Mixing alcohol and opioids is dangerous. Each substance acts as a depressant and slows down the body on its own, but together, they can quickly lead to life-threatening effects.
Many people don’t realize just how risky this combination is, especially when it’s unintentional or involves prescription medications. This guide explains what happens when alcohol and opioids are used at the same time and the health risks involved.
Co-use of alcohol and opioids
Data show that alcohol use is linked to opioid use disorder:
- People with AUD on long-term opioid therapy for chronic pain faced higher odds of overdose and injury.
- 23.4% of adults with opioid use disorder (OUD) also had a diagnosis of alcohol use disorder (AUD). This rose to 33.4% among those with OUD before pain began.
- In treatment settings, 38% of people seeking help for opioids also had AUD.
- From 2002 to 2012, reported alcohol and prescription opioid use at substance use disorder (SUD) treatment admissions increased 181%, from 1.6% to 4.5%.
- In 2010, alcohol was involved in 22.1% of opioid pain reliever deaths and 21.4% of benzodiazepine deaths.
- A 2006 study in West Virginia found that 13.5% of opioid overdose deaths involved alcohol.
- Among OUD patients in the UK, having AUD raised the risk of a fatal overdose.
The dangers of mixing alcohol and opioids
Mixing alcohol and opioids increases the risk of severe health problems, many of which can happen without warning.
These two substances affect the central nervous system. They are dangerous even when used alone, but combining them can quickly lead to problems.
Below are some of the most serious outcomes linked to mixing the two:
Respiratory failure and overdose
Mixing opioids and alcohol can slow breathing and reduce oxygen levels in the body.
This combination puts severe strain on the respiratory system and raises the chance of a fatal overdose even when:
- Low doses are taken together: Even small amounts of both substances can trigger dangerous breathing problems.
- Use happens close together: Drinking alcohol while taking prescription medications like oxycodone or fentanyl can make the effects stronger and less predictable.
Sedation and impaired coordination
Combining alcohol and opioids affects how a person thinks and moves. This could lead to:
- Falls and injuries: Loss of balance and drowsiness can lead to physical harm.
- Delayed reflexes: Confusion and slowed thinking reduce the ability to react in time.
- Dangerous decisions while impaired: Tasks like driving or operating machinery become much riskier under sedation.
Interactions with other medications
Mixing alcohol with opioids and other drugs can lead to dangerous outcomes. These interactions can:
- Change how drugs are processed: Alcohol can make opioids stronger or cause unpredictable effects.
- Lower the threshold for a fatal overdose: The presence of alcohol while taking medications like buprenorphine can be deadly.
- Amplify effects of opioid medications: Many opioids bind to opioid receptors in the brain, which can lead to severe respiratory depression when alcohol is added.
Other drug combinations that increase the risk
In some cases, alcohol and opioids are used alongside other drugs—intentionally or by accident. Some high-risk combinations include:
- Heroin and alcohol: Both substances slow down the central nervous system. Used together, they can quickly lead to loss of consciousness or death.
- Alcohol mixed with pain medications: Many prescribed opioids, including those used after surgery, can increase the risk of overdose when alcohol is also in the system.
- Morphine and codeine with alcohol: These opioids, derived from the opium poppy plant, become more dangerous when combined with alcohol because they intensify sedation and slow vital functions.
- Alcohol and medications for chronic health conditions: Alcohol can interfere with how these drugs work and increase the risk of serious side effects, especially when opioids are also being used.
Treatment for opioid and alcohol use disorder
Treating both opioid and alcohol use disorders at the same time can improve the chances of long-term recovery. These two conditions often reinforce each other, so integrated treatment is a common approach.
Here’s what treatment often includes for people with both OUD and AUD:
Medications
Medications can reduce cravings and help people stay in recovery. Treatment may involve:
- Use of medications for opioid withdrawal: Buprenorphine, methadone, and naltrexone are often prescribed to manage symptoms and reduce cravings.
- Use of medications for alcohol dependence: Naltrexone, acamprosate, and disulfiram may be included to support alcohol recovery.
