As a cheap, legal (for those of drinking age), and socially acceptable mind-altering substance, alcohol is the most frequently used addictive substance in the United States, the National Council on Alcoholism and Drug Dependence (NCAAD) reports.
 
As of 2014, nearly 88 percent of American adults (those 18 and older) reported consuming alcohol at some point in their lifetime, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes.

For most, moderate consumption of alcohol is not problematic; however, when alcohol is mixed with other psychoactive substances, things can go horribly wrong. Most medications will have warnings on their labels of the potential dangers of mixing them with alcohol. Alcohol can inhibit these medications from working the way they were meant to, and the substances may interact with each other in negative ways. Illegal drugs can be unpredictable and when mixed with alcohol, the side effects may be numerous.

About a quarter of all emergency department (ED) visits involving drug abuse in 2011 also noted the presence of alcohol, about half of which involved an illicit drug such, as cocaine or marijuana, and the other half involved pharmaceuticals like benzodiazepines, pain relievers, or psychotherapeutic drugs (antidepressants and antipsychotics), according to the Drug Abuse Warning Network (DAWN).

Physical Risk Factors and Overdose

As substances and the body a CNS depressant, alcohol slows down some of the vital functions a person needs to stay alive. Heart rate, blood pressure, respiration rates, and body temperature all decrease with alcohol abuse. Alcohol can also cause nausea, vomiting, headache, dizziness, drowsiness, lightheadedness, impaired motor coordination and slowed reflexes, and dehydration. In addition, alcohol can put stress on the heart, lungs, and cardiovascular system. Over time, perpetuated alcohol abuse can lead to a weakened immune system, heart problems, liver disease, brain damage, dementia, cancer, and around 200 disease and injury conditions, the World Health Organization (WHO) warns.

Mixing it with other drugs can increase all of the potential negative consequences, and depending on the type of drug abused, potentially lead to additional ones. NIAAA warns that a person may never be sure how drugs or medications may interact with alcohol, as pharmaceuticals have a variety of ingredients that work in different ways, and many even contain up to 10 percent alcohol in them.

Drug overdose fatalities are at an all-time high, as the Centers for Disease Control and Prevention (CDC) reports that in 2014 approximately 47,055 people died from a drug overdose in the United States. Adding alcohol to the mix only increases the risk for a fatal overdose, especially when combining it with other depressant drugs like opioids or benzodiazepines. The CDC publishes that within the United States, around six people die each day as the result of alcohol poisoning, which is a toxic overdose on alcohol.

NIAAA publishes that many injuries and fatalities that are reported to be “alcohol-related” involve both drugs and alcohol.

Risks of Specific Types of Drug and Alcohol Combinations

Drugs commonly mixed with alcohol may have the following negative side effects:

  • Cocaine: As a stimulant drug, cocaine may seem to counteract the effects of alcohol or vice versa. When combined, these substances may actually serve to amplify the effects of each other and potentially lead to more aggressive behaviors. Alcohol and cocaine combine to form cocaethylene in the liver, a toxic substance that can unduly tax the heart and liver and potentially cause heart attack and death.
  • Marijuana: Alcohol abused with marijuana can cause tetrahydrocannabinol (THC) to be absorbed faster, making it more potent. Nausea, vomiting, dizziness, paranoia, and anxiety may be common side effects of combining these two substances, as both the emotional and physical effects of each may be amplified.
  • Opioid drugs (heroin and prescription painkillers): Both alcohol and opioids slow the central nervous system and may lead to dangerously low respiration levels, an irregular heart rate, and hypotension. Fatal overdose may result from even small amounts of each, as both exacerbate the central nervous system (CNS) depressant effects of the other. Nausea, vomiting, dizziness, impaired motor coordination, muscle weakness, slurred speech, and decreased body temperature are all additional possible side effects of mixing alcohol with an opioid drug.
  • Benzodiazepines: Similarly to opioid drugs, these are also CNS depressant medications that can lead to fatal overdose when mixed with alcohol. All possible risk factors and side effects of both alcohol and benzodiazepine drugs are increased when these two substances are combined. This combination of substances can cause the brain to be deprived of oxygen for too long, leading to coma, brain damage, or death.
  • Psychotherapeutic drugs: These drugs also slow down some of the functions of the CNS related to the stress response, and when combined with alcohol, the effects are exaggerated. Alcohol is a depressant drug and may completely counteract the design of these medications, actually leading to worsened depression, anxiety, or other psychotic symptoms.
  • Amphetamines (methamphetamine and prescription ADHD medications): These stimulant drugs typically take effect rather quickly and then wear off fast. When combined with alcohol, the initial effects of the substances may be blunted and a person may drink more, not realizing that once the stimulant wears off, the full effect of the alcohol will be felt. Toxic overdose and extreme stress on the heart, stroke, or convulsions may result. Stimulant drugs generally increase energy and decrease inhibitions. When mixed with alcohol, the odds of engaging in risky behaviors may be greater. Individuals may also become paranoid, anxious, or aggressive when these substances are combined.
  • Hallucinogens (LSD, PCP, ecstasy, “magic” mushrooms): Alcohol and these types of drugs can cause unpredictable reactions, potentially leading to dangerous and hazardous behaviors or actions. The “trip” a person feels as a result of a hallucinogenic drug may be amplified and bring more negative effects than positive ones. Paranoia, delirium, anxiety, and aggression may be the result of a “bad trip” from mixing alcohol and hallucinogenic drugs.

