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The Risks of Mixing Alcohol and Drugs (Staying Safe)

Abusing more than one substance, or polydrug use is common.

One study that collected data from Tennessee from 1998 to 2004 concluded that approximately 48.7 percent of the people studied engaged in polydrug abuse.

Cocaine, marijuana, and alcohol were the drugs most frequently abused.
On its own, alcohol abuse can have fatal consequences. The risk of devastating side effects, including overdose and death, increases when someone uses another drug simultaneously.

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Alcohol Abuse 

In 2015, approximately 15.1 million people age 18 and older in the U.S. had alcohol use disorder. Alcohol abuse is among the most common substance use disorders.

Using alcohol alone can increase the risk of significant health issues, such as cirrhosis, other alcohol-related liver diseases, and several cancers, including cancers of the mouth, pharynx, liver, esophagus, larynx, and breasts. In fact, in 2009 in the U.S., one in three liver transplants were due to alcohol-related liver disease.

The following are signs of alcohol intoxication:

  • Reduced inhibitions
  • Trouble with concentration
  • Dulled perceptions
  • Mood swings
  • Decreased body temperature
  • Stumbling
  • Vomiting
  • Skin flushing
  • Loss of coordination
  • Slowed brain activity
  • Sleepiness
  • Dilated pupils
  • Increased heart rate
  • Passing out
  • Increased blood pressure
  • Irregular, slow, or shallow breathing

As someone continues to consume alcohol, their blood-alcohol concentration will rise. At 0.25 percent, loss of consciousness and alcohol poisoning can occur. At 0.4 percent and above, respiratory arrest, coma, and death are possible.

Drugs Commonly Mixed With Alcohol

Numerous drugs are mixed with alcohol. In general, people combine alcohol with other substances to either increase the effects or balance them out.

The illicit drugs people most commonly combine with alcohol include:

  • Marijuana: Marijuana taken with alcohol can intensify the “haziness” and relaxation that both substances cause.
  • Ecstasy: If someone using ecstasy feels too high, they may drink alcohol to reduce the feeling. 
  • Cocaine: People use alcohol and cocaine together to balance out the effects of each substance. Cocaine is stimulating while alcohol is depressing. 
  • Heroin: Both heroin and alcohol are depressants. Taking them together can intensify the relaxing effects of each drug. 
  • Psychedelics: Psychedelics, such as mushrooms and LSD, may be mixed with alcohol to help the person relax and reduce the psychedelic’s effects. 
  • Amphetamines: These drugs stimulate the body. Someone using amphetamines may drink alcohol to relax.

People may also combine alcohol with prescription medications to intensify the high they get from certain medicines. These medications include:

  • Adderall and other stimulants: Taking these drugs while drinking can reduce the feeling of drunkenness. 
  • Prescription painkillers: Taking prescription painkillers, such as hydrocodone and oxycodone, with alcohol can intensify the sedative effects of the drugs.

In the U.S. in 2009, there were approximately 4.6 million drug-related emergency room visits throughout the country. About 14 percent of these visits were related to alcohol use with at least one other drug. The drugs most often combined with alcohol were marijuana, cocaine, and heroin.

In 2009, approximately 519,650 emergency room visits were associated with using alcohol with at least one other drug. The drugs most frequently combined with alcohol included:

The Numbers

  • Painkillers, sedatives, stimulants, and other central nervous system agents accounted for 229,230 visits
  • Cocaine accounted for 152,631 visits
  • Marijuana accounted for 125,428 visits
  • Antipsychotics, antidepressants, and other psychotherapeutic agents accounted for 44,217 visits
  • Heroin accounted for 43,110 visits

The Most Dangerous Combinations

It is hazardous to mix any drug with alcohol, but the most dangerous combinations involve drinking alcohol with ecstasy, opioids (prescription pain medications and heroin), and cocaine.

Ecstasy: This is a type of stimulant that causes increased serotonin production. This affects sexual activity, aggression, mood, pain sensitivity, and sleep. When someone takes ecstasy and alcohol simultaneously, the combination may reduce how intoxicated they feel, putting them at risk for overdose.

Dehydration is more likely when combining both substances. In the most severe cases, it might lead to:

  • Kidney and urinary issues, such as kidney stones, kidney failure, and urinary tract infections
  • Low blood volume shock, which can be life-threatening due to reducing the amount of oxygen in the body
  • Heat injuries, including possibly fatal heatstroke
  • Seizures due to an imbalance in electrolytes, such as sodium and potassium

Other possible effects of combined ecstasy and alcohol use include:

  • Significant sleep issues
  • Paranoia
  • Rapid body temperature increase
  • Severe anxiety
  • Permanent or long-lasting brain damage, which can impact thinking, memory, and judgment

Opioids: Mixing opioids and alcohol may cause arrested or slowed breathing, blood pressure, and pulse; coma; unconsciousness; and death. This is because both opioids and alcohol have depressant effects on the body.

