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Effects & Risks of Mixing Drugs and Alcohol

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If you’ve ever taken prescription medications, you’ve seen warning labels advising not to mix with alcohol.

But what about illicit drugs or over-the-counter medications? 

Mixing any drug or medication with alcohol is dangerous. Certain mixtures can lead to: 

  • Irreversible changes in brain chemistry
  • Negative mental health effects
  • Severe health complications
  • Legal issues
  • Financial issues
  • Risk of injuries
  • Overdosing and potentially death 

Alcohol and Substance Abuse: Common Drug Interactions

While not all mixtures will have fatal results, there is an inherent risk in combining any drug with alcohol. Different results develop based on how the substances interact.

Each type of drug interacts differently with alcohol. It is important to understand the potential effects of each combination.  

Illegal Drugs (Illicit Drugs)

There are many types of illegal drugs. Cannabis is the most common. Although it is increasing in legality around the world.

Opioids and stimulants are Schedule II-IV Controlled substances. Most of these drugs are legal under doctor supervision and prescription but illegal on the street.

They can be injected, smoked, swallowed, or snorted. They create a sense of euphoria, drowsiness, and often severe impairment.

Lastly, “club drugs,” hallucinogens, and dissociative drugs are Schedule I-IV substances. They can be swallowed, snorted, or injected.

These substances can create extreme effects, from hallucinogenic and out-of-body experiences to lowered inhibition and severe sedation.

Below are some common interactions and risks associated with some of these drugs when mixed with alcohol.

Cocaine and Alcohol

When taken together, alcohol and cocaine mix to form a different substance called cocaethylene. This substance is more problematic to the body, particularly the liver.

It also causes dehydration more than either alcohol or cocaine ingestion alone. This causes further issues such as heat stroke or bad “comedowns.”

Heroin and Alcohol

Both heroin and alcohol are depressants. This causes a stronger and often overwhelming intoxication when combined. 

The likelihood of a fatal heroin overdose is more common when sedatives or other depressants, such as alcohol, are present in the bloodstream.

Methamphetamine and Alcohol 

Taking methamphetamines and alcohol together can lead to:

  • Adverse changes in mood
  • Raised heart rate
  • Severely impaired physiological abilities

Mixing these substances can also alter levels of certain neurotransmitters in the brain. This affects signals in the brain that help regulate critical functions.

Ecstasy/Molly and Alcohol

Ecstasy, has recently shifted to become MDMA or “Molly,” which is one of the most used party drugs in the world. However, problems arise when taken with alcohol as the liver metabolizes both substances.

Alcohol, which is trying to be processed by the liver simultaneously, can slow the removal of MDMA. This leads to potential adverse effects such as:

  • Confusion
  • Muscle spasms
  • Raised heart rate
  • High blood pressure

Prescription Drugs

As their name suggests, prescription drugs need to be prescribed by a doctor.

The FDA regulates them, and there has been a growing problem with abuse of these legal drugs. People use medication that was not prescribed for them or illegally obtain these drugs from street dealers.

Whether or not they are obtained legally, many of these drugs have severe and problematic interactions with alcohol, even in small amounts.

Below are some of the effects when common prescription medications are mixed with alcohol.

Xanax and Alcohol

Both Xanax and alcohol are depressants with sedative effects. When taken together, they can cause fatigue, drowsiness, and a loss of muscle control, coordination, and balance.

Mixing these substances can also lead to: 

  • Mood and behavioral effects
  • Memory impairments
  • Physical side effects, such as headaches, low blood pressure, blurred vision
  • Gastrointestinal symptoms like nausea, vomiting, and diarrhea
Opioids and Alcohol 

Combining alcohol with opioids can be extremely dangerous. On top of more common symptoms, such as nausea, vomiting, and low blood pressure, mixing these substances can lead to: 

  • Changes in heart rate
  • Dizziness
  • Loss of coordination
  • Loss of consciousness
  • Coma and even death
Benzodiazepines and Alcohol 

According to drug labels on all benzodiazepines, none of them should be mixed with alcohol. Combining these can lead to cognitive reduction and mental health disorders. It can also lead to developing a physical dependence on one or both substances.

Sleeping Pills and Alcohol

Mixing sleeping pills with alcohol can cause issues, such as: 

  • Excessive drowsiness
  • Disorientation
  • Memory problems
  • Slow reaction times
  • Low blood pressure
  • Changes in behavior

This is true of prescription sleeping pills and over-the-counter sleep aids and herbal supplements. All have these effects when mixed with alcohol.

Antidepressants and Alcohol

Consuming alcohol while taking antidepressants is problematic. Alcohol has the potential to deepen depression further and can also cause unwanted side effects. Some side effects include drowsiness, dizziness, and decreased coordination.

Over-The-Counter Medications

Many people use over-the-counter (OTC) medications. A doctor's prescription is not required for these medications.

Most of them can also be found in pharmacy aisles in addition to behind the pharmacist counter. They are generally considered safer than illicit drugs and are regulated by the FDA.

Some common examples of OTCs include:

  • Dramamine — motion sickness
  • NSAIDS (acetaminophen, ibuprofen, salicylic acid) — non-steroidal anti-inflammatory drugs
  • Loratadine — seasonal allergy medication
  • Bismuth subsalicylate — upset stomach
  • Hydroxycut — weight loss pills

Mixing OTCs with alcohol is often seen as less problematic than mixing other drugs with alcohol. However, that does not mean risks are absent. 

Depending on the amount of medication ingested and the amount of alcohol consumed, there could be serious consequences. This includes heart complications and death.

