There are many dangers associated with mixing drugs and alcohol. Mixing two or more drugs—whether they’re prescription, over-the-counter, or recreational—can increase the risk of side effects, reduce the effectiveness of medications, and increase the risk of overdose and death. Chronic polysubstance abuse can, over time, lead to deteriorations of your physical and mental health, negatively affect your relationships, drain your finances, and decrease your performance at school or work.
While many people may mix substances to enhance their high or alleviate comedown effects, combining drugs is not always intentional. For instance, if you were taking a prescription medication and fail to read the label thoroughly, you may be unaware that you shouldn’t drink alcohol or take another drug while on the medication.
Abusing two or more substances is referred to as polysubstance or polydrug abuse and can lead to the development of multiple, simultaneous addictions. If you suffer from polydrug abuse or addiction, you likely will require more comprehensive and integrated treatment than someone with a single addiction.
Mixing Alcohol and Street Drugs
Alcohol is commonly used in combination with other illicit drugs—in 2011, more than 14% of emergency department visits, or roughly 520,000 cases, involved a combination of drugs and alcohol.1 Alcohol was most often mixed with the following illicit drugs:1
Combining alcohol with street drugs can increase your risk of experiencing adverse or negative effects. Beyond a generalized increase in health risks that arise from any ill-advised substance combination, there are a number of known harmful outcomes that may result from the pairing of alcohol with specific drugs.
Side Effects of Mixing Alcohol and Cocaine
Cocaine use can produce euphoria (feelings of extreme pleasure) as well as increased energy and mental alertness.2 You may abuse cocaine and alcohol together to intensify these effects or to decrease your perception of drunkenness.3 But when you use alcohol and cocaine together, your liver produces a toxic substance called cocaethylene, which can cause arrhythmias and heart damage, making it far more deadly than using either substance in isolation.4
Other side effects of mixing alcohol and cocaine are:5
- Heart palpitations.
- Chest pain.
- Inappropriate aggressive or sexual behavior.
- Impaired judgment.
Research suggests that combining alcohol and cocaine may also increase the risk of violent thoughts and behaviors.3
Adverse Effects of Combining Alcohol with Marijuana
Marijuana, or cannabis, can be eaten or smoked to elicit a high, which generally consists of increased feelings of wellbeing, increased appetite, and distorted perceptions.5 Tetrahydrocannabinol (THC) is the active ingredient in marijuana that is responsible for its psychoactive effects. Though the mechanism behind the interaction may not be fully understood, when marijuana and alcohol are used together, you may develop higher concentrations of active THC in the blood than you would with marijuana alone—just one alcoholic drink can amplify your marijuana high.6 Mixing the two drugs can significantly impair your ability to drive, too; it is one of the most common combinations of substances present in car accidents.6
Other side effects of mixing alcohol with marijuana include:5
- Rapid heart rate.
- Impaired coordination and judgment.
- Slurred speech.
- Memory problems.
- Dry mouth.
- Bloodshot eyes.
- Social withdrawal.
- Slowed sensation of time.
Adverse Effects of Mixing Alcohol with Heroin
Get HelpIf you abuse one or more substances, call our helpline at 1-888-287-0471 to learn more about your treatment options.
Heroin is an illegal opioid that is commonly injected or snorted and can cause severe respiratory depression (slowed breathing). When you combine alcohol with heroin, these depressant effects are amplified, placing you at far greater risk of overdose, respiratory failure, and death.
Common signs of heroin and alcohol abuse are:5,7
- Mood swings.
- Slowed thought and movement.
- Attention problems.
- Memory impairment.
- Coordination issues.
- Slurred speech.
- Nausea and vomiting.
- Heart rate changes.
- Decreased respiratory rate.
Regardless of your street drug of choice, though, mixing drugs and alcohol can lead to an addiction to both substances. And having a polysubstance addiction can complicate your recovery process, making for an increasingly severe withdrawal period and ultimately requiring a more in-depth treatment plan. If you abuse alcohol and a street drug, understanding these signs of addiction can prompt you to seek help before it progresses even further.
Some signs of substance addiction include:5
- Using more of the substances or for longer periods than intended.
- Failing to cut down or quit using despite efforts to do so.
- Spending an inordinate amount of time getting and using substances, as well as recovering from their effects.
- Having strong urges to use.
- Failing to fulfill obligations at home, school, or work due to use.
