Mixing Alcohol With Other Drugs


Combining Alcohol With Different Substances

Alcohol can decrease the desired therapeutic effect of some prescription medications, increase the adverse effects of other drugs, and dramatically increase the risk of overdose and death.

Read on to learn more about mixing alcohol with other drugs, including:


Benzodiazepines and Sleep Aids (Xanax, Valium, Ambien)

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Benzodiazepines are often prescribed to treat anxiety and some seizure conditions, though they are sometimes also used as muscle relaxers and to manage insomnia. 1 Some common examples include Xanax , Valium, and Ativan. 1 Ambien , though not classified as a benzodiazepine, functions similarly to them. Ambien is a prescribed as a sedative-hypnotic drug to aid sleep. 2

Both benzodiazepines and Ambien are central nervous system depressants, which means that they slow down brain activity and breathing.

Effects

Alcohol acts similarly to the prescription sedatives in depressing central nervous system activity. When two depressants are used together, the sedative effects are amplified. A person's breathing can slow to dangerous levels and even stop.

Other effects of abusing sedatives and alcohol include: 1, 4

  • Slurred speech.
  • Memory and attention problems.
  • Confusion.
  • Impaired judgment.
  • Mood swings.
  • Incoordination.
  • Drowsiness.
  • Lethargy.
  • Stupor.

Effects of Mixing Alcohol With Other Drugs

Drug Effects
Benzodiazepines EffectsIncreased risk of overdose, extreme drowsiness, slurred speech, mood swings, stupor, coma, confusion, and memory and attention problems.
Opioids EffectsIncreased risk of overdose, nausea, vomiting, impaired judgment, slurred speech, constipation, coma, unsteady gait, and stupor.
Antidepressants EffectsIntense drowsiness and pathological intoxication, characterized by memory loss and lowered inhibitions.
Stimulants EffectsIncreased risk of overdose, heart palpitations, stroke, seizures, sweating or chills, paranoia, chest pain, and involuntary muscle contractions.
Marijuana EffectsRapid heart rate, impaired coordination, lethargy, problems with performing complex mental functions, social withdrawal, red eyes, sensation of slowed time, and slurred speech.
Antibiotics EffectsNausea, vomiting, convulsions, decreased therapeutic effect, and increased intoxication.
Tylenol EffectsSevere liver damage.
Nyquil and Robitussin EffectsVomiting, nausea, dizziness, coordination problems, slurred speech, and seizures.
Energy drinks EffectsIncreased risk of overdose, drunk driving, and inappropriate sexual behaviors.

Overdose

Signs of an overdose include bluish lips, slowed breathing, tremors, and vomiting.
Combining alcohol and sedatives can cause extreme drowsiness and significantly increase the risk of overdose. In 2011, there were an estimated 610,000 emergency department visits related to combining alcohol with another drug. 5 About 25% of those visits involved concurrent sedative and alcohol use. 5

Signs of an overdose include: 6, 7

  • Coma.
  • Stupor.
  • Slow or stopped breathing.
  • Blue-colored fingernails and lips.
  • Dizziness.
  • Double vision.
  • Tremors.
  • Seizures.
  • Vomiting.
  • Low body temperature.
If you are concerned that someone has overdosed, call 911 immediately. Try to have some information to give to the dispatcher, including: 6

  • Age and estimated weight of the person.
  • Name and dose of medication, if known.
  • Amount of alcohol consumed, if known.
  • What time the substances were consumed.
  • The person's condition.

If the person is unconscious and you have been trained in first aid, move the person to the recovery position to prevent asphyxiation of vomit while waiting for medical professionals to arrive.


Opioids (Oxycodone, Hydrocodone, Heroin)

Opioids, such as heroin , and prescription painkillers, such as oxycodone and Percocet, can cause profound respiratory depression. When alcohol is consumed with these drugs, the respiratory effects are exacerbated, and the risk of overdose greatly increases.

Effects

Signs that someone is abusing alcohol and opioids include: 4, 8

  • Drowsiness.
  • Slurred speech.
  • Issues with attention or memory.
  • Impaired judgment.
  • Slowed movements and thoughts.
  • Confusion.
  • Nausea and vomiting.
  • Stupor.
  • Unsteady gait.
  • Coordination problems.
  • Mood swings.
  • Constipation.

