Dr. Erin Miers is a clinical psychologist, she currently works at Dartmouth-Hitchcock Medical Center where she provides clinical services, consultation, supervision, and teaches at Geisel School of Medicine at Dartmouth University. She completed her doctorate in 2015 through California School of Professional Psychology in San Francisco. She has expertise in the areas of trauma, substance use disorder, HIV, and working with the LGBTQIA+ population. Her research interests include the impact of burnout on mental health providers, discrimination and internalized stigma generally but also specifically in people living with HIV.
Risks of Mixing Opiates and Alcohol
Opiates and alcohol. It may seem obvious mixing the two is a recipe for severe, irreversible consequences. Independently, each has the ability to take someone’s life slowly through deteriorating one’s body over time. Alternately, both substances can end someone’s life instantly by overdosing on opioids or unsafe behaviors while drinking.
Understanding the risks of each separately is important, helping us identify those who may be in need of drug rehabilitation in Scottsdale AZ. Knowing the risks of taking them together may just save your life or that of someone you know.
Getting and staying sober is very challenging, but with the right support network and tools, it's completely attainable.
Two Terrible Dangers
Before we talk about the danger of mixing opiates and alcohol, let us consider both substances separately.
Dangers of Alcohol
Individuals suffering from alcohol abuse may not see they have a problem for a long time. Unfortunately, it is when drinking begins to impact someone’s daily life before it is realized there may be an issue. When this occurs, the drinker may begin binging, suffer from memory loss, exhibit inappropriate behavior, develop health problems, and other non-characteristic behaviors.
Separately, consuming alcohol in excessive amounts can have the following side effects:
- Loss of coordination
- Loss of consciousness
Over time, continued increased consumption begins to damage vital organs in the body, such as the liver. Long-term use of alcohol wears on the body making alcoholism a slow killer. It is possible to cure the disease of alcoholism, especially if it is noticed at an early stage and professional treatment is received.
The Health Consequences of Alcohol
“Because their bodies have become sensitized to alcohol, once they have taken that first drink the tissues of the body cry out for more and more, until sufferers find that they cannot control the amount of alcohol consumed. – One drink is too many, a hundred, not enough.”
~ John G. Cooney, Under the Weather: Coping with Alcohol Abuse and Alcoholism
Alcohol use — even moderate drinking — takes a serious toll on a person’s physical and mental health. This is why experts recently established new guidelines recommending no more than one drink per day for anyone, man or woman.
- Nutritional deficiency — Alcohol abuse causes severe thiamine depletion
- Hormone imbalance — Low testosterone in men and elevated estrogen in women
- Digestive diseases — 21% of alcohol-related deaths
- Cardiovascular conditions — 19%
- Infectious diseases — 13%.
- Cancer — 13%.
- 40% of cirrhosis deaths and 36% of liver cancer cases are due to excessive drinking.
- Brain damage — “Wet Brain” syndrome
- Depression — Affects 2 out of 3 people with AUD
- Anxiety — 45%
- PTSD — 70%
- Bipolar Disorder — 60% of BPD patients abuse drugs and/or alcohol
- ADHD — 50% of ADHD patients have AUD
- Eating Disorders — Bulimics and anorexics are five times more likely to abuse substances as the general population.
- Schizophrenia — Greater than 1 in 3 patients struggle with diagnosable alcohol or drug problem before their very first psychotic episode.
- Obsessive-Compulsive Disorder — 1 in 4 OCD patients will have AUD at some point.
- Conduct Disorder — Among people diagnosed with conduct disorder, 65% of women and 78% of men will develop AUD.
The Impact of Opioid Use and Abuse
“One of the most heartbreaking problems I’ve faced as CDC Director is our nation’s opioid crisis. Lives, families, and communities continue to be devastated by this complex and evolving epidemic.”
~Dr. Thomas Frieden, former Director of the CDC
The opioid epidemic has captured the attention of both the government and the public. Because this is an enemy that does not respect boundaries of income, age, gender, race, or education every community in America has been impacted in some way.
- In 2018, opioids accounted for 69.5% of all overdose deaths.
- That equates to 46,802 fatal opioid overdoses.
