Since alcohol is legal and so widely available, it is easy to forget that it is a drug. Alcohol is a central nervous system depressant, which means it inhibits brain activity by interfering with the neurotransmitter GABA, according to the National Institute on Drug Abuse (NIDA).

When consumed by itself, alcohol can affect coordination, mood, behavior, and cognitive abilities. When combined with prescription drugs, alcohol can affect all of the above and more. For example, alcohol can reduce the effectiveness of some medications and enhance the effects of others. Either scenario can have serious negative repercussions.

Prescription Drugs and Alcohol

A Widespread Problem

According to the Washington Post, which compiled data from Philip J. Cook’s Paying the Tab and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), 70 percent of American adults consume alcohol in some capacity. Since researchers at Mayo Clinic found that nearly 70 percent of Americans are on at least one prescription medication, that means there is a wide margin for overlap.

There are all kinds of prescription medications available, and a few may be fairly safe to combine with alcohol; however, three of the most common kinds of prescription drugs — stimulants, depressants, and opioids — should never be combined with alcohol or other substances.

According to NIDA, there were an estimated 519,650 visits to the emergency room in 2009 that involved alcohol in combination with other drugs. The most common substances that alcohol was combined with were:

  • Central nervous system agents, including stimulants, depressants, and analgesics
  • Psychotherapeutic agents
  • Heroin
  • Cocaine
  • Marijuana

Combining Stimulants with Alcohol

Stimulants are substances that speed up neurological activity and their resulting functions throughout the body. Stimulants increase energy and alertness, and doctors typically prescribe them to treat ADHD, mild depression, and narcolepsy. Amphetamines and methylphenidate are two of the most commonly prescribed stimulants, and their side effects include:

  • High blood pressure
  • Irregular heartbeat
  • Insomnia
  • Increased temperature
  • Loss of appetite
  • Anger
  • Paranoia

Although stimulants essentially have the opposite effect on the body that depressants do, that does not mean their effects cancel out the effects of alcohol. For example, amphetamines increase heart rate while alcohol slows it down. Combining these two substances can lead to serious cardiac issues that stem from an irregular heartbeat. Additionally, even though the side effects of stimulants do not cancel out those of alcohol, they can mask them. That means individuals who consume alcohol while taking Adderall or Ritalin may drink far more than they should because they do not feel drunk, even if their blood alcohol content is well above the legal limit. This can result in risky behaviors like drunk driving, as well as alcohol poisoning.

Combining stimulants and alcohol is a very real problem at college campuses around the country because students often take part in binge drinking while taking stimulants to increase their academic performance. According to the National Institute on Alcohol Abuse and Alcoholism, nearly 60 percent of college students between the ages of 18 and 22 who took part in a national survey had consumed alcohol in the past 30 days. A survey conducted by the Partnership for Drug-Free Kids also found that 20 percent of college students abuse stimulants like Vyvanse, Ritalin, and Adderall at least once in their lifetime.

Combining Depressants with Alcohol

Depressants, which include barbiturates, benzodiazepines, and sedative-hypnotics, slow down certain neurological functions. According to the Drug Enforcement Administration, their therapeutic uses include relieving anxiety, reducing muscle spasms, and preventing seizures.

Mixing alcohol with other depressants is incredibly dangerous and can result in organ failure and even death. Both substances will increase the effects of the other and can slow down the central nervous system to the point of unconsciousness or coma. The most severe side effects include heart failure and respiratory depression. Depressants that people should not mix with alcohol include:

  • Xanax
  • Valium
  • Ativan
  • Halcion
  • Librium
  • Klonopin
  • Amytal
  • Nembutal
  • Seconal
  • Phenobarbital

Combining Opioids with Alcohol

Opioids are central nervous system agents that affect the opioid receptors in the brain. According to a review originally published in Experimental and Clinical Psychopharmacology, opioids are among the most effective drugs for treating moderate to severe pain. Doctors typically prescribe them to treat acute pain following injury or surgery; however, there is some disagreement in the medical community as to whether they are the best long-term treatment for chronic pain because they are habit-forming. According to the Centers for Disease Control and Prevention, as many as one in four people with a long-term prescription for opioids eventually struggles with opioid addiction.

Although opioids are not technically depressants, they still have sedative effects on the central nervous system, and combining them with alcohol is incredibly dangerous. People who take opioids are already at risk of respiratory depression, and when they combine them with alcohol, that risk only increases. People who consistently combine alcohol and opioids may also experience:

  • Liver damage
  • Irregular heartbeat
  • High blood pressure
  • Stroke
  • Cardiomyopathy
  • Pancreatitis
  • Weakened immune system
  • Impaired cognitive function
  • Coma

Some people who combine opioids with alcohol may do so inadvertently. For example, they might have a glass of red wine with dinner every night despite having a prescription for painkillers; however, there are others who purposely combine these substances in order to enhance their effects. If you think a loved one is mixing alcohol with opioids, you can look for some of the telltale signs of doing so, which include incoordination, impaired memory, insomnia, impaired judgment, drowsiness, slurred speech, vomiting, loss of appetite, and poor concentration.

Getting Help

Prescription Drugs and Alcohol

Treating addiction to one substance is much the same as treating addiction to two or more substances, and the road to recovery always begins with medical detox. Alcohol withdrawal symptoms are different from stimulant, depressant, and opioid withdrawal symptoms, but the healthcare providers at a qualified medical facility will still be able to manage the worst of them. Medical detox is always required for alcohol withdrawal as well as withdrawal from multiple substances of abuse.

Following medical detox, individuals may enter a program that provides them with the tools they need to combat cravings and remain sober for years to come. Those who began taking their prescription medication for a legitimate medical reason will also need to explore other effective treatment options for their condition.