Drugs Commonly Mixed With Alcohol

As one of the most widely used drugs in the country, alcohol is legal for adult consumption and accepted in most social and cultural circles.1 The use of alcohol is not only common and tolerated, but it is often encouraged in various situations, such as during parties, celebrations, and holidays.1 The effects of alcohol can be increased or altered by taking prescription drugs with alcohol or combining alcohol with illicit drugs, and combinations can put you at risk for dangerous reactions.2  Depending on the medication or drug that’s taken with alcohol, interference can occur in a variety of ways, from amplifying side effects to masking them. This can increase the likelihood of experiencing adverse side effects, medical complications, or overdose, as well as contribute to an increased risk of traumatic injury.2  These interactions can happen even if you take the drug at a separate time from when you drink, as the drug can stay in your system for several hours or longer.2

The substances that are commonly mixed with alcohol include marijuana, opioids,  sedatives, and stimulants. Opioids and sedatives can increase the effects of alcohol and raise the risk of breathing issues and overdose. Stimulants may mask the effects of alcohol and raise the risk of heart issues.

Mixing Alcohol With Marijuana

Marijuana is the most used drug (other than nicotine) among those who drink alcohol, and both substances are frequently used together.13 Combining marijuana and alcohol may lead to a greater level of motor skill and cognitive impairment than taking either one on its own.

Those who use alcohol and marijuana together compared to those who use alcohol only significantly increase the odds of drunk driving, social consequences, and harm to self.13 People who use alcohol and weed together tend to consume more of both. This can increase your risk of developing a dependence on alcohol, weed, or both.13 Recent studies of young adults who simultaneously use marijuana and alcohol report more negative consequences.  These include experiencing negative physical side effects, lapses in memory, or embarrassing themselves.14

Mixing Alcohol With Opioids

Opioids are extracted from the poppy plant and used in prescription medications or as illicit drugs.3 Prescription opioids are used to treat acute or chronic pain, most often associated with injuries, migraines, dental procedures, or surgery.2  The most commonly abused prescription opioids include Vicodin (hydrocodone), Oxycontin (oxycodone), Percocet (oxycodone), Demerol (meperidine), Norco (hydrocodone/acetaminophen), morphine, and fentanyl.2,6 Heroin and illicitly manufactured fentanyl are common illicit opioids.3 

Alcohol is a central nervous system depressant that has synergistic effects on both the analgesic and respiratory depressing effects of opioids. This means that combining these two substances can amplify certain shared side effects much more than you would experience from either substance alone.3  Combining any type of opioid with alcohol can cause significant respiratory distress and significantly slow or even stop breathing. Alcohol has increasingly been a contributing factor in fatal opioid overdoses during the past 20 years.

In addition to increasing the risk of opioid overdose, combining opioids and alcohol can cause dizziness, drowsiness, and weaken memory and cognitive functioning.2 These effects can impair a person’s fine motor skills and slow reaction time, contributing to falls, motor vehicle crashes, and other traumatic injuries.2,15

Mixing Alcohol With Sedatives

Sedatives include a range of medications that are used to manage different conditions. Benzodiazepines, such as Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam), are prescribed to treat anxiety disorders, seizure disorders, insomnia, and muscle spasms, as well as alcohol withdrawal.2  Other common types of sedatives are known as “Z-drugs” and include Ambien (zolpidem) and Lunesta (eszopiclone), which are medications prescribed to treat insomnia.2,4 While these are all prescription medications, they are commonly misused.

Since both sedatives and alcohol are central nervous system depressants, mixing the two will amplify sedation (i.e. feeling tired and promoting sleep), hamper motor skills, and impair judgement.7,8 The combination increases the risk of experiencing adverse side effects from either substance as well as their severity.

Alcohol was involved in 27.2% of benzodiazepine-related emergency department visits and 21.4% of benzodiazepine-related deaths in 2010.

Alcohol and benzodiazepine use, specifically, suppress the respiratory drive and have synergistic effects with the respiratory depressing effects of opioids. In 2017, This increases the risk of an overdose when the three are used together.

Long-term consequences of combined benzodiazepine and alcohol use can include cardiovascular, gastrointestinal, hepatic, kidney, and neurologic injury and exacerbation of existing mental health conditions.16

Mixing Alcohol With Stimulants

Stimulants can be prescription medication and illicit drugs. Prescription stimulants, such as Adderall (amphetamine and dextroamphetamine), Concerta and Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Focalin (dexmethylphenidate), and Vyvanse (lisdexamfetamine), are prescribed to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.2,9 These medications are commonly misused, often by young adults who use them in efforts to improve their ability to focus and improve academic performance.9  Illicit stimulants include cocaine, amphetamine, methamphetamine (crystal meth, glass, or ice), and MDMA (also known as ecstasy or Molly).4 

Stimulants are frequently taken together with alcohol to potentiate (strengthen) euphoria and pleasure and decrease the adverse subjective effects of alcohol, thereby allowing the person to ingest more alcohol without feeling as intoxicated as they actually are.6,9 

But taking alcohol with stimulants doesn’t “cancel each other out.” There can be serious effects on physical, psychological, and behavioral health associated with combining stimulants and alcohol.2,6 This includes some potentially serious damage to the brain and cognitive function, such as disrupting learning and memory processes, inadequate blood flow to the brain, and increasing drug-seeking behavior. Combining alcohol and stimulants can lead to an increase in heart rate, blood pressure, and heart and cardiovascular stress, as well as an increase in the risk of developing different types of cancer.18