Overdose

If someone mixes alcohol with opioids, he or she has an increased risk of experiencing severe respiratory depression and death. In 2011, there were more than 100,000 emergency department visits that involved mixing opioids with alcohol. 8 Further, in 2010, more than 22% of opioid painkiller deaths involved alcohol. 9

Signs of an overdose include: 4, 7, 10

  • Pinpoint pupils.
  • Extremely pale face.
  • Low body temperature.
  • Bluish lips or fingernails.
  • Unresponsiveness.
  • Coma.
  • Vomiting.
  • Slowed or stopped heartbeat or breathing.
  • Seizures.
If you suspect that someone has overdosed on opioids and alcohol, call 911 for medical assistance immediately. If you are trained in first aid, move the person into the recovery position so that he or she won't choke if vomiting occurs.

Monitor vital signs, such as breathing and heartbeat. If the person stops breathing, begin performing cardiopulmonary resuscitation (CPR) until medical help arrives. 10


Antidepressants and Antipsychotics (Prozac, Celexa, Paxil, Abilify, Chlorpromazine)

Antidepressants , such as Prozac, Celexa, Paxil, and Lexapro, are prescribed to treat depression, as well as other conditions such as anxiety and obsessive-compulsive disorder. 11,12,13,14

Some of these medications may make a person drowsy, and drinking alcohol while on an antidepressant can increase drowsiness or intensify other side effects. 11,12,13,14

All of the aforementioned antidepressants are in a class of medications called selective serotonin reuptake inhibitors (SSRI). They work to manage serotonin levels in the brain. Serotonin is an important neurotransmitter responsible for regulating many different things, such as mood, appetite, sleep, and sexual functioning.

In addition to intense drowsiness, research has found that mixing SSRIs and alcohol can lead to pathological intoxication. 15 In one study, participants who had mixed these two substances experienced lowered inhibitions related to sexual and violent behaviors. 15 Memory impairment was involved even in low to moderate doses of alcohol consumption. 15

Antipsychotic Effects

Antipsychotics, such as Abilify, are primarily prescribed to treat the symptoms of schizophrenia, though they can be used in combination with other medications to treat mania, depression, or bipolar disorder. 16

Chlorpromazine is another common medication that helps to reduce psychotic symptoms, such as hallucinations and delusions. But it has also been prescribed to treat manic symptoms in those with bipolar disorder, as well as behavioral problems in children. 17

Like antidepressants, alcohol can amplify the side effects of antipsychotics and lead to the following effects: 18

  • Extreme drowsiness.
  • Coordination problems.
  • Fatal respiratory depression.

In addition, mixing antipsychotic drugs and alcohol can lead to liver damage. 18


Stimulants (Concerta, Cocaine, Meth)

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Stimulants, such as cocaine and methamphetamine , are highly addictive drugs that cause euphoria and increased energy and attentiveness. 19,20 Concerta (methylphenidate) is a stimulant medication prescribed to treat the symptoms of attention-deficit hyperactivity disorder (ADHD) or narcolepsy. But it can produce a "high" when abused or misused and be habit-forming. 21, 22

People may mix cocaine and alcohol for different reasons: 23

  • To intensify the high from cocaine.
  • To reduce feelings of drunkenness.
  • To ease symptoms from the cocaine "crash" or "come down."

Effects

Cocaine is a profoundly dangerous drug. When it is used alone, it can lead to sudden death in new and in long-term users alike. 4

When cocaine is combined with alcohol, it can mask the feelings of drunkenness and increase the risk of alcohol poisoning. Additionally, when someone mixes alcohol with cocaine, the liver produces a deadly substance called cocaethylene. It is far more deadly than either drug in isolation and can lead to heart damage and arrhythmias. 24,

Much like cocaine, crystal meth and Concerta can hide alcohol's intoxicating effects, which can cause someone to overdose on alcohol. 25, 26

Some of the effects associated with mixing alcohol and stimulants include: 4, 25

  • Chest pain.
  • Arrhythmias.
  • Heart palpitations.
  • Increased body temperature.
  • Excessive sweating or chills.
  • Pupillary dilation.
  • Involuntary muscle contractions.
  • Involuntary eye movements.
  • Dizziness.
  • Drowsiness.
  • Depression.
  • Confusion.
  • Nausea.
  • Vomiting.
  • Stroke.
  • Seizures.
  • Loss of consciousness.
  • Coma.
  • Impaired memory.
  • Impaired judgment.
  • Changes in sociability.
  • Anxiety.
  • Anger.
  • Paranoia.
  • Inappropriate sexual or aggressive behavior.

