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Updated on September 19, 2023
7 min read

Why Is Mixing Opioids and Alcohol Dangerous?

The misuse of prescription opioids and the overuse of alcohol are an increasingly dangerous combination. The consequences of mixing these two substances can be life-threatening. Yet, it’s something that too many people continue to do. 

Unfortunately, when opioids and alcohol mix, the risk of developing a physical dependency increases. It also heightens the suffering from serious health issues in both the short and long term. 

This blog post explores why you should avoid this co-abuse, discusses its effects on your body and mind, and lists resources for seeking help if you or someone you know has started combining these drugs.

What is Alcohol?

Alcohol, or ethanol, is a depressant that affects the central nervous system. Makers produce it by fermenting carbohydrates and sugars.

When you consume it in moderation, alcohol can provide relaxation and increased sociability. It can also help reduce stress and anxiety.

However, alcohol can potentially do serious harm in excessive amounts. Alcohol abuse can lead to health issues, such as:

  • Addiction
  • Liver cirrhosis
  • Cardiovascular disease
  • Diabetes
  • Pancreatitis
  • Depression
  • Increased risk of certain cancers
  • Withdrawal symptoms if you quit suddenly

What are the Symptoms of Alcohol Intoxication?

The 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

What are the Symptoms of Alcohol Use Disorder?

Alcohol use disorder (AUD) is a medical term that describes an alcohol problem that has become severe.

Certain symptoms characterize it, such as:

  • Drinking in larger amounts or for longer periods than you intended
  • Wanting to cut down on your drinking but not being able to do so
  • Spending a lot of time getting or using alcohol, drinking it, or recovering from its effects
  • Craving alcohol and feeling the urge to use it
  • Continuing to drink despite the detrimental physical, emotional, and social consequences
  • Giving up important activities to consume alcohol
  • Experiencing withdrawal symptoms when you stop drinking
  • Increasing your tolerance for alcohol so that you need more for the same effects
  • Failing to meet family, work, or school obligations

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What are Opioids?

Opioids are natural or synthetic drugs physicians prescribe to reduce pain. Illicit drugs like heroin and prescription painkillers like hydrocodone and fentanyl fall under 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 of the body. 

Opioid drugs work by triggering a chemical change in the brain. This 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 you take them together, the effects of each substance can cause adverse symptoms that negatively affect the brain.

What are Opioid Effects?

Common side effects of prescription opioids include:

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

What are the Symptoms of Opioid Intoxication?

Symptoms of opioid intoxication include:

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

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

Why is Mixing Opioids and Alcohol Dangerous?

Alcohol and opioids have their own set of risks and side effects. These factors compound when you take the two substances together. 

Specifically, mixing alcohol and opioids may lead to higher toxicities and slower excretion rates.4 The combination can cause complications, such as: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 from prescription opioid misuse also involved alcohol. In addition, binge drinkers were nearly twice as likely to misuse prescription opioids as nondrinkers.11


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What are the Withdrawal Symptoms of Alcohol and Opioid Addiction?

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

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

Alcohol misuse interferes with treatment for opioid use disorder (OUD). In addition, opioid misuse leads to poorer alcohol use disorder (AUD) treatment outcomes. 11


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What are the Symptoms of Opioid and Alcohol Overdose?

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

In the case of an overdose, the body experiences a dangerous surge of alcohol or drugs. This leads to a disruption in critical functions such as breathing, heart rate, and temperature control.7

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

Statistics on Opioid-Related Deaths

In 2010, there were 21,089 opioid-related overdose deaths. This escalated to 47,600 in 2017 and maintained at a steady level until 2019.5

There was a sharp increase in 2020, with 68,630 reported deaths. This trend continued in 2021, with a staggering 80,411 reported overdose deaths.5

Immediate Responses to Overdoses

If someone overdoses on opioids, call 911 immediately. Excessive alcohol consumption, or alcohol poisoning, is an emergency situation.

A healthcare provider will administer a drug called naloxone to address overdose symptoms. It rapidly reverses opioid overdose by binding to the same brain receptors as opioids, blocking their effects.8

How To Treat Co-Occurring Alcohol and Opioid Use Disorders

People physically dependent on opioids and alcohol should seek medical care to treat substance use disorder (SUD). 