- In addition, the CDC reports that 67% of those are from synthetic opioids such as fentanyl, or over 31,000.
- Assuming the same rates for last year, that means that in 2019, opioids in general and synthetics, in particular, killed 49,331 and 33,051 people, respectively.
Between 2018 and 2020, the opioid epidemic is expected to impact the American economy in the amount of $500 billion.
The Health Consequences of Opioids
“For many Americans, opioid misuse still feels like an abstract issue. They don’t really believe it will touch them or their family. These data show that’s likely not the case.”
~ Maureen Vogel, Spokeswoman, National Safety Council
Even without considering overdose, long-term painkiller or heroin use is associated with a long list of adverse health conditions. This is why prescribing guidelines mandate that opioids should only be given as a “last resort”, after other methods of pain management have proven ineffective. When they absolutely must be given, it should be for the lowest effective dose and the shortest duration possible.
- Brain damage similar to Alzheimer’s
- Accelerated and irregular heartbeat
- Heart infections
- Liver damage
- Hepatitis C
- Pulmonary edema
- Opioid-induced constipation
- Sexual dysfunction
- Hormonal imbalance
- Compromised immune system
- Increased risk of HIV infection
Dangers of Opiates
Like most drugs, opiates affect the body’s system much faster than alcohol. In a much shorter period, and if not carefully monitored, opiate users can become addicted. The addiction can be so strong; it can consume someone’s entire life. Recovery from opiate addiction is possible, but requires treatment, both for the physical addiction to opiates and mental counseling to prevent relapse. While many medical facilities only treat the physical dependency of opiate use, drug rehabs in Scottsdale AZ treat the entire individual.
Although the side effects of opiates differ from alcohol, their impacts are just as severe including:
- Respiratory failure
- Decreased heart rate
- Extreme drowsiness
- Low body temperature
- Decreased blood pressure
Opiates, like alcohol, can cause death after years of use. However, opiates can kill instantly if an individual overdoses. Consuming large quantities of alcohol is possible; however, injecting enough alcohol to cause death is extremely difficult. Opiates, on the other, are taken in very easy to consume pills or in other forms such as smoking or injection. Reaching lethal limits can occur quickly.
The Dangers of Polydrug Abuse
“Unfortunately, we’re seeing more fatalities and people in emergency rooms after having misused or abused legally prescribed opioids, like oxycodone, while having consumed alcohol.”
~ Dr. Albert Dahan, Leiden University
Obviously, abuse of either substance can result in serious health problems, and in many cases, they overlap and worsen the conditions. For example:
- More than half of all people who misuse prescription painkillers also engage in dangerous binge-drinking.
- In an IV heroin user with Hepatitis C who also has AUD, the risk of developing cirrhosis of the liver increases 100-fold.
- Men who abuse both opioids and alcohol can suffer from extremely low testosterone levels to the point of loss of body hair, low sperm count, erectile dysfunction, and even breast development.
- Compounded brain damage can lead to permanent cognitive or motor function impairment, causing permanent disability.
- In different ways, alcohol and opiates are known to harm the heart. Combining chronic drinking with long-term opioid use can lead to heart failure and premature death.
Those are issues associated with long-term concurrent use. But combining opioids and alcohol puts the user at an immediate risk of death or disability.
According to a report from the Department of Health and Human Services, when opioids are used with other central nervous system depressants, such as alcohol or . benzodiazepines, then their individual effects are magnified. For example, respiratory depression becomes cessation of breathing.
This loss of oxygen can lead to:
- Heart complications
- Kidney failure
- Nerve damage
- Neurological consequences
- Temporary paralysis
- Fluid build-up in the lungs
Significantly, oxygen deprivation may also lead to permanent brain injury:
- Short-term memory loss
- Cognitive impairment
- Changes in physical functioning
- Decrease involuntary muscle control, i.e., walking or picking up objects
- Slowed reaction time
- Speech problems
- Difficulty swallowing
- Irregular eye movement
- Random repetitive movement or speech
- Loss of bowel control
- Susceptibility to future overdoses
Double the Danger – Mixing Alcohol & Opiates
Alcohol mixed with opiates, including prescription medications such as hydrocodone, oxycodone, or morphine, is extremely dangerous. The threat of death is always present if the two are mixed. When combined, individuals may experience a myriad of side effects including:
- Cardiac arrest
- High heart rate
- Respiratory arrest
- Irregular heartbeat
- Low blood pressure
- Blood pressure spikes
- Cardiovascular fluctuations
Combining opiate use and alcohol often enhances the effect of one or the other. Those addicted to opiates are at a high risk of increased side effects and possible death. More frightening is how individuals who use opiates as prescribed, often are not aware of the compromising position they put themselves in should they also consume alcohol with it.