Health Problems

Those who combine stimulants and alcohol over a long period of time are at increased risk of experiencing the following health risks: 4

  • Perforated nasal septum, sinusitis, nose bleeds (intranasal users).
  • HIV and hepatitis, track marks, collapsed veins, tuberculosis (intravenous users).
  • Coughing, pneumonitis, bronchitis (users who smoke the drug).
  • Malnutrition.
  • Increased risk of suicide.
  • Stroke.
  • Heart attack.
  • Respiratory or cardiac arrest.
  • Cardiomyopathy (weakening of the heart muscle). 27

Further, chronic methamphetamine users may experience "meth mouth," which is characterized by mouth sores, tooth decay, and gum disease. 4


Marijuana

Effects include impaired judgment, memory problems, and sedation.
Marijuana , or cannabis, is a psychoactive substance that can be smoked or eaten to produce a "high," which is usually characterized by euphoria, increased appetite, and distorted sensory perceptions. 4

Research has revealed that when any amount of alcohol is combined with marijuana, the user's blood concentration level of THC, the main psychoactive component of cannabis, is higher than it would be with marijuana use alone. 28 This means that even a single drink can cause someone who has used marijuana to become more impaired, leading to greater risks to health and an increased risk of accidents.

Effects

Some additional adverse effects associated with mixing alcohol and marijuana include: 4,

  • Red eyes.
  • Dry mouth.
  • Impaired judgment.
  • Rapid heart rate.
  • Sensation of slowed time.
  • Impaired coordination.
  • Anxiety.
  • Social withdrawal.
  • Sedation.
  • Lethargy.
  • Memory problems.
  • Issues with performing complex mental functions.
  • Slurred speech.
  • Unsteady gait.
  • Stupor.
  • Involuntary eye movements.
  • Coma.

Driving Under the Influence

Combining marijuana and alcohol can impair a user's driving ability even more than either substance independently. 28 It is one of the most common drug combinations associated with car accidents. 28

Anyone who abuses alcohol, marijuana, or both should avoid getting behind the wheel of a car while under the influence.


Other Medications and Drugs

Many other medications, both prescription and over-the-counter, can have adverse interactions with alcohol. It's important to be aware of how drinking alcohol can impact your body and the therapeutic effects of your medications.

Below are some common medication and alcohol interactions:

  • Antibiotics: When alcohol is combined with certain antibiotics, which are prescribed to treat bacterial infections, it can lead to vomiting, nausea, and sometimes convulsions. 18 Additionally, mixing alcohol and antibiotics can decrease the effectiveness of the medication, 18 as well as cause quicker alcohol absorption, leading to an increase in intoxication. 29
  • Blood pressure medications: These medications are prescribed to treat high blood pressure or hypertension. Drinking alcohol while taking these drugs can cause fainting or dizziness. 18 Alcohol may also decrease the availability of some hypertensive medications and, in turn, the effectiveness of them. 18
  • Aspirin and Advil: Mixing alcohol and aspirin or Advil (ibuprofen) can lead to stomach bleeding and a reduction in the blood's ability to clot properly. 18 Further, aspirin may lower a person's tolerance to alcohol, increasing inebriation. 18
  • Tylenol: Tylenol alone can cause liver damage. When mixed with alcohol, the risk of harm to the liver dramatically increases. 18
  • Dextromethorphan (DXM): This is the active cough suppressant ingredient in many over-the-counter cough and cold preparations, such as Nyquil and Robitussin DM. Some people abuse these drugs because they can produce psychoactive effects, especially when mixed with alcohol. 30 When taken in excess, DXM can lead to dizziness, nausea, vomiting, slurred speech, coordination problems, and seizures. 30 These effects will be exacerbated by alcohol consumption and could lead to overdose.
  • Energy drinks: Much like stimulant drugs, energy drinks containing caffeine, taurine, and ginseng can mask the intoxicating effects of alcohol when the two substances are mixed, which increases the risk of excessive drinking and alcohol poisoning. 31 Research has shown that those who consume energy drinks and alcohol together are four times more likely to operate a motor vehicle than those who don't, 31 and three times more likely to binge drink than those who don't mix the two. 32 What's more, those who combine the two substances are more likely to report riding with a drunk driver and taking advantage of someone or being taken advantage of sexually. 32

Getting Help for Alcohol and Drug Abuse

Many people who abuse alcohol also abuse other drugs and vice versa. People who are regularly abusing multiple substances should seek help at a drug treatment center. Even if these people aren't addicted yet, long-term abuse can lead to addiction down the line. It's best if addiction or abuse is caught early to prevent further consequences.