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Finding Rehab For Drug and Alcohol Use

If you or someone you care about is struggling with both drug and alcohol abuse, also known as polysubstance abuse, getting professional care at a treatment facility can help you learn how to maintain sobriety and avoid long-lasting detrimental effects on your physical and mental health that can occur from alcohol and drug abuse.10 Treatment involves more than just stopping substance use but also includes identifying and addressing ways in which substance use has affected a person’s life and functioning, helping them to change social and behavioral patterns that contribute or exacerbate substance use.10, 11 

Since drug and alcohol use isn’t the same for all patients and rehab centers typically offer a range of treatment options, it’s important for you to find a treatment program that offers the best fit for your individual needs.11 (p4) Treatment may be provided on an inpatient or outpatient basis. In inpatient treatment, you stay at a facility for the duration of treatment and staff offers monitoring and support around the clock while you receive care. In outpatient treatment, you live at your own residence and attend regularly scheduled appointments at a rehab facility.10,11 Inpatient and outpatient treatment programs can include a variety of components offered sequentially or simultaneously, including:5,11 ,12 

  • Medical detox. Detoxification, or medically managed withdrawal, describes the set of interventions designed to safely manage the physiological symptoms that some people experience when withdrawing from certain drugs.1 There are distinct withdrawal syndromes associated with different types of drugs, alcohol, and some prescription medications. Detox is where patients are stabilized, and you are kept as safe and comfortable as possible while your body clears itself of the substances you’ve been using.
  • Medication-assisted treatment (MAT). MAT combines pharmacological treatment (medications) with behavioral treatment. to take a whole-patient approach to treat opioid use disorder as well as alcohol use disorder.1 MAT can help minimize cravings for opioids and alcohol, reduce the severity of or eliminate opioid withdrawal symptoms, block some of the rewarding properties of alcohol, and prevent a return to illicit opioid use.
  • Behavioral therapy. These therapeutic techniques each work differently but commonly focus on teaching coping and relapse prevention skills, increasing motivation towards sobriety, improving communication and social skills, and identifying and managing situations that are high-risk for relapse. Commonly used therapies include cognitive-behavioral therapy (CBT), mindfulness-based intervention, family therapy, contingency management, and motivational interviewing. These therapies can be provided in both individual and group settings.
  • Mutual support groups. Examples of mutual support groups include 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) as well as non-12-step groups like SMART Recovery, Secular Organizations for Sobriety (SOS), or other groups based in the community. These groups are a way to give and receive support and build a sober peer network. Support groups also offer a way to sustain the progress made in treatment. Although these are not formal programs, they may include sober housing, alumni meetings and gatherings, private counseling, or telephone check-ins, and other ways of providing accountability or support.

Sources:

  1. National Institute on Drug Abuse. (n.d.). Alcohol.
  2. National Institute on Alcohol Abuse and Alcoholism. (2020). Harmful interactions: Mixing alcohol with medicines.
  3. Singh, A.K. (2019). Alcohol interaction with cocaine, methamphetamine, opioids, nicotine, cannabis, and γ-hydroxybutyric acid. Biomedicine, 7(1).
  4. NSW Health. (n.d.). Drug compendium: Supplement reference for AOD treatment.
  5. Witkiewitz, K., & Vowles, K.E. (2018). Alcohol and opioid use, co-use, and chronic pain in the context of the opioid epidemic: A critical review. Alcoholism, clinical and experimental research, 42(3), 478-488.
  6. University of California Santa Cruz. (2016). Common alcohol & drug combinations.
  7. Hirschtritt, M.E., Palzes, V.A., Kline-Simon, A.H., Kroenke, K., Campbell, C.I., & Sterling, S.A.(2019). Benzodiazepine and unhealthy alcohol use among adult outpatients. American journal of managed care, 25(12), e358-e365.
  8. Schmitz, A. (2016). Benzodiazepine use, misuse, and abuse: A review. Mental health clinician, 6(3), 120-126.
  9. Egan, K.L., Reboussin, B.A., Blocker, J.N., Wolfson, M., & Suffin, E.L. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and alcohol dependence, 131(0), 71-77.
  10. National Institute on Drug Abuse. (2019, January). Treatment approaches for drug addiction DrugFacts.
  11. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (Third edition).
  12. National Institute for Alcohol Abuse and Alcoholism. (2021). Treatment for alcohol problems: Finding and getting help.
  13. Subbaraman, M. S., & Kerr, W. C. (2015). Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey. Alcoholism, clinical and experimental research.
  14. 2021, June 22. Using Alcohol and Marijuana Together Exacerbates Negative Consequences in Young Adults.
  15. 2019, December 31. Drugged Driving DrugFacts.
  16. The American Journal of Managed Care. (2019, December). Benzodiazepine and unhealthy alcohol use among adult outpatients.
  17.  Gudin, J. A., Mogali, S., Jones, J. D., & Comer, S. D. (2013). Risks, management, and monitoring of combination opioid, benzodiazepines,    and/or alcohol use.
  18. Althobaiti, Y. S., & Sari, Y. (2016). Alcohol Interactions with Psychostimulants: An Overview of Animal and Human Studies.