Inpatient rehab or residential treatment is ideal for those with severe addiction or co-occurring disorders. People stay in the facility, receiving 24-hour care to manage withdrawal symptoms.10

Medication-Based Approaches for Addiction Treatment

Medications play a crucial role in treating opioid addiction. These drugs include: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.

The Food and Drug Administration (FDA) also approved Naltrexone 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 for Addiction

Behavioral treatments are effective, especially when you use them with medications. Examples of behavioral approaches include:1, 10

  • Cognitive-behavioral therapy (CBT): Helps you anticipate and avoid alcohol- or drug-inducing situations. It also helps you develop coping skills. 
  • Multidimensional family therapy (MDFT): For adolescents with drug abuse problems. It looks at their drug influences and improves family functions.
  • Motivational interviewing (MI): Helps you resolve your 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.”

What are the Societal Implications of Opioid and Alcohol Misuse?

The societal implications of opioid and alcohol misuse are devastating. In addition to the physical risks, substance abuse can cause:

  • Poverty: People with addiction may be unable to work or make a living, leading to poverty.
  • Crime: Addiction is linked to criminal behavior in several ways, including drug-related crimes and theft to buy drugs.
  • Mental health issues: Substance abuse can cause or worsen mental health issues, such as depression, anxiety, and bipolar disorder. In addition, people who suffer from mental health disorders may be more likely to abuse drugs or alcohol.
  • Social isolation: People with addiction may become isolated from friends and family, as substance use takes over their lives. This can lead to further physical and psychological harm.
  • Domestic violence: Substance misuse is a major factor in domestic violence. It increases aggression and reduces impulse control.
  • Homelessness: Substance abuse can contribute to homelessness by leaving people unable to afford housing and damaging their ability to maintain relationships.

Organizations like the Substance Abuse Mental Health Services Administration (SAMHSA) are committed to strengthening communities by helping those with addiction issues. Their approach emphasizes prevention, early diagnosis, integrated treatment, and recovery support.


Combining opioids and alcohol can be highly dangerous. Taking them together increases the risk of overdose, addiction, or death. Therefore, it’s essential to understand the potential risks and preventative strategies to avoid this substance abuse.

If you suspect someone is misusing opioids or alcohol, call 911 immediately. It's also important to seek medical care to treat substance use disorder (SUD).

Medication-based approaches and behavioral treatments are available to help those struggling with addiction. It’s also essential to understand the societal implications of substance misuse and take steps to reduce its effects on people and communities alike. 

Updated on September 19, 2023
2 sources cited
Updated on September 19, 2023
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. Prescription Opioids DrugFacts.National Institute on Drug Abuse, 2021.  
  2. Polysubstance Use Facts.Centers for Disease Control and Prevention, 2022.
  3. Alcohol's Effect on Health.National Institute on Alcohol Abuse and Alcoholism, 2014. 
  4. Singh, A. "Alcohol Interaction with Cocaine, Methamphetamine, Opioids, Nicotine, Cannabis, and γ-Hydroxybutyric Acid." MDPI, 2019.

  5. "Drug Overdose Death Rates." National Institute on Drug Abuse, 2023.

  6. Opioid use may affect treatment for alcohol dependence.Science Daily, 2018.
  7. Understanding the Dangers of Alcohol Overdose.National Institute on Alcohol Abuse and Alcoholism, 2023.
  8. Opioid Data Analysis and Resources.Centers for Disease Control and Prevention, 2023.
  9. Mixing Opioids and Alcohol May Increase Likelihood of Dangerous Respiratory Complication, Especially in the Elderly, Study Finds.” American Society of Anesthesiologists, 2017.
  10. Treatment Approaches for Drug Addiction.National Institute on Drug Abuse, 2023.
  11. "CDC: Prescription opioid misuse linked to binge drinking." American Academy of Family Physicians, 2019.
  12. Witkiewitz et al. "Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study: Mediation by Medication Adherence." Alcohol, Clinical and Experimental Research, 2018.
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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.
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