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Mixing Heroin & Alcohol: A Deadly Combination

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Nov 22, 2023 • 9 cited sources

Heroin and alcohol are central nervous system depressants. They slow breathing and heart rate, placing users in a sedated state. When used independently, these substances can cause death via overdose. When mixed, they are even stronger and more deadly. 

Researchers say about one in seven deaths tied to opioids like heroin also involve alcohol.[1] Many people believe they can mix these substances without consequence. But as the stats prove, mixing can lead to quick overdose deaths. 

What Is Heroin?

Heroin is an illicit opioid drug made from seed pods of opium plants. Dealers sell heroin as a white or brown powder, or they provide a black-tar version that’s sticky and very dark.[1]

Most heroin users inject the drug by mixing powder with water and shooting the substance into their veins with needles.[1] But heroin powder can be sniffed or snorted. And some people sprinkle the drug on tobacco and smoke it. 

Common Heroin Side Effects

Heroin produces intense effects. Opioid receptors are located in the brain, brain stem, gut and other areas of the body. Every time a person uses heroin, drug molecules bond to these receptors and trigger side effects. 

When heroin latches to receptors in the brain stem, sedation of the following critical processes begins:[3]

  • Breathing: Breaths become shallow, slow and irregular. As oxygen levels drop, lips and fingertips may change color. 
  • Blood pressure: The heart muscle relaxes, so it doesn’t beat as often or as hard. A person’s pulse may seem shallow or faint. 
  • Arousal: As brain cells are deprived of oxygen and overpowered with sedation, the person slips into a deep sleep. 

Some people awaken from these episodes feeling sleepy and groggy. But others take too much heroin and never wake up. 

People who keep using heroin may become physically and mentally dependent on the substance. Researchers say about 23% of people who use heroin become addicted to the drug.[3] Chronic users can develop side effects like collapsed veins, liver disease, kidney disease or heart infections.

What Happens When You Mix Heroin & Alcohol?

Heroin and alcohol are central nervous system depressants. Mixing them can mean overwhelming your body with sedation, leading to an overdose. 

Researchers say mixing these drugs can produce profound respiratory depression.[4] You’ll breathe so slowly and shallowly that your brain cells don’t get enough oxygen. As brain cells die, the rest of the body shuts down too. 

People who combine drugs are also at a higher risk of severe substance dependence.[5] Mixing alcohol and heroin can lead to significant brain cell changes, moving your use from voluntary to compulsive.[6] While anyone can get addicted to either heroin or alcohol, mixing the substances accelerates the addiction process and can make recovery harder. 

Researchers also say that people who mix drugs have a greater risk of co-occurring psychiatric disorders, such as depression or anxiety.[5,7-9] It’s not clear if these underlying conditions cause substance use or if substances spark these illnesses. But continued drug use can worsen your mental health. 

The Dangers of Mixing Heroin & Alcohol 

Using alcohol and heroin together is never smart, but alcohol can lower your decision-making ability and make heroin seem safe. Researchers say people who binge drink are four times more likely to use other substances than those who don’t drink.[1] Those who mix substances can face serious consequences. 

Common side effects of mixing alcohol and heroin include the following:[1]

  • Slow breathing: Mixing central nervous system depressants like alcohol and heroin can slow your breath to life-threatening levels. 
  • Organ damage: Slow breathing accompanied by drug-related toxins can harm your brain and heart. Some of the damage may be irreversible. 
  • Overdose: Combining these two substances can lead to life-threatening sedation and death. You may be unable to spot signs of overdose since one substance may mask some of the symptoms of the other.
  • Injury: Severely sedated people can fall, get into accidents or otherwise harm themselves due to a lack of muscle control. 
  • Violence: Both heroin and alcohol can lower inhibitions, making a bad mood easier to act upon. 
  • Risky sexual behavior: Alcohol and heroin can make unprotected sex with strangers more likely, or people can be assaulted while they’re passed out. 
  • Chronic disease: Substance use can lead to significant and long-term problems like hepatitis, AIDS or kidney disease. 

No one should mix these two drugs. It’s just not safe. 

Getting Treatment for Heroin & Alcohol Addiction

Alcohol and heroin can alter brain chemistry, making cells function “normally” when the addictive substance is present. When you try to quit, you can feel sick and overwhelmed with cravings for both substances. Treatment can help. 

Opioid use disorders related to heroin use respond to Medication for Addiction Treatment (MAT) programs. Doctors use medications like Suboxone to smooth chemical imbalances, reduce withdrawal symptoms and lessen opioid cravings. With this treatment, people can quit using heroin safely and participate in building a sober life. 

Bicycle Health offers Suboxone therapy across the United States via telemedicine. You can easily work with a provider in safe and private video appointments. You’ll then pick up your prescription at a nearby pharmacy, and check in with your doctor regularly regarding your progress. 

Telemedicine offers a discrete solution to addiction treatment. People in your life, like your boss or coworkers, don’t have to know you’re working on your recovery. But you’ll get better every day.

If you’re struggling with heroin use or any opioid use disorder, contact us at Bicycle Health. We can determine if this model of care is right for your needs. 

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Alcohol and other substance use. Centers for Disease Control and Prevention. Published July 25, 2022. Accessed October 29, 2023.
  2. Heroin drug facts. National Institute on Drug Abuse. Published December 2022. Accessed October 29, 2023.
  3. Heroin: Information for behavioral health providers in primary care. Department of Veterans Affairs. Published July 2013. Accessed October 29, 2023.
  4. Witkiewitz K, Vowles KE. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clinical and Experimental Research. 2018;42(3):478-488. d 
  5. Arias AJ, Kranzler HR. Treatment of co-occurring alcohol and other drug use disorders. Alcohol Research & Health. 2008;31(2):155-167. 
  6. The neurobiology of substance use, misuse, and addiction. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. U.S. Department of Health and Human Services. Published November 2016. Accessed October 29, 2023. 
  7. Kelly BC, Parsons JT. Predictors and comparisons of polydrug and non-polydrug cocaine use in club subcultures. The American Journal of Drug and Alcohol Abuse. 2008;34(6):774-781. 
  8. Bonfiglio NS, Portoghese I, Renati R, Mascia ML, Penna MP. Polysubstance use patterns among outpatients undergoing substance use disorder treatment: A latent class analysis. International Journal of Environmental Research and Public Health. 2022;19(24):16759. 
  9. Mohamed II, Ahmad HEK, Hassaan SH, Hassan SM. Assessment of anxiety and depression among substance use disorder patients: a case-control study. Middle East Current Psychiatry. 2020;27(1). 

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