The stress response is blunted by alcohol, as it interacts with levels of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and its receptors in the brain, the journal Pharmacology Biochemistry and Behavior reports. Alcohol is also thought to inhibit the production and movement of the excitatory neurotransmitter glutamate.

Neurotransmitters act as chemical messengers in the brain. While excitatory ones speed up functioning, inhibitory ones slow things down. Sedation, drowsiness, relaxation, and decreased anxiety are side effects of increased levels of inhibitory neurotransmitters in the brain.

Another neurotransmitter likely affected by alcohol is dopamine, which is related to feelings of pleasure. Alcohol, therefore, also acts on behaviors as moods are elevated, inhibitions decreased, and socialization levels heightened. Decision-making capabilities, the ability to recognize danger, and short-term memory functions are impaired. When combined with other mind-altering substances, these effects can be amplified, resulting in increased risk-taking behaviors, questionable sexual encounters, heightened aggression, episodes of violence, suicidal thoughts or behaviors, and even potentially criminal actions.

NCAAD publishes that in crimes that lead to incarceration, 80 percent involved alcohol or drugs, or potentially a combination of the two. Domestic violence, driving under the influence, property crimes, public order offenses, drug-related offenses, and violent crimes, including homicide and rape, are all more likely with the presence of alcohol and drugs. Being under the influence of alcohol and drugs can also increase the odds for being a victim of a crime, as senses, memory functions, sound decision-making skills, and movement may be impeded by these substances.

Alcohol can also impede treatment for both medical and mental health conditions and interfere with the medications necessary for managing symptoms. In a study of individuals suffering from chronic pain, for instance, the journal Postgraduate Medicine reports that nearly 6 percent reported consuming alcohol more than 10 times in the previous month. In addition, those who battled alcohol dependence were more likely to need to take painkillers to relieve their pain for longer than those who didn’t struggle with problematic alcohol abuse.

Alcohol and drugs may often be used as a form of self-medication for many mental health concerns, such as anxiety and depression. Even though they may seem to temporarily elevate moods and decrease symptoms, over time, alcohol and drug use can actually make these symptoms worse. Since alcohol is a depressant and mind-altering drug, when it is used regularly over a period of time, changes are made to the structure of the brain. It may become more difficult to feel pleasure or keep emotions balanced without alcohol. Drugs too, have similar methods of action in the brain. The combination of drugs and alcohol can make symptoms of mental illness worse and interfere with treatment methods.

As changes are made to the brain’s structure with both alcohol and drug use separately, these alterations may be made more prominent, or created faster, with simultaneous abuse of drugs and alcohol. According to the 2014 National Survey on Drug Use and Health (NSDUH), one out of every eight American adults battling addiction in the year leading up to the survey suffered from an addiction involving both drugs and alcohol. Abusing multiple substances at once may create what is called cross-tolerance, and an individual will need to take more of a substance in order to keep feeling the effects of it. Tolerance can quickly lead to drug dependence, which is what occurs when the brain relies on the drug and/or alcohol to keep itself balanced.

An individual may take “uppers” or stimulant drugs to increase energy, attention, and focus, and then take “downers” or depressant drugs or alcohol in order to sleep or “come down” from the effects of stimulants. This type of drug abuse can disrupt a person’s brain chemistry, making it more difficult for the brain to regulate itself. When these negative patterns of drug and alcohol abuse are perpetuated on a regular basis, the brain’s chemical makeup and circuitry may be altered. Impulse control, mood regulation, decision-making abilities, reward processing, learning, and memory functions are all impacted. Physical withdrawal symptoms, drug cravings, and intense mood swings may set in when the substances wear off, causing a person to take more.

From this, a loss of control over drug and alcohol use may develop, leading to an addiction involving drugs and/or alcohol. As a primary brain disease, addiction has many emotional, social, physical, and behavioral costs. Addiction involving not just alcohol but also drugs may be more resistant to treatment and require a longer and more comprehensive treatment model. Individuals also battling a co-occurring mental health disorder or medical condition may struggle with treatment complications involving the types of medications used and compliance.

Detox is often the first stage of addiction treatment, and medical detox is necessary when both drugs and alcohol are present in the body. Highly trained professionals in a secure and specialized facility can use both supportive and pharmacological methods to safely help clients through withdrawal before continuing with an individualized addiction treatment plan.