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What Are the Effects of Mixing Alcohol and Drugs?

Mixing alcohol and drugs is like playing medical Russian roulette – never knowing which time will be the one that harms you. Depending on the drug, there are almost always negative effects, and in some cases, these can lead to death. The drugs involved don't have to be illegal street drugs for problems to occur. Some over the counter medications, as well as non-narcotic prescriptions, can interact very poorly with alcohol. Whether the alcohol will interfere with the medication you have taken by blocking its effectiveness or create unpleasant or dangerous side effects depends on what you mix, and your body's tolerance at the time. The best rule of thumb is not to mix alcohol with drugs or medications.

Alcoholism and Substance Abuse

Alcoholism and substance abuse often go hand-in-hand. If you have a problem with alcohol, you might have a problem with other substances too - or it could happen in the future. Any type of substance abuse puts you at risk of mixing alcohol and illegal drugs, possibly with a lethal outcome. If you don't use illegal drugs but you are an alcoholic, you probably drink more than a social drinker and the excessive alcohol content in your body can have a negative reaction to over-the-counter medications and narcotic or non-narcotic prescription medications that you take. Even if you don't typically use illegal drugs, becoming intoxicated reduces inhibitions and the ability to make good decisions. Being intoxicated puts you at risk for deciding to ingest other substances – and it's not worth the risk.

Substances Commonly Mixed with Alcohol

While any substance or drug out there can be mixed with alcohol, there are several that are known to have an enhancing effect when taken along with drinking.

What you mix with your alcohol might depend on several factors including:

  • What's available
  • What you have mixed in the past
  • What the purpose of mixing it is currently – the result you wish to achieve
  • What others with you are mixing
  • Your drug of choice even without alcohol

There are two reasons one might mix alcohol with drugs.

Ignoring the Warning Label for Convenience

In most cases, if the patient shouldn't drink while taking the medication there will be a warning on the label included with every medication prescribed. In some cases, people either don't read the warning labels on their medication or they don't believe it will be a problem and choose to drink anyway.

For the High

Some people choose to mix drugs and alcohol because they know it will enhance or boost the high. It is a dangerous practice but one that happens across the nation.

Substances commonly mixed with alcohol include:

  • Cocaine
  • Energy Drinks – for the high powered caffeine
  • Adderall
  • Ecstasy
  • Marijuana
  • Opioids (pain pills, heroin, morphine, etc.)
  • Mushrooms
  • Amphetamines
  • Antidepressants
  • Birth Control
  • Antibiotics

A few of the above listed substances are not used for the purpose of getting high, but for medicinal reasons, however, they can be adversely affected when mixed with alcohol.

Alcohol and Medications

Depending on what is mixed with alcohol, there are several possible outcomes. In some cases, the alcohol will render the medication useless and the benefits of the medication will be lost. If the medication you’ve taken happens to be birth control, there is a window of opportunity, during which if one vomits from drinking and the pill is not yet fully metabolized in the body, pregnancy can occur if you engage in sexual activity that evening or soon after.

Using illegal drugs with alcohol can create many side effects, including life-threatening heart rate problems. The same can happen with caffeine, found in energy drinks and caffeine pills in stores across the country. Mixing medications with alcohol can create unpleasant side effects that can be both physical and mental.

The following list is not all-inclusive, but it does provide some common medications and drugs, the common side effects, and possible problems that can be caused by mixing them with alcohol.

ADHD Medications

When Adderall and other stimulant medications are prescribed for Attention Deficit Hyperactivity Disorder (ADHD), the bottle has a warning label reminding you not to mix the medication with any alcohol. Ignoring this warning can be dangerous. Problems that have occurred include dizziness, twitching, nausea, vomiting, headaches, heart rate issues including cardiac arrhythmia, and psychosis.

NOTE: If you are not prescribed Adderall/stimulants and accustomed to metabolizing them, using them with alcohol can be even more dangerous.

Antibiotics

Antibiotics are processed through the liver – so is alcohol. This means that when they are used together, the liver must work harder to process them both and, in some cases, the combination can cause liver damage. It is also important to know that alcohol reduces the effectiveness of most antibiotics, which means the condition (infection) for which they were prescribed might not go away and could also become worse if it becomes resistant to antibiotics.

NOTE: Some antibiotics are known for causing dizziness and nausea, and alcohol interacts with these can cause severe nausea, vomiting, and diarrhea.

