Mixing Alcohol and Opioids: Dangers, Effects, and Treatment

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Last updated: 01/26/2025

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Combining alcohol with any drug can be dangerous, but mixing alcohol and opioids can be particularly life-threatening. Both substances slow vital bodily functions, increase the risk of overdose and can lead to long-term health complications. Despite these risks, many people remain unaware of the serious dangers involved. This article will provide an in-depth look at the risks of mixing alcohol and opioids, explain why this combination is so hazardous and discuss treatment options for those struggling with alcohol and opioid misuse.


What Are Opioids?

Opioids are a class of drugs that act on opioid receptors in the brain to provide pain relief. They are derived from or synthesized to mimic compounds naturally found in the opium poppy plant. Opioids are commonly prescribed for the short-term management of moderate to severe pain, but they can also be produced and sold illegally (such as in the case of heroin).

When taken as prescribed and under professional supervision, prescription opioids can offer effective pain relief. However, opioids also carry a high risk of dependence and addiction, particularly with prolonged use. The body’s tolerance can develop quickly, meaning a person needs higher or more frequent doses to achieve the same effects. This tolerance increases the likelihood of misuse and overdose.

Common Types of Opioids

Opioids come in both legal (prescribed) and illegal forms. Some of the most commonly used include:

Natural and Semi-Synthetic Opioids

  • Morphine: Often used to manage severe pain (such as after surgery or in advanced cancer care).
  • Codeine: Commonly found in cough syrups or mild-to-moderate pain relievers.
  • Oxycodone (OxyContin, Percocet): Frequently prescribed for moderate to severe pain.
  • Hydrocodone (Vicodin, Norco): Often prescribed in combination with acetaminophen to treat pain.

Fully Synthetic Opioids

  • Fentanyl: Extremely potent; used in surgical settings and for severe chronic pain but also manufactured illegally, sometimes mixed with other substances without a user’s knowledge.
  • Tramadol: A weaker synthetic opioid used for moderate pain but can still pose addiction and overdose risks.

Illicit Opioids

  • Heroin: A highly addictive, illegal opioid. It is often injected, snorted or smoked, and carries additional risks from unregulated production and potential contamination.

Opioids work by binding to receptors in the brain and throughout the body, reducing the perception of pain and producing feelings of euphoria. This euphoric sensation is partly why opioids have such a high potential for misuse.


What Are the Effects and Dangers of Mixing Alcohol With Opioids?

Both alcohol and opioids are central nervous system (CNS) depressants. This means they slow down vital functions such as breathing, heart rate and brain activity. When taken separately, each substance can have harmful effects if misused. However, when used together, their combined effects can be more intense and far more dangerous.

Increased Sedation and Drowsiness

Combining alcohol with opioids amplifies the drowsiness and sedation caused by each substance individually. This can make activities like driving or operating machinery extremely unsafe, even deadly.

Respiratory Depression

One of the most significant dangers of mixing opioids and alcohol is respiratory depression. Opioids slow breathing by affecting the part of the brain that controls respiration, and alcohol can worsen this effect. When both substances are present, the risk of dangerously slow or stopped breathing (respiratory arrest) increases substantially.

Reduced Awareness and Judgment

Both alcohol and opioids can impair judgment, coordination and decision-making. When a person’s perception of their surroundings or their own well-being is altered, they may not recognize the warning signs of an overdose or other dangerous situations.

Higher Risk of Dependence and Addiction

Polysubstance use (using more than one drug simultaneously) can increase the likelihood of developing dependence or addiction. People who regularly mix alcohol and opioids may find they experience cravings for both substances and struggle with controlling their use.

Potential for Organ Damage

Chronic alcohol use damages the liver, among other organs. Many opioids are also metabolized by the liver, which can place added stress on this vital organ. Over time, mixing the two can increase the risk of liver disease and other health complications.

Greater Likelihood of Overdose

The combined respiratory-depressing effects of alcohol and opioids significantly increase the risk of a fatal overdose. Since both substances can make a person extremely sleepy or unconscious, they may not be able to seek help or recognize their life-threatening symptoms.


