I usually just skip the difficulties that have so fast streams that I'm unable to tap. That being said, I can pass Marisa using only the tablet (with bazillion combo breaks and D though) and 300 combo stacks in Scatman. If I really want to combo a map and there's only some deathstream between me and full combo, I might resort to z/x. But in general I don't like to play that way, because I can better keep the rhythm together with the tablet.