Mixing Alcohol and Drugs

Mixing alcohol with medication (whether prescribed or non-prescribed) can produce unwanted and unpredictable consequences.

You may not see combining alcohol with prescription medication as a big deal or may even mix illicit drugs to enhance the intensity of the desired ‘high’. Whatever the case, the effects can be disastrous to your health. In fact, alcohol is particularly dangerous when consumed with another depressant. According to health experts, two drugs that perform the same function in the body can produce extreme effects when taken together.

In 2011, the Drug Abuse Warning Network report discovered that 14% of admissions into the emergency room were for people who drank alcohol or mixed it with other types of drugs. That’s approximately 520,000 cases. These admissions often involved people who mixed alcohol with prescription opioids, heroin, cocaine and marijuana.

Besides a general increase in health risks that are common with the wrongful combination of substances, there are other well-known dangerous outcomes that can result from mixing alcohol and certain drugs.

If you know someone who engages in such habits, it’s advisable to talk with them and provide the right assistance. There are substance abuse professionals who are always ready to help you with your condition.

Alcohol interactions with medications

Many medications can interact with alcohol to produce damaging health risks that may lead to injury or even death. While such alcohol-medication interactions cause admissions to hospital every year, it is possible that an unknown number of less serious cases go unnoticed, only to result in adverse effects much later.

Over 2,800 prescription medicines are available, while doctors write about 14 billion prescriptions annually. In addition, more than 2,000 drugs can be acquired over the counter without a doctor’s prescription. Therefore alcohol-drug interactions are relatively high.

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The biological effect of alcohol-drug interactions

To produce the desired effect, a drug must generally flow through the bloodstream to its active site, where it exerts change on a tissue or organ. As the drug is metabolised by enzymes, its effect is diminished until it is removed from the body.

Alcohol reacts in a similar way, travelling into the bloodstream and acting on the brain to cause intoxication until it is metabolised and removed by the liver. The extent to which a

dose of drug acts on its target site is referred to as availability. Alcohol can alter a drug’s effectiveness by interfering with its availability.

Common alcohol-drug interactions occur this way:

It begins with an acute dose of alcohol (one or multiple drinks over several hours) which may inhibit the metabolism of the drug. This is done by competing with the drug for the same enzymes that metabolise them both. This leads to prolonged and enhanced drug availability, thus increasing the risk for a patient to experience harmful side-effects.

Next, long-term (chronic) ingestion of alcohol can activate enzymes that metabolise drugs, hence increasing the availability of a drug and diminishing its effects. After activation, these enzymes may remain this way, even without alcohol. This means they can still act this way, even weeks after ingesting alcohol. Because of this, a newly abstinent, chronic drinker may require more doses of a drug to work compared with non-drinkers.

Then, enzymes activated by chronic consumption of alcohol can convert some drugs into toxic substances that harm the liver and other vital organs. Finally, alcohol can enhance the inhibitory actions of narcotics and sedative drugs at their action sites in the brain.

To add to the complexity of these interactions, some drugs influence alcohol metabolisation, thereby changing the potential for intoxication, as well as the negative effects that come with drinking alcohol.

Dangers of mixing alcohol and prescription drugs

As mentioned, combining alcohol and drugs has the effect of damaging certain organs such as the liver, where alcohol is metabolised and eliminated. The following are the effects of interactions between alcohol and some specific drugs:

Anaesthetics: Anaesthetics are drugs administered before a surgical operation to make a patient unconscious and numb to pain. Chronic consumption of alcohol increases the concentration of Propofol 1 needed to cause unconsciousness. Drinking too much alcohol in the long-term also heightens the potential for liver damage caused by sedative gases halothane (Fluothane) and enflurane (Ethrane).

Antibiotics: Antibiotics are medicines used to treat communicable diseases. When you drink too much alcohol and take antibiotics, it may induce nausea, vomiting, migraines and possible seizures. Some of these reactive antibiotics include griseofulvin, furazolidone, metronidazole and quinacrine (antimalarial).

Together, rifampin and Isonazid are used to treat tuberculosis. Acute quantities of alcohol in the bloodstream reduce the availability of isoniazid. The availability of rifampin is also reduced by chronic alcohol use. In both cases, the effectiveness of the drug is diminished.