Risks of Mixing Non-Opioid Pain Relievers With Alcohol

Although opioids carry high risks when combined with alcohol, it is important to note that mixing alcohol with any pain reliever can be dangerous. While non-opioid pain relievers typically have different mechanisms of action, consuming them with alcohol can still have serious health implications.

Acetaminophen (Tylenol)

Acetaminophen is commonly used for mild to moderate pain and fever reduction. While it is not an opioid, large doses of acetaminophen can cause liver damage. When taken with alcohol, the risk of liver injury increases significantly because the liver must work harder to metabolize both substances. Chronic heavy drinkers are especially susceptible to acetaminophen-induced liver damage, even at lower doses.

NSAIDs (Aspirin, Ibuprofen, Naproxen)

Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and naproxen can irritate the stomach lining and cause gastrointestinal bleeding. Alcohol also irritates the digestive tract and can exacerbate these effects. Together, they can increase the risk of stomach ulcers, bleeding and other gastrointestinal issues.

Prescription Pain Relievers

Certain prescription medications for chronic or acute pain (such as muscle relaxants, anti-convulsants or antidepressants) may also have sedating effects or interact negatively with alcohol. People with chronic pain conditions should be especially cautious about mixing any medication with alcohol and should always consult their healthcare provider.

It is critical to follow dosage instructions on over-the-counter and prescription medications and avoid alcohol use if there is any known interaction risk. If you are unsure about whether a non-opioid pain reliever is safe to use with alcohol, consult a medical professional.


Opioid and Alcohol Overdose

Overdose is a life-threatening medical emergency. An overdose occurs when the body is overwhelmed by a substance (or multiple substances) to the point that vital functions start to fail. With opioids, overdose typically results from severe respiratory depression. When alcohol is thrown into the mix, breathing can become dangerously slow or even stop altogether much more quickly.

Signs and Symptoms of an Opioid and Alcohol Overdose

  • Extreme Drowsiness or Unconsciousness: The person may have difficulty staying awake or be completely unresponsive.
  • Slow or Shallow Breathing: Breathing may become labored, irregular or excessively slow (fewer than eight breaths per minute). Gurgling or snoring sounds may indicate partial airway obstruction.
  • Blue Tint to the Skin: Due to a lack of oxygen, lips or fingertips may turn a bluish color (cyanosis).
  • Unusual Body Temperature or Pale, Clammy Skin: The person may feel significantly colder to the touch, have clammy skin or appear very pale.
  • Slowed Heart Rate or Weak Pulse: Vital signs (such as blood pressure and pulse) can drop dramatically.
  • Loss of Consciousness: The individual may not respond to shaking, calling their name or other stimulation.

Even if you are unsure whether symptoms are related to overdose, it is essential to treat them as an emergency. Quick medical intervention can mean the difference between life and death.


What to Do If Someone Overdoses on Opioids and Alcohol

If you suspect that someone is experiencing an overdose from opioids and alcohol, taking immediate action is critical:

  1. Call 911 Immediately: Explain the situation clearly, mentioning both opioid and alcohol use. Stay on the line until the operator tells you it is okay to hang up.
  2. Administer Naloxone (Narcan) If Available: Naloxone is a medication that can temporarily reverse opioid overdoses by blocking opioid receptors. While naloxone will not reverse alcohol’s effects, it can restore breathing if opioids are the primary cause of respiratory depression. If you have access to naloxone, follow the instructions provided for administration.
  3. Perform Rescue Breathing or CPR If Necessary: If the person is not breathing or their heart has stopped, a 911 operator or an on-scene medical professional may instruct you to begin rescue breathing or CPR. If you have received training, follow those guidelines.
  4. Place the Person in the Recovery Position: If the person is unconscious but breathing, gently roll them onto their side with one arm under their head and their mouth pointed downward. This position helps keep the airway clear and prevents choking if the person vomits.
  5. Stay With the Person: Remain on the scene until emergency services arrive. Be prepared to provide medical personnel with any information about the substances taken, how much was consumed and when.
  6. Follow Medical Advice: Once first responders arrive, follow any instructions they give. It is vital to remain cooperative and give them any additional information about the substances used, such as the specific type of opioid or amount of alcohol consumed.