- Use of a single medication for both conditions: Naltrexone is sometimes used to treat both OUD and AUD.
Behavioral therapies
Therapy helps people understand substance use patterns and develop healthier coping strategies. Common approaches include:
- Therapy through inpatient or outpatient treatment: Support is offered in various settings depending on individual needs.
- Cognitive behavioral therapy (CBT): CBT focuses on changing harmful thinking patterns and behaviors.
- Motivational interviewing: This approach encourages internal motivation to make changes and stay in recovery.
- Addressing co-occurring mental health conditions: Many people with substance use problems also live with anxiety, depression, or PTSD.
Integrated care
Integrated care addresses both alcohol and opioid use through a coordinated treatment plan.
This approach combines services and support systems to treat the whole person, not just the addiction.
Here’s what integrated care often includes:
- Combination of services in one program: Some treatment centers offer care for both opioid use disorder (OUD) and alcohol use disorder (AUD) within the same program.
- Mental health screening and support: Identifying co-occurring issues like anxiety, PTSD, or depression helps shape a more effective treatment plan.
- Referral to dual diagnosis programs: These programs, often connected to agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA), treat substance use and mental health conditions at the same time.
- Medical oversight during detox: Medically supervised detox reduces the risks tied to withdrawal symptoms and helps patients safely begin recovery.
Long-term support
Support after initial treatment can help people maintain progress. Recovery services often offer:
- Access to peer support groups: Talking with others who have similar experiences can strengthen recovery.
- Help with life challenges: Case managers may assist with housing, jobs, or transportation needs.
- Options like sober living homes: These environments offer structured recovery support.
- Plans for relapse prevention: Ongoing tools and check-ins help people stay on track.
Resources such as the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention offer guidance on substance use, overdose prevention, and detoxification support. For many, early treatment can help reduce the risk of fatal overdose and lead to better long-term health.
How Modern Recovery can help
Mixing opioids and alcohol is a serious risk, but you don’t have to face it alone. If you or someone you love is struggling with opioid or alcohol use, support is available—right from home. Here’s how our telehealth program helps people stay safe and start recovery:
- Get care without leaving home: Online treatment works around your schedule and helps minimize disruption to work, family, or school.
- Connect with people who’ve been there: Our recovery coaches have lived through addiction and offer judgment-free support when it matters most.
- Heal with your family: Family sessions give everyone tools to rebuild trust and support each other’s progress.
- Get help for both body and mind: Our licensed therapists and medical team help manage opioid dependence and underlying mental health concerns.
When someone is struggling with opioid use and alcohol together, the risks are too great to ignore.
Modern Recovery offers a private, flexible path forward—so you can take the next step toward feeling better, safely and with support.
We’re in-network and accept insurance
Online therapy covered by insurance does exist. Modern Recovery works with leading insurance providers across the United States to bring you quality mental health treatment that’s both accessible and affordable.
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Sources
1. Witkiewitz, K., & Vowles, K. E. (2018). Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcoholism: Clinical and Experimental Research, 42(3), 478–488. https://doi.org/10.1111/acer.13594
2. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2025, January 6). Alcohol-Medication Interactions: Potentially Dangerous Mixes. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
3. Centers for Disease Control and Prevention. (n.d.). Drinking Alcohol While Using Other Drugs Can Be Deadly | Alcohol Use. https://www.cdc.gov/alcohol/fact-sheets/alcohol-drug-interactions.htm
4. American Society of Anesthesiologists (ASA). (2017, February 7). Mixing Opioids and Alcohol May Increase Likelihood of Dangerous Respiratory Complication, Especially in the Elderly, Study Finds. https://www.asahq.org/about-asa/newsroom/news-releases/2017/02/mixing-opioids-and-alcohol-may-increase-likelihood-of-dangerous-respiratory-complication-especially-in-the-elderly-study-finds
5. American Addiction Centers. (2025, April 1). Mixing Opioids and Alcohol: Morphine, Oxycodone, Hydrocodone, Fentanyl. https://americanaddictioncenters.org/opioid-abuse/mixing-with-alcohol