Anticoagulants: Warfarin is an anticoagulant prescribed by doctors to reduce blood coagulation. Acute consumption of alcohol enhances the effect of warfarin, thereby increasing the patient’s potential for fatal haemorrhages. Conversely, chronic alcohol consumption decreases the availability of warfarin, thus exposing the individual to dangers of blood-clotting disorders.

If you are taking such medication, your doctor will advise against excessive drinking. Avoid mixing pills with alcohol too.

Antidepressants: Many alcoholics suffer from depression; both conditions may occur as dual diagnostic disorder. This has the potential for alcohol-antidepressant interactions. Alcohol enhances the soporific effect of tricyclic antidepressants (such as Elavil), as well as impairing cognitive functions.

Acute alcohol consumption increases the sedative effect of tricyclics, hence increasing their calming effects. Chronic consumption of alcohol appears to drive up the availability of some tricyclics whilst reducing the availability of other drugs. The relevance of these interactions is still unclear and chronic effects may persist in recovering alcoholics.

Antihistamines: Medications such as diphenhydramine (Benadryl) can be bought over the counter without a doctor’s prescription to treat problems such as insomnia and allergies. Being a central nervous system (CNS) depressant, alcohol intensifies the sedative actions of antihistamines.

These drugs may trigger dizziness and sedation in older individuals; combining alcohol and histamines may be a major cause of concern amongst this age group.

Antipsychotic medicines: Chlorpromazine is a drug used to reduce symptoms of psychosis, such as hallucinations and delusions. Drinking too much alcohol enhances the drug’s sedative properties, thus impairing coordination and leading to potentially dangerous breathing complications. Combining alcohol and antipsychotic drugs at high doses can lead to liver damage.

Anti-seizure medicines: People who suffer epileptic fits rely on this medication to treat their condition. Acute consumption of alcohol increases phenytoin (a drug prescribed for epilepsy) availability and the danger of drug-related adverse effects. Chronic drinkers may experience a decrease in phenytoin availability, thereby considerably lessening the patient’s defence against epileptic fits – even after a period of alcohol abstinence.

Anti-ulcer drugs: Ranitidine and cimetidine are the two most commonly prescribed drugs for treating ulcers. Both may increase their availability under a low consumption of alcohol, given certain circumstances.

Sedatives and hypnotics: Insomnia medications (such as benzodiazepines) are used to treat sleeplessness and anxiety. Due to their reputation as safer medications, they have largely replaced barbiturates.

Antidiabetic medications: Do you know someone who takes oral hypoglycaemic drugs? These are used mainly by diabetic patients to reduce their blood sugar levels. Acute alcohol consumption protracts, while chronic alcohol consumption lessens the availability of Orinase (tolbutamide). Alcohol also interacts with certain drug classes to cause nausea and headaches.

Alcohol abusers may mix alcohol with benzodiazepines to increase the ‘high’ effect. However, such combinations put individuals at risk of overdose or alcohol poisoning. Since benzodiazepines act as a sedative, they inhibit the effect of alcohol, thus making the individual consume more. Excessive drinking can lead to dependence in the long-term.

Other associated side effects include insomnia, depressed breathing and heart complications.

The short-term effects of mixing alcohol and drugs

The consequences of mixing alcohol and prescription drugs can be divided into short-term and long-term effects. While short-term effects are often felt instantly, the long-term effects manifest sometime later after a period of prolonged use.

Both conditions can be dangerous, but chronic side-effects tend to have more fatal consequences.

Examples of short-term effects include:

  • Severe drowsiness
  • Muscular co-ordination
  • Respiratory depression
  • Mood swings
  • Confusion
  • Poor cognitive functions
  • Impaired memory
  • Slurred speech
  • Headache and seizures
  • Inattention/apathy
  • Nausea and vomiting
  • Elevated heart rate

Each of these effects is not as fatal, because they can be treated immediately. However, if neglected, they can escalate. For instance, a respiratory depression can lead to asphyxiation, coma or death.

Long-term effects of mixing alcohol and drugs

Some people can manage their substance abuse behaviour for prolonged periods without experiencing any severe side-effects. While this may seem like a good thing, it is actually misleading, because the main harm is occurring internally. Over time, the body gives in to the cumulative effects of mixing alcohol and prescription drugs.

