substance is on the page, the plan gets built in layers that run at the same time, not in a line.

On the medication layer, if opioid use disorder is part of your picture, buprenorphine or methadone stays on the table. If alcohol use disorder is part of it, naltrexone or another medication may be added. The VA/DoD guideline is direct that these medications should not be automatically pulled because you are also using a stimulant or another substance ¹. There is no FDA-approved medication for methamphetamine use disorder, so the stimulant piece leans harder on behavioral treatment — and that treatment runs in parallel, not after the opioid piece is “done.”

On the therapy layer, evidence-based approaches like cognitive behavioral therapy, dialectical behavior therapy, and trauma-focused work address the thinking patterns, the emotion regulation, and the memories underneath all the substances at once. One therapist, one relationship, one plan — not a separate track per drug.

On the experiential layer, things like equine therapy, art therapy, recreational therapy, and outdoor time do work that talk therapy alone cannot. They help a nervous system that has been running on stimulants and depressants learn how to feel safe in a quiet room again. That layer is not decoration. For polysubstance clients, it is often where the body catches up with what the mind is starting to understand.

Country Road Recovery Center sits on 136 acres in Pink, Oklahoma, a rural setting near Shawnee and Oklahoma City. The physical distance from the neighborhoods, dealers, and routines tied to active use is part of the clinical design, not a marketing detail. For someone using multiple substances, changing environment is often the first thing that lowers the daily temperature enough for real assessment to happen.

The center specializes in dual diagnosis, which is the clinical language for what most polysubstance clients actually need — treatment that holds the substances, the mental health conditions, and the trauma in one plan instead of handing them off to three different providers. Clinical programming pulls from CBT, DBT, and trauma-focused therapy, with equine therapy, art therapy, and other experiential modalities layered in. Residential, PHP, and IOP levels of care allow the plan to step down without starting over with a new team.

Many staff members are in long-term recovery themselves. That lived experience shows up in how questions get asked at intake and how honesty about every substance gets received. If you want to know how a plan would get built for your specific mix, ask Country Road’s admissions team to walk you through it.