Mixing is Deadly Dangerous
The combination of alcohol and opiate use can be lethal. The external effects can increase the level of intoxication. This increase can lead to decisions an individual may have not made normally, such as driving or participating in hazardous activities. A single drink, while usually not concerning by itself, can lead to severe impairment when consumed while using opiates.
Inside the body, the layered effects of each substance combine to form a deadly combination. Opiates, by their very nature, are designed to reduce pain and stress levels within the body. When alcohol is consumed, its effects as a depressant are compounded. The breathing rate lowers along with circulation. The reduction of both reduces the amount of oxygen reaching the brain. Eventually, the brain is starved of the life-giving oxygen, dizziness sets in then unconsciousness. And, if not treated immediately, death can soon follow.
Continued after infographic:
Addiction is Addiction
“Alcoholism is an addiction – it’s just one type of addiction. When you break out the specific things that someone who is suffering from alcoholism contends with…they are no different from any other type of addict.”
~ Dr. John Sharp, M.D., Harvard Medical School and the David Geffen School of Medicine at the University of California Los Angeles
There is the mistaken assumption among some people that alcohol abuse is somehow “not as bad” as being dependent on heroin or opioid painkillers. But the truth is, all forms of Substance Use Disorder are incurable diseases that often prove fatal if not treated.
And in the specific case of alcohol and opioids, changes to the brain may happen sooner than you think:
- Recent research suggests that neurological impact supporting future alcohol abuse and addiction occurs after the very first drink a person takes in their life.
Dr. Dorit Ron, of the University of California, says, “Consuming alcohol for the first time is a learning event that drives further drinking.”
- Painkiller dependence can develop in just a few days. A person given a one-day supply has just a 6% chance of long-term use. But when they receive a month’s worth of opioids, 30% of patients are still taking them a year later.
- When taken intravenously, heroin’s effects are felt within seconds, possibly creating psychological dependence from that very first use.
All substances of abuse affect the brain’s reward pathways, and chronic or heavy usage can cause lasting impairment that “primes” the brain for addiction.
Treating Alcohol and Opiate Abuse
Individuals who abuse two or more substances have more challenges to overcome than those who rely on a single substance. Not only is it important to treat both the body physically, it is imperative treatment also includes mental rehabilitation involving counseling, goal setting, and support groups. Drug rehabs in Scottsdale AZ focuses on treating the individual as a whole, instead of just focusing on detoxifying the body.
For individuals using two substances, treatment is compounded. Detoxification requires professional assistance to ensure the body can withstand the withdrawal symptoms associated with both opiates and alcohol. Sufferers and their families need to carefully evaluate rehabilitation centers who can address two or more substance addictions, along with the ability to provide short and long-term treatment solutions.
Getting the Help You Need
“We have multiple drug problems in the US. We need to focus on more than one drug at a time.”
~ Dr. Keith Humphreys, Stanford University School of Medicine
It is hard enough to overcome any one SUD, but when you are struggling with multiple addictions, you definitely need specialized professional help if you are to safely and successfully regain your long-term sobriety.
If you live in Arizona, you can get the evidence-based treatment and support you need at SpringBoard Recovery. As one of the best outpatient alcohol and drug rehab programs in Scottsdale, SpringBoard uses a holistic approach that allows you to heal in mind, body, and spirit.
For more information or for a free confidential assessment, contact SpringBoard Recovery TODAY
What Types of Treatment are Available for Opiate and Alcohol Addiction?