Antidepressants

If you are taking antidepressants, it’s possible for alcohol to cancel out the effect of that medication on neurotransmitters, while simultaneously increasing the chance that you suffer from the negative side effects of the drug. Examples of antidepressants include Prozac, Zoloft, Paxil, and more. In addition to reducing the ability for the antidepressant to do its job, alcohol can increase negative emotions. Finally, antidepressants can speed up quickly alcohol affects you. For instance, if you have two drinks, you might feel as if you’ve had four drinks or, if you’re used to drinking several cocktails in a short time, you might suddenly realize that you’re much more intoxicated than you intended. This can lead to poor decision making, blackout, and dangerous situations. Check with your doctor prior to drinking while on antidepressants.

Antihistamines

The problem with drinking alcohol while taking antihistamines is that the body will always choose to metabolize the alcohol before metabolizing the medicine. This reduces the effectiveness of the antihistamine. Be sure to read all warnings on packages of antihistamines, as some have more severe reactions to alcohol than others. Additionally, some other side effects of antihistamines are drowsiness and dry mouth, which alcohol only makes worse. Antihistamine can also affect your ability to make memories, meaning a black out is much more likely when you take them with alcohol.

Cold and Allergy Medications

Much like antihistamines, cold and allergy meds are going to have to wait in line while your body metabolizes alcohol. What this means is your body might discard some of the medication before it gets a chance for the liver to do its job with it. The result will be a reduced effectiveness of the medication. As well as being less effective, this means that your liver is working overtime and can cause serious liver damage if you take cold medication the same evening you have a wild night with friends.

Opioids

Opioids are often prescribed for pain after surgery of for those who have chronic pain. In addition, the nation is in the middles of an opioid crisis as people become addicted and continue to take them illegally. This could include taking more than prescribed, buying them on the street when they are not prescribed, or taking street opioids such as heroin. None of these methods is a good idea but the impact of mixing opioids with alcohol is the same whether there is a valid prescription or not.

Opioids depress the respiratory system – so does alcohol. When they are combined, they can cause a life-threatening reduction in respiratory function. In addition, both substances can cause liver damage, and when they are combined, this process is enhanced.

OTC Pain Relievers (Like Acetaminophen & NSAIDs)

Taking over-the-counter pain medication such as acetaminophen or NSAIDs sounds harmless, but can be dangerous, especially when mixed with alcohol. Acetaminophen and alcohol can cause acute (quick onset) and serious liver damage. Though your liver is excellent at regenerating itself, this liver damage cannot always be corrected and it could set you up for a lifetime of health issues. It’s important to check with your doctor before mixing alcohol with any dose of acetaminophen.

NSAIDs can also cause you to bleed internally and alcohol carries this risk as well. Mixing them intensifies the risk.

  • Sleeping Pills
    All sleeping medications carry warnings not to mix them with alcohol. The reason for this is that they are both sedatives that depress the nervous system and mixing them has been known to cause death. Individual respiratory systems not only react differently in each person but can also respond differently in the same person at different times. For this reason, it is strongly recommended that you not mix sleeping medication with any alcohol as it increases the chance that you go to sleep and don’t wake up.
  • Antiseizure Medications
    Excessive alcohol consumption can disrupt the electrical impulses in the brain. This is similar to the process that causes many types of seizures. If you are already on anti-seizure medications as a preventive measure for a seizure disorder, and add a large amount of alcohol, you could bring on a seizure.
    Drinking is not forbidden with all seizure meds, but it is important to discuss drinking with your doctor prior to having that first drink. If you have been drinking excessively recently, consult a doctor about the safest way to stop drinking, as alcohol withdrawal can cause seizures to occur, even if you don’t have a history of seizures. It is important in this case to reduce your alcohol intake under a doctor's guidance.