- Continuing to use despite interpersonal, physical, or mental health problems caused by or worsened by use.
- Prioritizing substance use over previously important recreational or occupational activities.
- Consistently using substances in hazardous situations, such as before or while driving.
- Developing tolerance, or requiring increased amounts to elicit desired effects.
- Developing withdrawal symptoms that occur when you reduce or stop use.
Mixing Alcohol and Prescription Drugs
As previously mentioned, not all drug interactions are intentional. Many people fail to read the label on medications and don’t know that you can’t drink alcohol while on medication. Additionally, if you take a prescription drug, you may be unaware of the drug’s half-life, or the rate at which it is eliminated from the body. For this reason, you may be under the impression that the drug is out of your system when it really isn’t. If you drink alcohol while the prescription drug is still in your body, it can have detrimental side effects. And, if you already suffer from a dependence or addiction to alcohol, it’s even more likely you’ll mix your prescription meds with alcohol simply because you already drink a lot.
Prescription painkillers, sedatives, antidepressants, and antipsychotics are the most commonly used drugs mixed with alcohol.1
Potential Side Effects of Mixing Opioid Painkillers and Alcohol
The adverse effects of mixing opioid painkillers and alcohol are virtually the same as those resulting from heroin and alcohol abuse. This is because prescription painkillers and heroin are so similar to each other in both chemical structure and effects, even though painkillers are available as legally prescribed medications.8 If you are prescribed opioid painkillers, follow your doctor’s instructions carefully and avoid drinking alcohol or taking any other drugs.
Potential Adverse Effects of Mixing Sedatives and Alcohol
Both alcohol and sedatives, such as benzodiazepines, act as a central nervous system (CNS) depressant, which means that they slow brain activity. When these depressants are used in combination, their sedative effects are intensified and your breathing can slow until it stops. Other effects associated with alcohol and sedative abuse are:5,9
- Mood swings.
- Impaired judgment.
- Memory impairment.
- Slurred speech.
Mixing alcohol and sedatives can have life-threatening consequences. Using this combination of drugs greatly increases your risk for overdose. Signs of an overdose can include blue-colored lips and fingernails, uncontrollable vomiting, seizures, and coma.10,11
Possible Adverse Effects of Combining Antidepressants/Antipsychotics and Alcohol
Antidepressants are usually prescribed to treat depression and anxiety disorders and one of the common side effects of many of these medications is increased drowsiness. So, if you drinking alcohol while taking an antidepressant, the combined effects of the drugs could enhance sleepiness and exacerbate other adverse effects.12,13
Many antidepressants fall under the class of medications known as selective serotonin reuptake inhibitors (SSRI), which regulate your brain’s serotonin levels. Mixing alcohol and an SSRI can lead to a condition called pathological intoxication, which is characterized by lowered inhibition toward committing violent and sexual acts.14 And severe memory impairment is evident even with low to moderate amounts of alcohol with these drugs.14
Antipsychotics, such as Thorazine15 and Abilify,16 are primarily used to treat the symptoms of schizophrenia. Similar to antidepressants, alcohol can intensify the side effects of antipsychotics and cause the following:17
- Extreme respiratory depression.
- Coordination problems.
- Severe drowsiness.
- Possible liver damage with chronic use.
Mixing Street Drugs
You may mix street drugs, such as cocaine, marijuana, methamphetamine, heroin, LSD, and MDMA (ecstasy), for a number of different reasons. While some people may combine two illegal drugs to enhance the high, others may accidentally ingest two substances if they were unknowingly mixed beforehand. Drugs that are sold on the streets are not regulated so dealers often cut them with other additives to increase profits. This practice can have serious consequences as you ingest a deadly mix of substances.
There are countless slang terms for combinations of drugs and they’re constantly changing and evolving, depending on the region and time period—it’s a good idea to be familiar with them so you aren’t caught by surprise taking a drug you didn’t intend to take.
Every drug user has a different reason for combining certain drugs. Some want to negate the negative effects of one drug by using another; others want to amplify the desired effects of one drug; and others may use one substance to counteract the comedown effect of another.
Although every street drug is different and elicits varying effects, possible side effects of mixing street drugs include:5
- Impaired judgment.
- Erratic behavior.
- Suicidal thoughts or behaviors.
- Blurred vision.
- Increased or decreased heart rate.
- Chest pain.
- Heart attack.
- Respiratory arrest.
- Liver failure.