As an alcoholic, if heavy drinking doesn’t affect you now, it will sometime in the future. By then, your immunity will be weak, and the habit presents a gateway for other health-opportunistic diseases. For instance, mental health disorders like schizophrenia and anxiety can stem from years of suppressed alcoholism.

Other long-term effects of alcohol/drug abuse include:

  • Respiratory complications
  • Heart problems (cardiac arrest)
  • Dual diagnostic disorders (co-occurrence)
  • Liver damage (cirrhosis)
  • Hallucinations
  • Insomnia
  • Suicidal thoughts
  • Tremors
  • Chest pain
  • Poor sight/blurred vision
  • Stroke
  • Coma
  • Death

Some long-term effects of mixing alcohol and drugs can be influenced by the mode of ingestion. HIV and abscesses are common amongst people who inject drugs, while those who crush pills to sniff may suffer from nasal bleeding, sinusitis or a perforated septum.

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15 Drugs You Should Never Mix with Alcohol and the Effects of Each

One of the strict warnings you’ll see on the bottle of a prescription drug is ‘Do Not Mix with Alcohol’. There is a reason for this and breaking the rules can lead to severe consequences, yet many people take their chances. Doing so will not only affect the efficacy of the drug but may also put your health at risk.

Whether it’s Xanax, Tylenol or Nyquil, most medication should never be mixed with alcohol. If you’ve ever taken pills whilst drinking (alcohol), one of the first things you’ll notice is a light-headedness or dizziness.

Besides prescription drugs, recreational drugs also pose a danger when combined with alcohol.

Drugs you must never mix with alcohol include:

General pain relief medicine: Even common painkillers such as Aleve, Excedrin and Advil should not be taken with alcohol. While they might seem harmless enough to combine, the consequences are far from safe. Reactions to mixing alcohol and painkillers include:

  • Stomach upset
  • Internal bleeding
  • Ulcers
  • Elevated heartbeats
  • Liver damage (especially Tylenol)

Painkillers: Painkillers are one of the prescription medications most commonly combined with alcohol, yet one of the riskiest. The adverse effects of the drugs are exacerbated by alcohol. You are strongly advised against drinking alcohol whilst taking painkillers. Examples of painkillers include Darvocet, Percocet and Vicodin. Side effects of mixing include:

  • Dizziness
  • Drowsiness
  • High risk of overdosing
  • Respiratory depression
  • Strange behaviour
  • Memory impairment

Muscle relaxers: Examples of muscle relaxant medicines include Soma and Flexeril. If you mix either of these drugs with alcohol, the interactions are somewhat like the effect with painkillers. They are:

  • Dizziness
  • Drowsiness
  • Increased risk of seizures
  • Impacted motor control
  • Unusual behaviour (restless)
  • High risk of overdose
  • Memory problems

Sleep aids: Drugs that are prescribed for insomnia, such as Lunesta, Ambien, Sominex, Prosom and Restoril have their own side-effects. Symptoms such as drowsiness are already common with these drugs. However, when you mix them with alcohol, their side effects are multiplied.

Sleep aids and alcohol cause:

  • Drowsiness
  • Dizziness
  • Breathing difficulties
  • Poor muscular coordination
  • Memory impairment
  • Unusual behaviour

Cough syrup: Combining cough syrup and alcohol is a popular practice, especially amongst young people. Cough medication brands such as Robitussin and Delsym are used by many alcohol and drug abusers. When mixed with alcohol, common interactions include:

  • Drowsiness
  • Dizziness
  • Tendency to overdose

Mood stabilisers:
People who suffer from mood swings are prescribed drugs to help stabilise their moods. Typical examples of mood stabilisers are Depakote, Lithobid and Eskalith. In addition to the side-effects, when mixed with alcohol, mood stabilisers cause:

  • Tremors
  • Dizziness
  • Drowsiness
  • Poor coordination
  • Restlessness
  • Nausea
  • Loss of appetite
  • Joint pain
  • Depression
  • Liver complications (Depakote)

Antidepressants: There are several different types of antidepressants available and you are advised never to drink alcohol whilst taking them. Since alcohol is a depressant, consuming it alongside antidepressant drugs is counterproductive to the results. Common antidepressants include Cymbalta, Celexa, Prozac, Seroquel and Risperdal.