Below are some common treatment options:

  • Detox centers : Before attending a recovery program, it may be necessary for you to attend a detoxification center, where you can safely eliminate alcohol and drugs from your body and receive care to alleviate potential withdrawal symptoms. Detox is not treatment, however, and you should find some type of recovery program after completing detox.
  • Inpatient treatment : Inpatient treatment offers a high level of care in which you live at the facility for the duration of the recovery program. You receive a variety of services, such as an intake evaluation, individual therapy, group counseling, medical maintenance, and aftercare planning .
  • Outpatient treatment : Outpatient treatment allows you to live at home while receiving addiction treatment. This option is ideal for those with less severe addictions since it is less intensive than inpatient treatment.
  • 12-step programs : Fellowship programs, such as Narcotics Anonymous and Alcoholics Anonymous, are free to join. The only requirement is that you wish to get sober. These groups provide you with encouragement and support and also have a sponsorship program.
  • Dual diagnosis treatment : Many people who abuse drugs and alcohol are struggling with some kind of mental health disorder, such as depression, anxiety, post-traumatic stress disorder, or a personality disorder. Dual diagnosis facilities focus on identifying and treating mental health disorders as well as substance use disorders.

Find a Recovery Center

If you or someone you know is mixing alcohol with other drugs, call our helpline at 1-888-319-2606Who Answers? to learn about recovery options. A representative can provide you with local programs and confirm your insurance coverage.

Sources

[1]. University of Maryland Center for Substance Abuse Research (2013). Benzodiazepines .

[2]. Food and Drug Administration (FDA). (2013). Medication Guide: Ambien .

[3]. National Institute on Drug Abuse. (2014). What are CNS depressants?

[4]. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

[5]. Substance Abuse and Mental Health Services Administration. (2013). Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits .

[6]. National Library of Medicine. (2015). Diazepam overdose . MedlinePlus Medical Encyclopedia.

[7]. National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol Overdose: The Dangers of Drinking Too Much .

[8]. National Institute on Drug Abuse. (2014). How do opioids affect the brain and body?

[9]. Centers for Disease Control and Prevention. (2014). Alcohol Involvement in Opioid Pain Reliever and Benzodiazepine Drug Abuse-Related Emergency Department Visits and Drug-Related Deaths - United States, 2010 .

[10]. Substance Abuse and Mental Health Services Administration. (2016). Opioid Overdose .

[11]. National Library of Medicine. (2014). Fluoxetine . MedlinePlus Drug Information.

[12]. National Library of Medicine. (2014). Citalopram . MedlinePlus Drug Information.

[13]. National Library of Medicine. (2014). Paroxetine . MedlinePlus Drug Information.

[14]. National Library of Medicine. (2016). Escitalopram . MedlinePlus Drug Information.

[15]. Herxheimer, A. and Menkes, D. (2011). Drinking alcohol during antidepressant treatment - a cause for concern? The Pharmaceutical Journal .

[16]. National Library of Medicine. (2016). Aripiprazole . MedlinePlus Drug Information.

[17]. National Library of Medicine. (2011). Chlorpromazine . MedlinePlus Drug Information.

[18]. National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol-Medication Interactions . Alcohol Alert No. 27-1995.

[19]. National Institute on Drug Abuse. (2013). Cocaine .

[20]. National Institute on Drug Abuse. (2014). Methamphetamine .

[21]. National Library of Medicine. (2016). Methylphenidate . MedlinePlus Drug Information.

[22]. National Institute on Drug Abuse. (2014). Stimulant ADHD Medications: Methylphenidate and Amphetamines .

[23]. Pennings, E., Leccese, A., & Wolff, F. (2002). Effects of concurrent use of alcohol and cocaine. Addiction, 97(7), 773-783.

[24]. 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.

[25]. New Mexico State University. (2014). Other Drugs: Methamphetamine .

[26]. University of Michigan University Health Service. (2016). The Effects of Combining Alcohol with Other Drugs .

[27]. National Institute on Alcohol Abuse and Alcoholism. Alcohol's Effects on the Body .

[28]. Science Daily. (2015). Any dose of alcohol combined with cannabis significantly increases levels of THC in blood .

[29]. Weathermon, R., & Crabb, D. W. (1999). Alcohol and Medication Interactions. Alcohol Research & Health, 23(1), 40-54.

[30]. University of Maryland Center for Substance Abuse Research (2013). Dextromethorphan (DXM) .

[31]. California State University at Chico. (2016). Alcohol and Energy Drinks: A Dangerous Mix .

[32]. Centers for Disease Control and Prevention. (2015). Fact Sheets - Caffeine and Alcohol .

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