Alcohol and Illegal Drugs

  • Amphetamines:
    Amphetamine use on its own presents a significant risk of cardiac issues including increased blood pressure, straining the heart, and arrhythmia events. Once you add alcohol to it, these same side effects can cause death. Alcohol is a sedative while amphetamine is a stimulant and that makes it harder for you to know just how intoxicated you are. It can lead to an increase in how much alcohol you consume, increasing other effects even more. The two together are also very hard on the kidneys and can cause kidneys to fail. In addition, the combination can cause severely aggressive behavior, which can lead to legal trouble.
    NOTE: Due to how hard it is on kidney function, your hangover will be much worse if you have combined amphetamines with alcohol.
  • Benzodiazepines:
    These are very dangerous. It is very possible to die with this combination of depressors acting on your body. Xanax, Valium, and other benzodiazepines carry strong warning labels on prescription bottles about not ingesting alcohol while taking these medications.
    For those who buy them on the street without prescriptions, that danger increases, as the body has not built a tolerance through regular prescription use. In addition, many recreational, street users of this type of drug take dosages larger than therapeutically prescribed. The larger dosage mixed with alcohol can be very dangerous, causing lowered respiratory function, coma, and death.
  • Cocaine:
    While no illegal substances are safe to mix with alcohol, cocaine ranks among the most lethal, partially because it is commonly used as a recreational drug. People mix them with the belief that they cancel the impact each one has on the body. This is not true. In fact, when they are combined, they create a large amount of a third substance called cocaethylene. This substance intensifies the stress on the heart and blood pressure more than any other illegal drug. Sudden cardiac death can result.
  • Hallucinogens:
    The most significant issue with mixing alcohol and hallucinogens, such as LSD, is how it intensifies the experience of coming down from the hallucinogens. Severe vomiting for longer than normal is not uncommon in this scenario. When not vomiting, you can suffer from extreme, relentless nausea.
  • Heroin:
    As happens with prescription pain pills mixed with alcohol, heroin and alcohol together greatly increase the sedative effect in the body. With heroin, however, there is another risk. Heroin is no longer manufactured in a medical lab but is put together on the street. Recently, fentanyl, a very powerful narcotic pain killer, has been added to heroin before it is sold. This dangerous drug combined with heroin is causing thousands of emergency room and EMT visits each year, and when mixed with alcohol it can become a quick acting killer.
  • Marijuana:
    Marijuana and alcohol together can clear the path for alcohol poisoning to occur. This is because marijuana suppresses the gag reflex. One way the body rids itself of excessive alcohol when needed is by vomiting. When the gag reflex doesn't work properly, the alcohol stays in the stomach to be absorbed into the body, which leads more quickly to alcohol poisoning.
    Alcohol in moderate amounts, that would not cause alcohol poisoning, mixed with marijuana can still have negative side effects including intense paranoia, inability to concentrate or think clearly, severe vomiting, and decreased motor functions.
  • Methamphetamine – (Meth):
    Some people mix methamphetamine and alcohol together because it inhibits the sedative effect of alcohol, while still letting the high come through. Meth is known for keeping the user awake, for days sometimes. Mixing some alcohol with it is believed to help reduce that side effect and allow the user to rest more often.
    However, the negative side effects of this can be much worse. Methamphetamine alone puts a strain on the cardiovascular system, but when mixed with alcohol that stress intensifies and puts the user at risk for heart attack and stroke.

Other Substances

Energy Drinks/Caffeine

Surprisingly, people have died from overdosing on caffeine alone. Combining energy drinks and alcohol doesn’t fix this problem. Even if you avoid caffeine pills, the most common source of caffeine overdose, the energy drinks being sold today pack huge amounts of caffeine. Enough that it can challenge the cardiovascular system by producing severely high heart rates if consumed in excessive amounts.

In the past, there were products for sale that combined alcohol and large quantities of caffeine, but due to FDA warnings, those have been taken off the market or had the caffeine removed. However, that doesn't stop some people from creating the same drink by combining an energy drink and alcohol on their own. According to the CDC, those who consume a combination of alcohol and energy drinks are more likely to be sexually assaulted, drive while intoxicated, or get into a car with an intoxicated driver. Other studies report the combination of caffeine and alcohol causes the drinker to crave more alcohol, yet feel less intoxicated, due to the stimulant effect in caffeine. This can cause the drinker to consume large amounts of alcohol without passing out, and alcohol poisoning becomes a real possibility.

Herbal Supplements

While there are some herbal supplements used in the treatment of alcohol addiction, there are others that increase the sedative impact on those who combine them with drinking.

Examples of herbal supplements that should not be ingested with alcohol include:

  • California Poppy
  • Echinacea
  • Kava
  • Melatonin
  • St. John's Wort
  • Valerian

Be on the Safe Side

The best way to avoid having a health problem from mixing medications and alcohol is to read all information provided with your prescription. Don't throw out the insert without reading it, and be sure to read every label on the pill bottle prior to drinking any alcohol.