Long-term effects of mixing street drugs could vary depending on the method for use or route of administration. For example, injecting drugs may intensify the desired effects but also increases the risks of:5
- HIV and hepatitis.
- Infection of the heart lining.
- Track lines.
- Collapsed veins.
And users who snort drugs may experience the following complications:5
- Nasal bleeding.
- Perforated nasal septum.
Treatment After Mixing Drugs
If you mix drugs, you increase your risk of overdose—and death, if the overdose goes untreated. The signs of an overdose may include unresponsiveness; respiratory distress or no breathing; blue-colored lips or fingernails; or slipping into a coma. In this situation, 911 should be called immediately.
Once you have been treated for an overdose and medically stabilized, it is important to seek treatment for drug abuse or addiction. There are various types of treatment programs available if you are suffering from polydrug abuse or addiction, including:
- Detox: A period of detoxification is often incorporated into the start of or, in the case of standalone detox programs, precedes substance abuse rehabilitation. Professional detox programs allow you to safely eliminate drugs and alcohol from your body and receive supervision and care to help alleviate your withdrawal symptoms and maximize your comfort.
- Inpatient: Inpatient programs provide you with a high level of care in which you must live at the facility for the duration of the recovery program. In inpatient or residential settings, you receive a variety of services, such as individual therapy, group counseling, medical care, and aftercare planning.
- Outpatient: Many people can’t take the time off work or away from other responsibilities to seek addiction treatment. Outpatient programs provide you with the flexibility to live at home while recovering from an addiction. There are many types of outpatient treatment: more comprehensive options are known as Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP).
- Therapy: Therapists and psychiatrists use a variety of therapies to aid your addiction recovery. These may include cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational enhancement, and contingency management. Each type of therapy focuses on positive behavior change and abstinence.
- Long-term care: As your stay at your initial treatment program nears, the treatment team will create an individualized aftercare plan for your ongoing recovery. Examples of long-term care (or aftercare) include support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); individual or group therapy; or evidence-based groups, such as SMART Recovery.
More People Treated for Alcohol than Any Other SubstanceAlcohol, or ethanol, is the most common drug of abuse for people in recovery, as a 2017 survey by Recovery Brands revealed. The survey reports that 68.85% of people in recovery listed an alcohol problem among their reasons for seeking help, and a surprising 52.87% of respondents cited alcohol as the substance they received the most treatment for. Out of all the substances of abuse, ethanol is one of the most worrisome. Don’t despair, it’s easy to find treatment. Call our helpline at 1-888-287-0471 to begin recovering from substance abuse today.
Mixing drugs and alcohol can have serious consequences on your physical, mental, and emotional health. Getting the right care is essential to your wellbeing and chances for a full recovery. If you are interested in learning more about your treatment options, call us now at 1-888-287-0471 .
- National Institute on Drug Abuse. (2011). Drug Facts: Drug-Related Hospital Emergency Room Visits.
- National Institute on Drug Abuse. (2016). Drug Facts: Cocaine.
- Pennings, E., Leccese, A. & Wolff, F. (2002). Effects of concurrent use of alcohol and cocaine. Addiction, 97(7), 773–783.
- Wilson, L., Jeromin, J., Garvey, L. & Dorbandt, A. (2001). Cocaine, Ethanol, and Cocaethylene Cardiotoxity in an Animal Model of Cocaine and Ethanol Abuse. Academic Emergency Medicine, 8(3), 211–222.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Publishing.
- American Association for Clinical Chemistry (AACC). (2015). Any dose of alcohol combined with cannabis significantly increases levels of THC in blood.
- National Institute on Drug Abuse. (2014). Misuse of Prescription Drugs.
- National Institute on Drug Abuse. (2014). America’s Addiction to Opioids: Heroin and Prescription Drug Abuse.
- Center for Substance Abuse Research. (2013). Benzodiazepines.
- U.S. National Library of Medicine. (2015). Diazepam overdose.
- National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol Overdose: The Dangers of Drinking Too Much.
- U.S. National Library of Medicine. (2014). Fluoxetine.
- U.S. National Library of Medicine. (2014). Citalopram.
- Herxheimer, A., Menkes, D.B. (2011). Drinking alcohol during antidepressant treatment—a cause for concern?
- U.S. National Library of Medicine. (2011). Chlorpromazine.
- U.S. National Library of Medicine (2016). Aripiprazole.
- National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol Alert.