The interactions are severe and include:

  • Dizziness
  • Drowsiness
  • High chances of overdose
  • Increased feeling of depression and hopelessness
  • Poor motor skills
  • Potential for liver harm (Cymbalta)

Attention and Concentration: drugs (amphetamines):
People who take drugs for narcolepsy or attention deficit hyperactivity disorder (ADHD) should not combine them with alcohol. However, to boost their effect, people tend to mix both substances together.

Although mild amphetamines such as Ritalin, Concerta and Adderall facilitate drinking for longer periods, they expose you to dangers such as:

  • Potential risk of heart complications (Vyvanse, Adderall)
  • Drowsiness
  • Dizziness
  • Liver complication (Strattera)

Anxiety drugs:
Valium, Xanax and Klonopin are just some examples of anti-anxiety medications that can trigger a reaction with alcohol. There is a list of significant reactions you are likely to experience when mixing such drugs with alcohol. People who drink whilst on these types of medication may experience:

  • Impacted motor functions
  • Restlessness/instability
  • Memory impairment
  • High risk of drug overdose
  • Drowsiness
  • Dizziness

It’s not unusual for patients to experience slow breathing caused by respiratory depression.

Diabetes medication: Alcohol contains a lot of sugar. The sudden sugar rush into the body can affect a diabetic instantly if they don’t apply caution, especially if they are taking special medication. Typical branded drugs for diabetics are Glucotrol, DiaBeta, Tolinase, Orinase and Glynase. Mixing alcohol with any of these drugs could lead to:

  • Flushing
  • Headache
  • Elevated heartbeat
  • Unexpected changes in blood pressure
  • Lethargy
  • Nausea
  • Significantly low blood sugar levels

Arthritis medicines: Various types of arthritic drugs are available, such as Naprosyn, Celebrex and Votaren. Regardless which of these drugs you take, there is a high risk of complications when mixed with alcohol. Common side effects of your body’s interaction with alcohol and these drugs include:

  • Bleeding stomach lining
  • Ulcers
  • Liver damage

Medicines for high cholesterol: People with elevated amounts of cholesterol in their body usually take any of the following medication: Vytorin, Pravigard, Crestor, Lipitor, Advicor or Zocor. However, taking these drugs alongside alcohol is dangerous. Some of the possible effects include:

  • Unusual itching and flushing
  • Increased stomach bleeds (particularly common with Pravigard)
  • Liver damage

Drugs like Advicor and Niaspan may cause itching or flushing when you take them with alcohol.

Allergy medicines: Common antihistamines and other allergy drugs include the brands Benadryl, Dimetapp, Zyrtec and Sudafed. A typical side-effect associated with some of these drugs is drowsiness, which is exacerbated by consuming alcohol.

Common risks of mixing both substances are:

  • Increased risk of overdose
  • Dizziness
  • Drowsiness

Heartburn medication: Common examples of heartburn medication include Reglan, Zantac and Pepto-Bismol. These medicines provide a soothing remedy for uncomfortable heartburn. However, do not drink alcohol when you are taking any of these medications.

Known side-effects include:

  • Increased heartbeat
  • Chances of hypertension

It’s even worse if you have a low tolerance for alcohol. However, that’s not to say people with high tolerance are safe. Just don’t combine both substances under any circumstances.

Blood pressure medications: Do you often experience high blood pressure? Your physician might have prescribed drugs such as Lotensin, Lopressor HCT, Losartan or Norvasc. If you’re taking any of these medications or something similar, you are advised not to drink at the same time.

In addition to causing hypertension, you could develop a co-occurrent disorder. Some examples of side-effects include:

  • Faint spells
  • Dizziness
  • Drowsiness

The chances of developing heart problems such as arrhythmia are also high. Avoid drinking too much alcohol, whether you are taking drugs or not. The low risk alcohol guidelines for men and women suggest you should not regularly drink more than 14 units of alcohol a week.

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Three dangerous alcohol and drug combinations

Certain drug and alcohol combinations can kill you. People who indulge in polydrug abuse (combining multiple substances such as alcohol and illicit drugs) expose themselves to a variety of risks that could affect their brain functions or suppress the respiratory tract. Failure to get professional help could result in fatal consequences.

While there are many dangerous substance combinations, the following three are especially dangerous and have been known to cause fatalities.

