Opioids and Alcohol Interactions

Alcohol, or ethanol, is a chemical substance that produces an intoxicating effect. Drinking alcohol is legal in the U.S. for people 21 years of age or older. However, drinking in excess can lead to harmful health consequences. 

People who regularly drink alcohol can develop tolerance, requiring them to drink more to feel the same effects. They may also experience withdrawal symptoms if they quit suddenly. 

Opioids are a type of natural or synthetic drug prescribed to reduce pain. Illicit drugs, like heroin, and prescription painkillers, like hydrocodone and fentanyl, are included in this class. 

Doctors prescribe opioid medications for moderate-to-severe pain. These drugs block pain signals by binding to opioid receptors in the brain, spinal cord, and other areas in the body. 

Opioids cause a chemical change in the brain, which results in pain relief and mood changes such as intense pleasure or euphoria. These chemical changes can reinforce repetitive drug use, making opioids highly addictive.¹

Both alcohol and opioids are central nervous system (CNS) depressants. When taken together, the effects of each substance can cause adverse symptoms that negatively affect the brain.

Alcohol Effects

Some symptoms of alcohol intoxication include:^{2, 3}

• Slurred speech
• Decreased coordination
• Confusion
• Drowsiness
• Dizziness
• Nausea
• Vomiting
• Mood swings
• Headaches
• Impaired hearing and vision
• Depressed breathing
• Irregular heartbeat
• Loss of consciousness

People with alcohol use disorder (AUD) may have symptoms like: 

• An inability to stop drinking once started
• Drinking a lot
• Excessive cravings for alcohol
• Drinking more to achieve the same results
• Ignoring enjoyable activities to drink
• Failing to meet family, work, or school obligations
• Drinking even though it causes trouble with family and friends
• Experiencing withdrawal symptoms when there is no alcohol

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Opioid Effects

Common side effects of prescription opioids include:

• Nausea
• Vomiting
• Constipation
• Itchiness
• Dizziness
• Dry mouth
• Sedation

Symptoms of opioid intoxication include:

• Extreme sedation
• Confusion
• Small pupils
• Difficulty breathing
• Nausea
• Vomiting
• Decreased consciousness

Opioid use disorder (OUD) can happen with both illicit and prescription opioids. Like alcohol use disorder (AUD), cravings, tolerance, withdrawal, and loss of control may be experienced. 

Mixing Opioids and Alcohol is a Deadly Combination

Both alcohol and opioids are associated with their own set of risks and side effects. These factors compound when the two substances are taken together. 

Combined Effects

Mixing alcohol and opioids may lead to higher toxicities and slower excretion rates.⁴

The combination can cause complications like:^{2, 3, 5}

• Drowsiness
• Dizziness
• Overdose risk
• Respiratory depression (slowed or difficulty breathing)
• Loss of coordination
• Memory loss
• Damage to the brain and other organs
• Abnormal behavior
• Death

Research has shown that approximately one in five deaths attributed to prescription opioid misuse also involved alcohol. In addition, binge drinkers were nearly twice as likely to misuse prescription opioids as nondrinkers.¹¹

Withdrawal Symptoms

Withdrawing from opioid or alcohol use is a complex process. Dangers, difficulties, and risks are increased when withdrawing from the two substances simultaneously. 

People who use opioids, and who have alcohol dependence, may experience seizures, delirium tremens (DTs), and other severe symptoms if they quit drinking. 

Treatment Outcomes

Research has shown that alcohol misuse interferes with treatment for opioid use disorder (OUD). In addition, opioid misuse has been linked with poorer alcohol use disorder (AUD) treatment outcomes. ¹¹

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Symptoms of Opioid and Alcohol Overdose 

An overdose happens when there is a high level of alcohol or drugs in the body. Functions like breathing, heart rate, and temperature control become disregulated.⁷

Roughly 500,000 people died from opioid overdoses between 1999 and 2019.⁸ Over half of the opioid overdose cases involved alcohol abuse.⁵

Alcohol and opioids are both depressants. Mixing two depressants can cause symptoms like:²

• Respiratory depression (slowed or difficulty breathing)
• Weak pulse
• Confusion or altered mental status
• Passing out

With respiratory depression, breathing slows down which decreases oxygen levels. The brain will shut down organ systems, and can lead to coma or possibly even death.⁹

If someone overdoses on opioids, call 911 immediately. A drug called naloxone should be given to anyone who shows symptoms of overdose. It rapidly reverses opioid overdose by binding to the same brain receptors as opioids, blocking their effects.⁸

Excessive alcohol consumption, or alcohol poisoning, is an emergency situation. If someone experiences alcohol poisoning, call 911 and seek medical help immediately.

Treatment for Co-Occurring Alcohol and Opioid Use Disorders

People with a physical dependence on opioids and alcohol should seek medical care for treatment of substance use disorder (SUD). 

Inpatient rehab or residential treatment is recommended for people with severe addiction or co-occurring disorders. People stay in the facility where they are given 24-hour care to manage withdrawal symptoms.¹⁰

Medications may also be used for opioid addiction, including:^{1, 10}

• Methadone: An opioid agonist that binds to opioid receptors in the brain. It reduces opioid cravings and withdrawal.
• Buprenorphine: A partial opioid agonist. It acts similarly to methadone.

Medications for alcohol addiction include:¹⁰

• Acamprosate: This medication reduces the desire to drink alcohol. It’s effective for people with severe alcohol addiction.
• Disulfiram: This medication interferes with alcohol breakdown. Acetaldehyde (the byproduct of alcohol metabolism) builds up and causes nausea and other unpleasant symptoms. People on disulfiram will be motivated to avoid alcohol if they want to avoid these symptoms.

Naltrexone is approved by the Food and Drug Administration (FDA) to treat both AUD and OUD. It can block opioid receptors and decrease opioid cravings. It can also reduce cravings for alcohol.^{1, 10}

Behavioral treatments are effective, especially when used with medications. 

Examples of behavioral approaches include:^{1, 10}

• Cognitive-behavioral therapy (CBT): Helps people anticipate and avoid alcohol- or drug-inducing situations. It also helps people develop coping skills. 
• Multidimensional family therapy (MDFT): For adolescents with drug abuse problems. It looks at their drug influences and is designed to improve family functions.
• Motivational interviewing (MI): Helps people resolve their uncertainty in entering alcohol or drug addiction treatment.
• Contingency management (CM): Uses vouchers or price incentives to encourage abstinence. It’s also called “motivational incentives.”