Respiratory depression is the most concerning effect. If this occurs, it reduces the level of oxygen the brain has, which can decrease its function. The brain will also start shutting down different organ systems in the body. Eventually, the lack of oxygen can result in death or brain damage.

Cocaine: People mix cocaine and alcohol to balance the effects of each drug. Cocaine is a stimulant, and alcohol is a depressant.

When these two substances are combined, cocaethylene is produced. This substance is a metabolite of cocaine. It can result in both neurotoxic and cardiotoxic effects, including:

  • Cerebral infarction (brain tissue because necrotic due to reduced oxygen and blood)
  • Bleeding in the brain
  • Cardiac arrhythmias (irregular heartbeat)
  • Heart attack
  • Cardiomyopathy (heart muscles becoming thick, enlarged, or rigid, which negatively impacts function)

The Effects of Mixing Drugs and Alcohol

There are several ways that mixing alcohol with drugs can impact health.  Alcohol and other substances can affect each other’s distribution, excretion, absorption, and metabolism when consumed together. Depending on how much alcohol someone drinks, it can either increase or delay the absorption of the other drug the person is taking.

If alcohol delays drug absorption, the person may not experience the desired effects when they think they should. This could cause them to take more of the other drug, which could result in an overdose.

The reduction in metabolism may increase the blood concentration of the other substances a person is taking. This could result in the formation of new metabolites and boost toxicity.

When using alcohol with another drug, the side effects of each substance may be more severe. For example, cocaine can put stress on the heart. When someone is also consuming alcohol, the drug combination can result in cardiovascular toxicity, which increases stress and pressure on the heart.

Other common effects of combining substances include:

  • Vomiting and nausea
  • Balance issues
  • Heart rate changes
  • Blood pressure changes
  • Body pain
  • Respiration changes

When combining substances, the risk of overdose is higher. This is partially due to one masking the effects of the other. For example, if someone is taking Adderall and alcohol, the Adderall may mask the symptoms of alcohol intoxication. This can result in people inadvertently taking more of a drug than they usually would. 
If someone using alcohol and another drug overdoses, it can be harder to treat the overdose. For example, if someone is using heroin and drinking, and they overdose, naloxone can only reverse the heroin component of the overdose.

Addressing Polydrug Abuse

Treating polydrug use that involves alcohol and illicit drugs can be challenging. Because of this, it is necessary for people to seek help at a professional treatment facility. The treatment team can create a care plan focused on this type of polysubstance abuse.

Polysubstance use may also amplify the symptoms of a co-occurring mental health disorder. A survey conducted in 2014 concluded that in the U.S., approximately 7.9 million people have both a substance use disorder and a mental health disorder at the same time. 
Cases of polydrug abuse present a more complicated treatment situation. As a result, they are often recommended for inpatient care initially.

Sources

(July 2007) Mono- Versus Polydrug Abuse Patterns Among Publicly Funded Clients. Biomed Central. from https://substanceabusepolicy.biomedcentral.com/articles/10.1186/1747-597X-2-33

Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

(March 2013) Evolving Frequency and Outcomes of Liver Transplantation Based on Etiology of Liver Disease. Transplantation. from https://www.ncbi.nlm.nih.gov/pubmed?cmd=search&term=23370710

Blood Alcohol Concentration. University of Notre Dame. from https://mcwell.nd.edu/your-well-being/physical-well-being/alcohol/blood-alcohol-concentration/

(May 2011) Drug-Related Hospital Emergency Room Visits. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits

(October 2010) Neurotoxicity and Persistent Cognitive Deficits Induced by Combined MDMA and Alcohol Exposure in Adolescent Rats. Addiction Biology. from https://www.ncbi.nlm.nih.gov/pubmed/21040238

The Effects of Combining Alcohol with Other Drugs. University of Michigan. from https://uhs.umich.edu/combine

(September 2009) Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol. Journal of Medical Toxicology. from https://www.ncbi.nlm.nih.gov/pubmed/19655286

(October 1979) Drug Interactions with Alcohol. Drugs. from https://www.ncbi.nlm.nih.gov/pubmed/387374

(May 2018) Cocaine Cardiac Toxicity: Revisited. Intech Open. from https://www.intechopen.com/books/cardiotoxicity/cocaine-cardiac-toxicity-revisited

Dual Diagnosis. National Alliance on Mental Illness. from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Dual-Diagnosis

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