Alcohol and opiates: Alcohol and opiates are a lethal combination, as they enhance each other’s sedative properties. Illicit opiates like heroin and prescription opioids such as Vicodin, OxyContin and Hydrocodone greatly depress the central nervous system (CNS).

Together, alcohol and opiates have the effect of depressing the respiratory tract and thus reducing the breathing rate. In addition to this, both substances inhibit coughing reflexing. The disadvantage of this is that it can lead to choking. As a result, there is a real risk of respiratory depression.

Alcohol and benzodiazepines: Benzodiazepines are perhaps the most common type of medication to mix with alcohol. Some examples of benzos include Xanax, Valium and Ativan. Many physicians have dubbed this combination as the most dangerous because alcohol and benzodiazepines both decelerate the CNS.

The central nervous system is affected twice as much, which can lead to poor muscular coordination, seizures, coma and, in severe cases, death. People who take benzos increase their capacity for alcohol consumption, thereby increasing the risk of overdose or alcohol poisoning.

Alcohol and stimulants: Unlike the combination of alcohol/opioids or alcohol/benzos (which complement each other), the mixture of alcohol and stimulants counteracts the effects of each to some extent. This means that stimulants like meth, cocaine, speed and Adderall dampen the depressive influence of alcohol, while alcohol dulls the ‘edge’ of these stimulants.

Likewise, when you mix cocaine and alcohol together, your body produces a by-product known as cocaethylene, which rests in the liver. This chemical compound increases the potential for overdose.

Like a dangerous game of Russian Roulette, mixing alcohol and drugs leads to tragic consequences sooner or later. Regardless of your tolerance level, the human body is ill-equipped to handle the intense effects of certain toxic combinations.

While other alcohol/substance combinations are dangerous, nobody should try any of these three, as they could easily prove fatal.

The effects of combining alcohol with other drugs

So far, we have focused on the effect of combining alcohol with prescription drugs such as hydrocodone, Valium and Adderall, but what about illicit drugs like cocaine and heroin?

If these drugs are highly addictive and dangerous on their own, what happens when you combine them with alcohol? The effects can be devastating. Most illicit drugs fall into the same category as stimulants (mentioned above). Therefore, any such combinations must be avoided. The following are some of the most common illicit drug/alcohol combos:

Alcohol and cocaine: When you snort cocaine and drink alcohol, the results can be unpredictable. Sometimes, combining both substances prevents you from feeling the full effects as you should. Alternatively, the mixture can significantly enhance the effect of both drugs. When you take too much cocaine, you are likely to experience the worst side of both drugs and may even suffer an overdose.

Alcohol is a depressant, while cocaine is a stimulant. When you take cocaine, it increases your body’s metabolism, thus transmitting the alcohol to your brain quicker. This has the same effect as drinking alcohol hastily.

Taking both cocaine and alcohol can produce cocaethylene, which is a toxic substance that settles in the liver and causes complications, including heart problems and even death.

Alcohol and Heroin: These substances produce the same effect on the body, as they are both depressants. When taken separately, alcohol and heroin can cause breathing complications, so together, they create even more problems for your respiratory system.

Excess amounts of alcohol in the body can lead to cognitive impairment. It also increases your tolerance for alcohol, causing you to drink more than is healthy for you. This is one of the leading causes of overdose and alcohol poisoning amongst substance abusers.

Alcohol and cannabis: Marijuana is known for preventing a person from vomiting or feeling nauseous, so it is dangerous because it can suppress vomiting when your body needs to. The human body has a fail-safe solution for eliminating toxic substances by throwing up. Marijuana can be counterproductive to this effect.

Combining marijuana and alcohol means alcohol remains in your body for prolonged periods, making you more vulnerable to alcohol poisoning. Mixing both substances has the following effects on the body:

  • A spinning effect (greening)
  • Panic attacks
  • Concentration problems
  • Nausea
  • Poor muscle coordination

Many people who suffered alcohol poisoning did so because they combined it with marijuana. They were unable to naturally get rid of the alcohol from their body.

Myths about mixing alcohol and drugs

Over the years, many have formed their own beliefs about what it means to use drugs and alcohol. Most of them are myths of course and only serve to mislead unsuspecting people. We shall discuss some of these myths and how dangerous they are. You are better off not combining alcohol and drugs, or even taking them in the first place.