There is enough medicine in a bottle of ibuprofen or acetaminophen, often seen as harmless, to harm adults seriously. The risks increase when alcohol is added to the mix. 

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Other Substances

Generally, you should not consume alcohol with substances that alter the way you feel. Drinking alcohol with caffeinated products can hide the effects of alcohol. As a result, users may feel more impaired than they realize.

Other over-the-counter items or supplements may also contain untested ingredients that negatively interact with alcohol.

Energy Drinks

As well as high levels of caffeine, many energy drinks have chemicals that can increase energy levels and hide the effects of alcohol. These chemicals include guarana, taurine, ginseng, and sugar.

This can increase the risk of dangerous behavior when a person combines energy drinks and alcohol.

Herbal Supplements

Over-the-counter herbal supplements have become popular for various health issues. Many claim to treat a selection of health problems, including weight gain, cosmetic problems, and mood issues. 

Many diet pills, in particular, are addictive and can lead to many health issues when combined with alcohol. Herbal supplements marketed as mood enhanced may also combine dangerously with alcohol. 

Some users have reported blacking out or experiencing seizures after drinking alcohol with 5-HTP. This is a supplement that may improve depression. 

It is essential to be careful when you drink alcohol with herbal supplements. Always follow the directions on medication labels. If you take any form of supplement, speak with your doctor before drinking alcohol.

The Development of Polysubstance Abuse

When someone regularly abuses more than one drug, they are prone to developing polysubstance abuse.

People who chronically combine different drugs may worsen physical dependence on one or both of the drugs. They may develop a substance use disorder.

As well as developing a physical dependence on several drugs, polysubstance abuse may lead to:

  • Problems with personal relationships, school, work, or other responsibilities 
  • Potentially using drugs in places and situations where it is dangerous to do so
  • A failure to fulfill obligations, including problems with parenting, work responsibilities, and relationships

Polysubstance abuse can be challenging to treat for various reasons. Clinicians may accidentally miss or overlook an individual’s alcohol use and instead focus on their drug use.

Patients in treatment for alcohol use disorder who have problems with polysubstance abuse need to have all of their issues assessed simultaneously. Treatment focused on one substance abuse is unlikely to be successful. 

All substance abuse issues must be identified and treated. Chronic polysubstance abuse problems typically lead to significant issues with emotional, cognitive, and physical functioning. 

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Treatment Options for Alcohol Abuse & Addiction

There are many treatment options available for alcohol use disorder (AUD) and addiction, including:

Inpatient Programs

Inpatient treatment takes place at a licensed residential treatment center.

These programs provide 24/7 comprehensive, structured care. You'll live in safe, substance-free housing and have access to professional medical monitoring. 

The first step of an inpatient program is detoxification. Then behavioral therapy and other services are introduced. These programs typically last 30, 60, or 90 days, sometimes longer.

Most programs help set up your aftercare once you complete the inpatient portion of your treatment.

Partial Hospitalization Programs (PHPs)

Partial hospitalization programs (PHPs) provide similar services to inpatient programs.

Services include medical care, behavioral therapy, and support groups, along with other customized therapies. 

However, in a PHP program, you return home to sleep. Some services provide food and transportation, but services vary by program.

PHPs accept new patients as well as people who have completed an inpatient program and require additional intensive treatment.

Outpatient Programs

Outpatient treatment is less intensive than inpatient treatment or partial hospitalization programs.

These programs organize your treatment session based on your schedule. The goal of outpatient treatment is to provide therapy, education, and support in a flexible environment.

They are best for people who have a high motivation to recover and cannot leave their responsibilities at home, work, or school. Outpatient programs are often part of aftercare programs once you complete an inpatient or PHP program.

It is important for people undergoing treatment to have a stable and supportive home environment. If family members/roommates drink or use drugs in the home environment, it will be extremely difficult for the person to maintain abstinence when they return home after treatment. It is extremely difficult to undergo successful outpatient therapy if you are living in a home environment with ready access to drugs and alcohol.

Medication-Assisted Therapy (MAT)

Sometimes medications may be used in alcohol addiction treatment.

Some medicines can help reduce the negative side effects of detoxification and withdrawal.

Others can help you reduce cravings and normalize body functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone are the most common medications used to treat AUD. 

When combined with other evidence-based therapies, such as cognitive behavioral therapy (CBT), MAT can help prevent relapse and increase your chance of recovery.

Support Groups

Support groups such as Alcoholics Anonymous (AA) and Self-Management And Recovery Training (SMART) are open to anyone with a substance use disorder.

They are peer-led organizations dedicated to helping each other remain sober.  Support groups can be the first step towards recovery or part of a long-term aftercare plan.

Updated on March 29, 2022
6 sources cited
  1. Bujarski, S., Roche, D. J., Lunny, K., Moallem, N. R., Courtney, K. E., Allen, V., Hartwell, E., Leventhal, A., Rohrbaugh, T., & Ray, L. A. . The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users. Drug and alcohol dependence, 142, 127–132
  2. Anglin MD, Almog IJ, Fisher DG, Peters KR. Alcohol use by heroin addicts: evidence for an inverse relationship. A study of methadone maintenance and drug-free treatment samples. Am J Drug Alcohol Abuse. 1989;15:191-207
  3. Food and Drug Administration . Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers. FDA 
  4. National Institute of Alcohol Addiction and Alcoholism . Harmful Interactions. NIAAA 
  5. Moore, Alison A et al. “Risks of combined alcohol/medication use in older adults.” The American journal of geriatric pharmacotherapy vol. 5,1 : 64-74
  6. Martin, Christopher S. “Timing of alcohol and other drug use.” Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism vol. 31,2 : 96-9.

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