Polysubstance puzzle: A case report on alcohol, pregabalin, cyproheptadine, and dexamethasone dependence

Abstract

This case report explores the intricate landscape of polysubstance dependence, focusing on a 24-year-old male presenting with concurrent reliance on alcohol, pregabalin, cyproheptadine, and dexamethasone. This unique case underscores the complexities inherent in diagnosing and managing overlapping substance use disorders, emphasizing the need for thorough assessment and comprehensive intervention strategies. With substance dependence representing a significant global health concern, this report contributes valuable insights to the scientific literature by elucidating the multifaceted dynamics of polysubstance misuse. A 24-year-old male of asthenic built, with a history of alcohol consumption for 8 years initiated by peer pressure and escalated by life stressors, presented with depressive symptoms and reliance on multiple substances. His main concerns included mood disturbances, fatigue, and decreased appetite. Clinical evaluation revealed depressive features, substance dependence, and comorbidities associated with polysubstance misuse. Notably, he self-medicated with pregabalin for its euphoric effects, consumed cyproheptadine and dexamethasone to alter his body weight, and relied on alcohol as a coping mechanism. Treatment involved pharmacotherapy and motivational enhancement therapy, resulting in significant improvement and subsequent abstinence from all substances. This case underscores the complexities encountered in diagnosing, treating, and managing polysubstance dependence, exemplified by the dependencies on alcohol, pregabalin, cyproheptadine, and dexamethasone within a single patient. A comprehensive treatment approach incorporating detoxification, tapering, and psychological counseling facilitated significant progress. Achievements included successful abstinence from alcohol and notable reductions in cravings for pregabalin, cyproheptadine, and dexamethasone.