If you are still unsure about whether it is safe to drink while taking the medication, check with your doctor. If the doctor is not available, try calling your pharmacist, who is also knowledgeable about various medication interactions. It is always best to err on the side of caution and not drink any alcohol until you are comfortable via medication inserts, or the advice of your doctor/pharmacist, that is safe to do so.

There might be alternative medications your doctor can prescribe, that do not interact with alcohol. If you wish to drink socially and are on a medication that prohibits it, talk to your doctor about switching to a different medication.

In the case of illegal drugs, it is never wise to mix them with alcohol. Most illegal drugs are manufactured in uncontrolled conditions, so each and every time you use, you can’t be 100% sure of what you are taking. Combined with alcohol consumption, you are playing Russian roulette with your health and possibly your life. If you currently use street drugs or non-prescribed prescription medications, this is a good time to seek help so that you no longer risk physical harm from uncontrolled drug use.

Schedule I & II Drugs

While over the counter drugs are medications you can buy easily, without a prescription, there are some drugs that are purposefully more difficult to obtain. These are drugs which are addictive, can be abused, or could otherwise be harmful to those who don’t need them. Controlled substances such as these are divided into Schedules, from Schedule I-IV (1-5). Schedule I drugs are considered to have the highest risk for abuse and may lead to “severe psychological or physical dependence” and include drugs which are too unsafe to be prescribed as medication, such as heroin. Schedule II drugs may lead to moderate to low physical dependence, which is why they are categorized differently. However, both of these levels are considered to be high risk when taken outside prescription parameters.

Opioids

Opioids were originally designed to be safer, less addictive versions of the original drug, opium, which are prescribed for acute and long-term pain. And, while these drugs did, and still do, provide a safer option than prescribing straight opium, they still create their own problems including addiction, overdose, and some lab created opioids cannot even be used for medical purposes because of their addictive properties (heroin). Instead of removing the danger of opium, opioids have created their own issues, having been prescribed more and more often over the last 10-20 years and creating what we now know is a dangerous level of commonplace addiction called the Opioid Epidemic.

Stimulants

Stimulants can increase attention, energy, and mood. Indeed, they are most often prescribed for attention deficit disorder and narcolepsy, among other things. While we can probably all remember ingesting a stimulant at some point in our lives: coffee, energy drinks, and even chocolate, prescription stimulants have a much more potent effect of the body. When they aren’t prescribed, they can create dangerous interactions with alcohol, create a sense of false, euphoria, and produce a host of negative side effects on the body.

Depressants

The most commonly consumed depressant is alcohol. If you think about how this affects your system, you’ll have a good idea of what depressants do. These drugs work to create the opposite effect of a stimulant, lowering the activity in your central nervous system, slowing your breathing, and often making you sleepy as well. This effect can be particularly useful for those who suffer from anxiety, tense muscles, or experience seizures related to overactive neural activity. However, for those with normal functioning, or who combine them with another depressant, the outcome can be dangerous and even fatal.

Sedatives

Much like depressants, sedatives work to slow the central nervous system; they are also used to treat anxiety or nervousness. These may be used in psychiatric care to maintain control over aggressive patients or prescribed to someone who simply cannot get to sleep most nights. As with many medications, the danger in taking sedatives comes from taking too much or continuing to take it for an extended period of time.

OTC Medications

OTC, when it is used to refer to a medication, simply means ‘Over the Counter’. This term indicates that a medication or drug can be obtained without a prescription. These are sold at pharmacies, grocery stores, and even your local gas station to provide you easy access to low-level pain medication, sleep aids, and cold and flu relief. However, no matter what you might think, OTC does not mean that these medications have zero side effects or chance to cause damage. As you will see from reading the labels on most OTC drugs, overdose or overuse of these can cause liver damage, addiction, and many more negative consequences if you don’t pay attention to what you’re doing.

Prescription Drugs

Prescription drugs are the opposite of over-the-counter medications. These are usually considered controlled substances and can be found on the lists of schedule 1-5 drugs. You must have a prescription to obtain them in order to be sure that you 1. Require them and 2. Have the lowest possible likelihood of becoming addicted or experiencing dangerous side effects. Your doctor will prescribe the medication and explain it to you in detail so that it can be used to best effect. If you experience negative side effects, there will be a record of your prescription on your medical history and any treating physician can easily correct your prescription or find you a new one that will not cause negative effects.