Combining drugs is not harmful: We have already established the dangers of using both alcohol and drugs. One substance may enhance the effect of the other and send the body into shock. Overdosing is the most dangerous effect of combination abuse and can lead to severe consequences and death if proper treatment is not provided in time.

Combining drugs complement each other: When you combine drugs and alcohol, they either complement or counteract each other. However, this is not a good thing. For instance, if you are taking an antidepressant such as Zoloft and you drink alcohol, you are negating the effect of the medication, because alcohol is a depressant.

Eventually, you will end up feeling worse than you did before taking the drug. That’s not all. Antidepressants and alcohol combined can produce negative side-effects such as liver damage. Other effects include poor motor functions and potential for overdose.

Only teens and young adults mix alcohol and drugs: While teens and young adults aged 18 – 25 are most at risk of the dangers of combining substances, it is not limited to this age group alone. Some older age groups also use alcohol and drugs together to enhance the effect of the substances.

For instance, most people who start the habit when they were younger carry it on well into their later years if not treated. Some seniors are at risk of combining liquor with opioids to numb pain.

Marijuana is natural, so combining it with alcohol is safe: While marijuana is a natural plant, it doesn’t absolve it from being a psychoactive substance. It contains tetrahydrocannabinol (THC), which, like alcohol, is a depressant. Separately, both substances weaken your reaction time and make you unresponsive to your surroundings.

When you take them together, they increase lethargy, which means if you need to respond to stimuli, it will be very difficult. This makes driving and other cognitive functions impossible. More so, marijuana suppresses the urge to vomit, so people who overdose are at risk of choking or suffering alcohol poisoning.

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Facts about Mixing alcohol and drugs

In 2009, only 11% of people addicted to drugs or alcohol were treated: This means up to 20 million people with substance dependence (on drugs or alcohol) were not treated for their disorder. Those who don’t sign up for a recovery programme risk developing a psychological disorder or physical health problems, sooner or later.

25% of substance-related emergencies involved alcohol-drug combinations: Based on insight gathered by the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 25% of substance-related hospital admissions were due to people combining alcohol and drugs.

Benzodiazepines are one of the most common types of drugs to combine with alcohol: Of all the drugs combined with alcohol, Benzodiazepines (or ‘benzos’ such as Xanax, Valium and Ativan) are the most common. This is because they have the tendency to increase the intensity of both substances on the body and enhance alcohol tolerance. However, the side-effects include significant loss of coordination, the risk of alcohol poisoning, coma and death.

Getting help to stop the habit

Have you been mixing alcohol with drugs? You now know that it not only increases the risk of dependence but also has severe side-effects as well.

If you don’t stop immediately, you could be putting yourself at risk of alcohol poisoning or worse. Perhaps someone you care about is currently mixing alcohol and drugs?

You can save them by contacting an intervention specialist. Because the issue of addiction is sensitive to many people, they might be in denial, making treatment more complicated.

It’s never too late to seek help for your habit or help a loved one. Professional counsellors and addiction experts can help you to get the treatment and support you need.


Frequently Asked Questions

What happens when you mix prescription drugs and alcohol?

Depending on whether the drug is a stimulant or depressant, the mixture could send your body into overdrive or shut it down altogether. Either way, it breaks your body’s ability to function normally. The ensuing side effects range from drowsiness to dizziness and poor muscle control. In many cases, mixing both substances increases the risk of overdosing or alcohol poisoning.

Why do people do it?

It’s believed that mixing drugs and alcohol heightens the effect of ‘euphoria’. Another reason is that the drugs increase tolerance, so alcoholics can drink more. For example, people who take benzos with alcohol do so to be able to drink more alcohol and feel ‘high’.

Are there drugs I can safely mix with alcohol?

The answer is a definite ‘No’. It is safer to avoid taking both substances at the same time. Alcohol is metabolised in the liver – the same organ that metabolises several drugs. So, it has the potential to interact with a host of other drugs – including those you are unaware of.
To be on the safe side, keep your medication time and happy hour separate. This way, you will avoid potential ‘chemical conflicts’ in your body.

I find it hard to stop mixing alcohol and drugs. What do I do?

See an addiction specialist immediately. If you don’t know how to contact one, call any of many helplines in the UK for support.

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