Responding quickly to an overdose can save a life. Even if the individual becomes alert and appears fine after a short period, they still need to be evaluated by medical professionals. Substances can continue to affect the body even after initial symptoms subside.


Treatment for Alcohol and Opioid Addiction

For those struggling with alcohol and opioid dependence or addiction, professional treatment is often the most effective path to recovery. A multifaceted approach addresses both the physical and psychological aspects of addiction.

Medical Detox

Detoxification is the process of allowing the body to rid itself of substances while managing withdrawal symptoms. Attempting to stop opioid or alcohol use suddenly can be dangerous due to severe withdrawal symptoms, including seizures, extreme agitation and delirium tremens (for alcohol), as well as flu-like symptoms and intense cravings (for opioids). A medically supervised detox can provide:

  • 24/7 medical monitoring
  • Controlled tapering or medications to ease withdrawal
  • Immediate intervention for any medical complications

Inpatient or Residential Rehab

Inpatient or residential rehab programs provide round-the-clock supervision and structured treatment in a live-in facility. These programs offer:

  • Individual Counseling: Therapists help individuals identify the root causes of addiction and develop coping mechanisms.
  • Group Therapy: Peer support groups offer a safe environment to share experiences and learn from others on similar journeys.
  • Family Therapy: Addiction often affects the entire family. Family therapy can address relationship dynamics, communication issues and how to support the person in recovery.
  • Holistic and Wellness Activities: Many rehab programs include nutrition counseling, exercise programs, yoga, meditation and other activities that promote overall wellness.

Outpatient Programs

Outpatient treatment can be an option for people with stable living environments and a lower risk of relapse. These programs vary in intensity, from partial hospitalization programs (PHPs) that meet multiple times a week to standard outpatient services that may only require a few hours of therapy per week. Outpatient programs can include:

  • Individual and group therapy
  • Medication management
  • Relapse prevention planning
  • Support group attendance (e.g., 12-Step programs)

Medication-Assisted Treatment (MAT)

Medication-assisted treatment can be extremely helpful for individuals addicted to opioids. MAT combines behavioral therapy with FDA-approved medications such as:

  • Buprenorphine (Suboxone, Subutex): Helps reduce cravings and withdrawal symptoms.
  • Methadone: A long-acting opioid that prevents withdrawal and reduces cravings.
  • Naltrexone (Vivitrol): Blocks the effects of opioids and reduces alcohol cravings.

For alcohol use disorder, naltrexone, acamprosate and disulfiram are often prescribed to curb cravings and reduce relapse rates. These medications do not work alone; they are most effective when combined with counseling and other supportive interventions.

Aftercare and Ongoing Support

Recovery from opioid and alcohol addiction is an ongoing journey that extends far beyond initial treatment. Aftercare programs provide continued support and accountability. Examples of aftercare include:

  • Sober Living Homes: Structured, substance-free living environments that support the transition back to everyday life.
  • Support Groups: Organizations like Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or SMART Recovery provide peer support and a sense of community.
  • Ongoing Therapy: Individual or group counseling can help people continually work on coping skills, relapse prevention and emotional regulation.
  • Alumni Programs: Some treatment centers offer alumni programs where graduates can stay connected, attend events and mentor newer members.

Final Thoughts

Mixing opioids and alcohol can be deadly due to the compounded effects they have on the central nervous system. Even in small amounts, the risk of respiratory depression, overdose and long-term organ damage increases significantly when these substances are combined. Recognizing the dangers, knowing how to respond to an overdose and seeking professional treatment can save lives.

If you or someone you love is struggling with opioid and alcohol use, reaching out for help is a courageous first step. At The Recovery Village Palmer Lake, we understand the complexities of polysubstance addiction and offer individualized treatment plans that address both opioid and alcohol dependence. Through medical detox, evidence-based therapies, medication-assisted treatment and comprehensive aftercare, healing and long-term recovery are possible.

Remember: No one has to face addiction alone. Support is available, and professional treatment can help individuals reclaim their health, well-being and future.

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