Mixing Drugs and Alcohol: Effects and Dangers

The Dangers of Mixing Drugs and Alcohol

Alcohol is commonly mixed with other substances. Research indicates that more than 11% of individuals diagnosed with a substance use disorder in the United States have concurrent illicit drug or alcohol use disorders.³ There is also evidence that mixing alcohol and other substances is a practice that has gone up. Between 2019 and 2020, the number of opioid overdose deaths that also involved alcohol increased by 41%.²

The effects that an individual might experience from mixing drugs and alcohol vary widely, depending on several factors—including the type and amount of substance used and other co-occurring physical and mental health disorders.

While individuals may use alcohol with any substance, some of the most common substances concomitantly used with alcohol include:³

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

Mixing Alcohol and Opioids

Opioids belong to a class of drugs that are used for pain relief.⁴ The opioid class includes both prescription medications—such as morphine, hydrocodone, and oxycodone—and illicitly manufactured, distributed, and used opioids, including heroin and fentanyl.⁴

Prescription opioids work by altering pain signaling in the central nervous system to reduce pain-signal perception.⁵ Thus, doctors often use them to treat patients after surgery or severe injury.⁵

In addition to the pain-relieving, therapeutic effects, when misused in higher doses or taken in ways other than how they were prescribed, opioids lead to increased dopamine activity in the brain, which is associated with euphoria. This rewarding effect has the potential to lead to continued opioid misuse and addiction.⁵

Misusing opioids can cause dangerous, life-threatening effects alone.⁵ When combined with alcohol, besides causing sedation and slowed breathing—a side effect of each substance—together, alcohol and opioids can increase the risk of adverse health outcomes, including:^1,6

• Drowsiness.
• A weak pulse.
• An altered mental status.
• Confusion.
• Memory problems.
• Passing out, or loss of consciousness.
• Impaired motor control.
• Damage to the brain and other organ systems.

The greatest risk posed by mixing alcohol and opioids is lethal overdose. Data shows that in past years, alcohol contributed to 22.1% of prescription opioid-related overdose deaths.⁷

Mixing Alcohol with CNS Depressants

Mixing Alcohol with Stimulants

Stimulants include prescription medications—such as the Dexedrine, Adderall, Ritalin, or Concerta—used to treat conditions like attention-deficit hyperactivity disorder (ADHD) or narcolepsy by helping an individual improve their alertness, attention, and energy. Stimulants also include illicit drugs, such as cocaine and methamphetamine.¹¹

When mixed with alcohol, both prescription stimulants and their illicit counterparts can induce unpredictable, even life-threatening effects. There’s a common misconception that taking a stimulant (like cocaine) with a depressant (like alcohol) causes the two substances to balance or cancel out the effects of the other drug.¹ This is, in fact, inaccurate. When taken with prescription stimulants, alcohol can cause dizziness, drowsiness, poor concentration, and an increased risk of heart problems.⁶ That’s because the concurrent use of alcohol and a stimulant can result in the effects of one masking the other. This can cause an individual to incorrectly judge their level of intoxication or the amount they’ve taken and use more of one or both substances. Aside from the above mentioned adverse effects, this can also lead to overdose.¹

As previously stated, there is also an increased risk of cardiovascular events when alcohol is used in combination with stimulants.¹² For example, when cocaine and alcohol mix, they produce a cardiotoxic metabolite called cocaethylene that is similar in potency to cocaine, but lasts longer, and increases the risk of sudden death from heart attack or stroke.^12,13

Mixing Alcohol with Hallucinogens and Dissociative Substances

Hallucinogens, or psychedelic substances, such as LSD, and dissociative drugs—like PCP, ketamine, and dextromethorphan—can distort a person’s perceptions of time, motion, color, sound, and self.¹⁴

While some psychedelic and dissociative drugs are derived from plants and fungi, many are synthetic, man-made substances that were created in a lab.¹⁵ Most individuals, who use psychedelic and dissociative substances, do so for recreational purposes; however, research is being done to assess whether these drugs may be utilized to help treat substance use disorders, depression, and other mental health conditions.¹⁵

As research into the potential benefits of psychedelic and dissociative substances continues, taking these substances alone or combined with other substances, such as alcohol, is not without risks.¹⁵ For instance, taking an over-the-counter cough suppressant that contains dextromethorphan—and also consuming alcohol—can cause drowsiness, dizziness, and increase the risk of overdose.⁶ In fact, fatal overdoses associated with psychedelic and dissociative substances typically involve extremely high doses or the commitment use of other substances, including alcohol.¹⁵