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The Dangers of Mixing Drugs and Alcohol

Polysubstance use occurs when one knowingly or unknowingly combines two or more drugs. Someone may engage in polysubstance for different reasons; certain types of substances may be used to enhance the effects of other substances, while in other instances, one substance may be used to lessen the effects of another.1 Additionally, one may unintentionally engage in polysubstance use, especially if they are given substances mixed with other substances without their knowledge.1

While polysubstance use can involve mixing a number of substance types, alcohol is frequently one of them.2 Already one of the most commonly used drugs on its own, an estimated 5.6% of U.S. adults used both alcohol and some other type of illicit substance within the past year—with opioids (both illicit and prescription), central nervous system (CNS) depressants, amphetamines and other stimulants, and marijuana commonly being part of the mix.2 Understanding the dangers of mixing alcohol and drugs can be critical in making healthy life choices and in finding recovery for substance misuse and addiction.

Combing Alcohol with Drugs

Alcohol is commonly mixed with other substances. Some may knowingly or intentionally use other substances while intoxicated, while others might drink alcohol while also taking certain types of medications, unaware of the potential for harmful side effects or other contraindications.

While the physical effects one may experience while mixing alcohol and drugs can vary greatly depending on various factors, including the type and amount of each substance being used, alcohol-related polydrug use is also associated with an increase in the risk of certain mental health issues, including substance use disorder (SUD, also known as addiction), mood disorders (depression and other disorders), and anxiety disorders.2 Addiction treatment centers have also noted a sizeable portion of patients attending treatment for polysubstance misuse, with an estimated 17% of treatment admissions related to both alcohol and drug misuse.2  

While alcohol may be misused and mixed with many substances, some of the more common ones include:2

  • Illicit and prescription opioids.
  • Central nervous system (CNS) depressants.
  • Illicit and prescription stimulants.
  • Marijuana.

Alcohol and Opioids

Opioids are a type of drug that alters pain signaling in the CNS to diminish pain perception.3 While opioids are valued for their therapeutic painkilling properties,  at high enough doses, their use is also associated with a rewarding euphoria. As a result of this reinforcing effect, opioids have a high potential for misuse and addiction.3

The opioid class includes both prescription medications and illicit drugs. Commonly prescribed opioids include morphine, hydrocodone, and oxycodone.4 Well-known illicitly manufactured and/or used opioids include heroin and fentanyl (though there are pharmaceutical preparations of fentanyl, illegally made fentanyl use has been on the rise).4, 5

Due to their specific pharmacological effects, opioids can lead to potentially severe or life-threatening symptoms, especially when misused or mixed with other sedating or respiratory depressant substances, including alcohol. Mixing alcohol with drugs like opioids can increase the likelihood of several adverse effects, including:1,6

  • Drowsiness.
  • Loss of consciousness.
  • Altered mental status or confusion. 
  • Memory problems. 
  • Dizziness.
  • Impaired motor control. 
  • Weak pulse. 
  • Slowed or stopped breathing. 
  • Anoxic injury to the brain and other organs.
  • Increased risk for overdose fatalities. 

Lethal overdose becomes a very real risk when mixing opioids with alcohol. In past years, more than 22% of prescription opioid-related drug overdose deaths also involved alcohol use.7

Alcohol and CNS Depressants

Prescription central nervous system (CNS) depressants include a variety of sedating medications—including benzodiazepines, non-benzodiazepine sedative-hypnotics (sleep medications), and barbiturates. 8

Benzodiazepines are widely prescribed for conditions such as panic and anxiety, and some seizure disorders. Examples of commonly used prescription benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium).8 Commonly prescribed to manage insomnia, non-benzodiazepine sedative hypnotic drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon).8 Though the relatively safer benzodiazepines have largely supplanted their use, some historically prescribed barbiturates include phenobarbital and pentobarbital.8

When benzodiazepines and alcohol are mixed, for example, their combined sedative effects can place a person at a heightened risk of fatal overdose than either substance on its own.10 Out of all benzodiazepine-related deaths reported in American emergency rooms In 2010, alcohol was involved in 21.4% of these deaths.10

Due to their sedating properties, CNS depressants and alcohol can dangerously interact. Combined adverse effects may include:6

  • Marked over-sedation or drowsiness.
  • Impaired motor control.
  • Unusual behavior.
  • Memory problems.
  • Respiratory depression.

Alcohol and Stimulants

CNS stimulants include several substances—both illegal drugs and licit medications—including several that are prescribed for their abilities to increase focus and energy.11 stimulants may be used to treat a wide range of medical disorders like attention-deficit hyperactivity disorder (ADHD) and narcolepsy.11 Like their illicit counterparts cocaine and methamphetamine, prescription stimulants may be misused due to their ability to induce feelings of increased energy and other rewarding effects. Commonly misused prescription stimulants include: dextroamphetamine (Adderall, Dexedrine) and methylphenidate (Ritalin, Concerta).

The interaction(s) between alcohol and stimulants can vary greatly depending on what stimulant is misused. A primary concern for mixing alcohol and stimulants is damage to the heart and cardiovascular system.12 For example, mixing alcohol and cocaine can result in a cardiotoxic metabolite substance called cocaethylene, which can increase the already marked cardiovascular risks of alcohol and cocaine use alone.12

Alcohol and Marijuana

Marijuana is a broad term used to describe various drug products derived from the Cannabis sativa plant that primarily contain a psychoactive compound called tetrahydrocannabinol (THC).13 In recent years, marijuana has been increasingly legalized for both medical and recreational usage in parts of the United States. While generally safe for medical use when taken as prescribed, marijuana does carry the risk of overdose, dependence, and addiction.13

Mixing alcohol and marijuana may result in a variety of negative health and social outcomes. Studies suggest that those who use alcohol and marijuana concurrently may experience greater impairment, potentially resulting in an increased risk of physical and social harm.15 Furthermore, analysis of research surveys suggests that simultaneous use of alcohol and marijuana may lead somebody to increase the amount of alcohol consumed and the regularity with which they consume alcohol, potentially leading to negative health outcomes like overdose or the development of a SUD.14

Finding Help for Polysubstance Use

If you’re ready to find treatment for polysubstance misuse or addiction, American Addiction Centers (AAC) can help. With facilities across the country, AAC offers various levels of evidence-based care to suit your needs. Contact us by 24 hours a day, 7 days a week, or verify your insurance now and reach out for more information later. Our compassionate admissions navigators are here to answer your questions, discuss treatment options, and help you begin the admissions process once you’re ready.


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