Effects & Dangers of Mixing Alcohol and Opioids

Polysubstance use occurs when at least two substances (drugs and/or alcohol) are consumed together or within a short time frame.¹ This “mixing” of substances (using drugs and alcohol in the same time frame) can lead to dangerous, unpredictable outcomes that can vary based on the types of substances used, and can even be deadly.¹

In this article, we will discuss alcohol and opioid polysubstance use in depth, including the potential dangers and effects that can occur, addiction potential, and what types of addiction treatment can help. Examples of opioids include prescription pain pills such as oxycodone, fentanyl and heroin.

Combining Alcohol and Opioids

In 2023, 28.9 million Americans had an alcohol use disorder, while approximately 5.7 million Americans had an opioid use disorder.² More specifically, 5.3 million people with opioid use disorder were addicted to prescription pain relievers while 587,000 were addicted to heroin.² Examples of opioid prescription pain relievers include oxycodone, hydrocodone, hydromorphone, and legally manufactured fentanyl.

While there is little data detailing how many Americans are currently misusing alcohol and opioids simultaneously, there are statistics showing that opioids and alcohol are being combined and the effects can be deadly.³ For example:

• In 2020, an estimated 17.4% of fatal opioid overdoses involved alcohol.⁴
• Approximately 26.4% of adults with opioid use disorder also had an alcohol use disorder, according to data collected between 2015-2017.⁵
• From 2000-2019, there was a 4.6-fold increase in combined alcohol and opioid poisoning deaths.⁶

While many people use opioids and alcohol, it should be noted that doing so can be extremely dangerous and potentially fatal.¹

Dangers of Mixing Alcohol and Opioids

Alcohol and opioids are both depressants, meaning that they decrease arousal and stimulation in the brain, slowing down how the brain communicates with the body.^1,6 This can result in decreased reaction times, slower reflexes, poor concentration, and coordination.⁷

When two depressants are used at the same time, these effects can become greater, which explains why there is significant cause for concern regarding the polysubstance use of alcohol and opioids.⁸ Misusing alcohol or opioids independently can pose its own risks, however combining them can drastically increase these risks.⁷ Certain components, such as how the substance is administered and specific biological risk factors, can influence the severity of these dangers.^9,10

Effects of Alcohol

The misuse of alcohol can lead to several immediate, short-term effects, which often depend on an array of variables, including how much was consumed and how quickly.

Some short-term effects of alcohol can include:¹¹

• Slurred speech.
• Poor coordination.
• Unsteady gait.
• Impaired memory or attention.
• Stupor.
• Coma.

Additionally, a person may experience a drop in their inhibitions shortly after consuming alcohol, making them more likely to engage in unsafe behaviors, such as having unprotected sex or becoming violent.¹⁰

When alcohol is misused regularly and/or over long periods of time, more severe and complicated effects can occur.

Some long-term effects of alcohol can include:^12,13

• High blood pressure.
• Damage to the heart muscle.
• Irregular heartbeat.
• Stroke.
• Liver problems, including fatty liver, cirrhosis, and alcoholic hepatitis.
• Pancreatitis.
• Cancer, including cancer of the liver, breast, colon, head and neck, or esophagus.
• The development of addiction.

Effects of Opioids

Opioids, both prescription and illicit, can trigger the onset of a number of short-term effects when misused.

Short-term effects of opioids can include:¹⁴

• Euphoria.
• Nausea.
• Constipation.
• Drowsiness.
• Confusion.
• Respiratory depression.

The continued, long-term misuse of opioids can create even more effects, including ones that are more severe and lasting.

Some long-term effects of opioids can include:¹⁵

• Sleep-disordered breathing.
• Intestinal blockages.
• Heart attack or failure.
• Chronic constipation.
• Increased risk of falls and fractures.
• The onset of depression.
• The development of addiction.

Interactions Between Alcohol and Opioids

The combined use of alcohol and opioids exponentially increases the risk of overdose, primarily due to the respiratory effects that can occur.^16,17 Both alcohol and opioids diminish activity in areas of the brain responsible for vital functions, such as breathing, which can lead to serious complications like respiratory failure, coma, and even death.^16,17

If opioids are believed to be involved in a potential overdose, if there is uncertainty regarding what substances someone may be overdosing on, or if someone is showing signs of opioid overdose (e.g., pinpoint pupils, slowed or stopped breathing, or being difficult to arouse), administering naloxone is still recommended.^18,19 Doing so will not harm the person, but may potentially save their life.¹⁸

Alcohol and Opioid Addiction

Alcohol and opioids are highly addictive substances, and the continued misuse of them can quickly lead to tolerance, dependence, and addiction.¹³

• Tolerance occurs when a person must begin taking a substance more frequently or in larger amounts in order to achieve the desired effects.²⁰
• Dependence refers to the adaptations that have occurred in the body that cause withdrawal symptoms when the substance is either no longer being used in its normal capacity or use is stopped altogether.²¹
• Addiction occurs when a person has lost control over the cravings they experience , therefore continuing to use the substance even if by doing so causes negative consequences.²¹

The continued use of addictive substances like alcohol and opioids can interfere with the normal functioning of the brain, leading to the onset of these and other troublesome outcomes.⁹

Alcohol and Opioid Polysubstance Addiction Treatment

If you or a loved one is struggling with opioid and alcohol addiction, know that effective treatment is available. Some of these can include:

• , a set of interventions led by medical professionals that help clear a patient’s system of addictive substances in a safe, comfortable manner.²⁰
• , which involves residing at the facility for the duration of the program. Patients will have 24/7 supervision and care and can participate in a number of therapies designed to address the underlying causes of their addictions.²²
• Partial hospitalization programs for addiction, which are also referred to as high-intensity outpatient programs (HIOPs). This type of program requires patients to be at the facility for several times a day to receive therapy, but allows them to return home at the end of the day.²³
• , or IOPs. Similar to above, patients go to the facility for therapy, but not as frequently or for as long as those in a PHP.²³
• Standard outpatient addiction treatment programs, where patients can attend after school or work or even on the weekends while still maintaining their daily lives outside of treatment.²³
• , which is important in helping to sustain progress made in rehab and prevent relapse.²³ Sober living is a form of aftercare, where patients reside in a substance-free house as they work to transition from rehab to independent living.²³

Getting Help for Alcohol and Opioid Addiction

If you or a loved one is ready to seek rehab for a substance use disorder, explore your options and reach out to a rehab center using our rehab directory tool today!