Updated on July 20, 2021

Effects & Risks of Mixing Drugs and Alcohol

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If you’ve ever taken prescription medications, there is a good chance that 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 type of drug with alcohol. Different results develop based on how the substances interact.

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

Illegal Drugs (Illicit Drugs)

There are many different types of illegal drugs, most of which are Schedule I Controlled Substances. Cannabinoids are perhaps the most ubiquitous, although they are not unlawful everywhere (with legality increasing in the United States and elsewhere in the world). These are smoked or ingested to create a relaxed state, which can sometimes bring anxiety and paranoia.

Opioids and stimulants are Schedule II-IV Controlled substances. The majority of these drugs are legal under doctor supervision and prescription but illegal on the street. They can be injected, smoked, swallowed, or snorted to create a sense of euphoria, drowsiness, and often severe impairment.

Lastly, “club drugs,” hallucinogens, and dissociative drugs are Schedule I-IV substances that can be swallowed, snorted, or injected. Substances in this subcategory 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 readily than either alcohol or cocaine ingestion on its own, causing further issues such as heat stroke or bad “comedowns.”

Heroin and Alcohol

Both heroin and alcohol are depressants, leading to a more pronounced and often overwhelming intoxication when combined. 

Heroin, which is already one of the most addictive known substances, can be elevated as a dependent drug when mixed with alcohol. In addition, 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 

When taking methamphetamines and alcohol together, it can lead to adverse changes in mood, raised heart rate, and severely impaired physiological abilities. Mixing these substances can also alter levels of certain neurotransmitters in the brain, affecting signals in the brain that help regulate critical functions.

Ecstasy/Molly and Alcohol

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

Alcohol, which is trying to be processed by the liver simultaneously, can slow the removal of MDMA, leading to potential adverse effects such as confusion, muscle spasms, raised heart rate, and high blood pressure.

Prescription Drugs

Prescription drugs, as their name suggests, need to be prescribed by a doctor.

The FDA regulates them, and there has been a growing problem with abuse of these legal drugs, from people using medication that was not prescribed for them to illegally obtaining these drugs without a prescription 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

Since both Xanax and alcohol are depressants with sedative effects, especially in higher doses, 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 (including Xanax). 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 not only true of prescription sleeping pills but also over-the-counter sleep aids and herbal supplements, which can all have these effects when mixed with alcohol.

Antidepressants and Alcohol

Consuming alcohol while taking antidepressants is problematic because 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, including 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. 

Other Substances

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

Other types of over-the-counter items or supplements may also contain untested ingredients that interact negatively 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 and reckless 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 an individual abuses more than one drug regularly, they are prone to developing polysubstance abuse. In some circumstances, those 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:

  • Impairment in essential areas of functioning, like 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 because of one or both drugs, including problems with parenting, being responsible at work, and being responsible to others

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. As 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 of the substance abuse issues must be identified and treated. Chronic polysubstance abuse problems typically lead to significant issues with emotional, cognitive, and physical functioning compared to alcohol use disorder alone. 

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Resources

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Bujarski, S., Roche, D. J., Lunny, K., Moallem, N. R., Courtney, K. E., Allen, V., Hartwell, E., Leventhal, A., Rohrbaugh, T., & Ray, L. A. (2014). The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users. Drug and alcohol dependence, 142, 127–132

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(2):191-207

Food and Drug Administration (2017). Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers. FDA 

National Institute of Alcohol Addiction and Alcoholism (2020). Harmful Interactions. NIAAA 

Moore, Alison A et al. “Risks of combined alcohol/medication use in older adults.” The American journal of geriatric pharmacotherapy vol. 5,1 (2007): 64-74

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 (2008): 96-9.

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