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Dangers of Combining Drugs with Alcohol

Various pills in a pile next to a glass of alcohol  

Even when taken without other chemicals, alcohol is a potent drug with profound adverse effects on the developing brain. Teenagers who regularly drink alcohol, or who occasionally binge drink, are at risk for life-long, irreversible developmental abnormalities in the brain. Studies have determined that alcohol use among teenagers results in reduced brain volume, altered neurochemistry, altered structural connectivity and abnormal functionality, among others. The consequences of these changes include memory impairments and cognitive dysfunction along with mental health and behavioral disorders.

Mixing alcohol with other drugs can increase the risk of immediate and long-term negative consequences. It is important for teenagers and parents to understand the potential adverse outcomes of combining alcohol and drugs.

Why is Mixing Alcohol With Drugs Dangerous?

The overall effect of alcohol is to inhibit normal brain activity, thus alcohol is known as a central nervous system (CNS) depressant. Mixing alcohol with other CNS depressants (e.g., opioids, sleeping pills, benzodiazepines) or with CNS stimulants ( e.g., amphetamines or cocaine) can be dangerous.

Many drugs interact “synergistically” with alcohol, meaning that the combination of drugs has a stronger effect than predicted based on the effect of either drug individually. This synergistic effect is why many drug overdose fatalities include alcohol.

Polysubstance Use Disorder

Adolescents and young adults are at particular risk for developing dependence or addiction to two or more drugs, known as polysubstance use disorder (PSUD). A recent study followed over 2,500 10th graders from 137 high schools across the country and found that 8% met criteria for PSUD. The study found that they had higher rates of depressive and other mental health disorders. Alcohol use during adolescence has been shown to be a risk factor for later development of PSUD.

Potential Interactions of Drug Mixing

The effects of mixing drugs and alcohol are often unpredictable. While some alcohol-drug interactions may be less dangerous than others, there is always the risk of serious, even lethal outcomes.

OTC Medications and Alcohol

When combined with alcohol, some over the counter drugs can have dangerous interactions. Read the label to determine whether the manufacturers recommend mixing the particular drug you are taking with alcohol.

Pain Relievers

Most OTC pain relievers (including aspirin, ibuprofen [Advil], naproxen [Aleve] and acetaminophen [Tylenol]) should not be combined with alcohol. Potential consequences include upset stomach, stomach bleeding or ulceration of the stomach lining and, in extreme cases, liver failure.

Sleeping Pills

Sleeping pills and alcohol are both CNS depressants that can cause respiratory depression, leading to coma or even death. Other dangerous effects of combining alcohol and sleeping pills include the potential for “complex sleep behaviors,” like sleepwalking, sleep-eating and sleep-driving. Deaths from complex sleep behaviors have attributed to hypothermia, drowning, falls and automobile accidents.

Cold and Allergy Medicines

Many cold and allergy medicines have OTC pain medications like acetaminophen in combination with antihistamines (Benadryl) or antitussives (Robitussin). Combining these drugs can cause significant liver or stomach damage as well as increasing the risk of respiratory depression.

Prescription Pills and Alcohol

It is strongly recommended that people talk to their doctor about mixing alcohol and prescription drugs. Many prescription drugs, including painkillers, anti-anxiety medications, antidepressant medications and stimulants, can have dangerous interactions.

Benzodiazepines and Sedatives

Like alcohol, benzodiazepines (“benzos”) are CNS depressants. When taken together, they act synergistically. Mixing benzos and alcohol puts the person at risk for impaired cognition, unconsciousness or respiratory depression.

Stimulants and ADHD Meds

Prescription stimulants are amphetamines that are prescribed for attention deficit or related disorders. Adderall and Vyvanse are among the most popular prescription stimulants. These drugs have an opposite effect on the brain as alcohol does, but that does not mean that combining them is safe. Stimulants can mask alcohol intoxications, increasing the risk of alcohol poisoning and giving people the misperception that they are less intoxicated than they truly are, which may lead them to drive or participate in other risky behaviors while intoxicated.


Mixing alcohol and opioids is dangerous. As with benzodiazepines, opioids and alcohol act synergistically and the consequences may include potentially fatal respiratory depression.


Mixing antidepressants with alcohol can have poor outcomes. Side effects of drinking alcohol while on antidepressants can include increased depression or risk of suicide, particularly when alcohol is combined with SSRIs, like Prozac or Zoloft. In addition, combining alcohol with MAOIs, like Nardil or Pamate, can cause dangerously elevated blood pressure.


Combining antibiotics and alcohol often reduces the effectiveness of the antibiotics. In addition, drinking alcohol while on antibiotics can cause dehydration, sleep disruptions and gastrointestinal upset. Among the most dangerous interactions occur with linezolid (Zyvox) and rifampin (Rifadin), which can cause a risk of hypertension or liver injury, respectively.

Illicit Drugs with Alcohol

Teenagers face serious legal ramifications if they are caught mixing illegal drugs with alcohol. However, devastating health consequences can far outweigh the legal risks.


Mixing marijuana with alcohol is known as “getting crossfaded.” Marijuana is the most common illicit drug that teenagers co-use with alcohol. Studies that have followed teens who co-use alcohol and marijuana over the course of several years found that they have worse verbal learning and memory, visuospatial functioning, and working memory and attention compared to teenagers who did not combine the two. Other studies have shown that marijuana and alcohol co-use have more significant impacts on brain structure and function than either drug used independently.


The effects of mixing ecstasy and alcohol are substantial. Risks include dehydration and urinary retention, which can affect kidney function, as well as impaired judgment and cardiovascular issues. Making this combination even worse is the high probability that ecstasy includes dangerous adulterants like methamphetamine or synthetic cathinones (“bath salts”).


Mixing cocaine and alcohol can cause someone to feel less intoxicated than they truly are, putting them at risk for alcohol poisoning and other risky behaviors associated with intoxication. However, combining cocaine and alcohol has another major risk: When these drugs are taken together they form an active metabolite called cocaethylene that causes liver damage and increases the already powerfully addictive capacities of both alcohol and cocaine.


Mixing heroin and alcohol can cause potentially lethal CNS depression, including coma, respiratory failure and death. This combination is already incredibly dangerous, but a recent trend towards including the synthetic opioid fentanyl in heroin substantially increases the risk of death.

Treating Teen Alcohol and Drug Abuse

While there are several Florida drug and alcohol treatment programs, they are not all alike. Look for teen-specific drug rehab programs that are evidence-based and offer multidisciplinary techniques in order to maximize long-term success for your teenager.

If you are concerned that your teen is using alcohol and other drugs, contact Next Generation Village. You deserve a healthier future, call today.

Medical Disclaimer: Next Generation Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.


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