If a person is addicted to both alcohol and opiates, they need to go to treatment in order to stop taking them safely. This will involve two different types of care, which are detox and rehab.
It is necessary to go through detox for both alcohol and opiates because they both can cause dangerous withdrawal symptoms. When a person is addicted to both of these drugs, they should expect to experience both types of symptoms.
Some of the more common alcohol withdrawal symptoms include:
- Feeling depressed.
- Getting anxious or nervous.
- Brain fog and the inability to think clearly.
- Feeling jumpy or shaky.
- Having mood swings.
- Having nightmares.
- Feeling irritable.
- Getting fatigued.
- Clammy, sweaty skin.
- Dilated pupils.
- Painful headaches.
- Loss of appetite.
- A rapid heart rate.
- Nausea and/or vomiting.
- Tremors in the hands and elsewhere in the body.
Some common opiate withdrawal symptoms include:
- Feeling anxious and agitated.
- Having muscle aches and pains.
- A runny nose.
- Excessive yawning.
- Excessive sweating.
- Abdominal cramps.
- Dilated pupils.
- Nausea and/or vomiting.
Also, please be aware that people who are addicted to alcohol could be at risk for delirium tremens when they stop drinking. This is a type of severe alcohol withdrawal that can be life-threatening if it is left untreated.
Some of the symptoms of delirium tremens include:
- A fever.
- Severe confusion.
- Hallucinations and delusions.
- Getting easily agitated.
- Having seizures.
How Many People in the United States are Abusing Opiates and Alcohol?
The statistics paint an interesting picture of how opiates and alcohol are abused in the United States today.
- The National Institute on Alcohol Abuse and Alcoholism reports that 88,000 people die from alcohol-related issues every single year.
- NIDA reports that around 130 people die in the United States each day because of overdosing on opiate or opioid drugs.
- The CDC stated that alcohol is involved in about 22% of deaths every year.
- It is involved in 19% of emergency room visits that also involved the misuse of opioid drugs.
- More than 50% of teenagers who misuse opioids have combined them with alcohol at least once.
- The journal, Anesthesiology reports that the combination of alcohol and Oxycodone leads to a significant increase in breathing problems. It is an effect that is much more pronounced in elderly individuals.
What Types of Respiratory Complications Can Result From This?
People who abuse both alcohol and opiates at the same time put themselves at risk for respiratory depression. While this can happen to anyone, it is especially problematic for the elderly population. According to Science Daily, taking even one Oxycodone tablet with a modest amount of alcohol could put someone at risk.
They cite one study in which researchers examined the effects of Oxycodone with alcohol in 12 healthy, young volunteers and 12 elderly volunteers. None of the participants had been taking the drug or they had never taken an opioid before.
Three separate times, the participants were given one 20mg tablet of Oxycodone with an intravenous infusion of ethanol. The amount of alcohol that was given was increased over time, and baseline measurements were taken at the beginning of the study. It was found that one tablet decreased ventilation by 28%. The addition of alcohol decreased it by another 19%. Participants experienced as many as 11 incidents of breathing cessation.
They concluded that there was a synergistic effect between opioids and alcohol on breathing. Elderly participants were much more likely to experienced stopped breathing.
- Google Books: https://www.google.com/books/edition/Under_the_Weather_Coping_with_Alcohol_Ab/BUt_BAAAQBAJ?hl=en&gbpv=1&dq=under+the+weather:+coping+with&printsec=frontcover
- CNBC: https://www.cnbc.com/2018/02/12/economic-cost-of-the-opioid-crisis-1-trillion-and-growing-faster.html#:~:text=Economic%20cost%20of%20the%20opioid%20crisis%3A%20%241%20trillion,from%202001%20through%202017%2C%20a%20new%20report%20says.
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- National Institute on Drug Abuse: https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/pdf/prescribing/AlcoholToolFactSheet-508.pdf
- American Society of Anesthesiologists: https://www.asahq.org/about-asa/newsroom/news-releases/2017/02/mixing-opioids-and-alcohol-may-increase-likelihood-of-dangerous-respiratory-complication
- Science Daily: https://www.sciencedaily.com/releases/2017/02/170207105306.htm