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Alcohol is commonly used at the same time with over-the-counter medications, prescription drugs, and illicit drugs. However, doing so can have unpredictable and unwanted consequences — and some of these are extremely dangerous. Here’s a brief description of the general effects that can occur by combining alcohol and various classes of drugs.

Alcohol and antidepressants

Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, as well as other conditions. An increasing number of people are turning to such drugs. According to the Centers for Disease Control and Prevention (CDC), the percentage of people aged 12 years and over using antidepressant in the United States rose from 7.7 percent in 1999-2002 to 12.7 percent in 2011-2014.

There are many classes of antidepressants and the effects of the use of alcohol, also known as ethanol (ETOH), in conjunction with these drugs will depend on their class.

Generally, the symptoms of using alcohol in conjunction with most antidepressant drugs include:

• Inhibiting the medicinal effect of the antidepressant drug (Zoloft, Prozac, Lithium, etc.);
• Drowsiness, dizziness, and even an increase in depression; alcohol itself is a depressant and can exacerbate the symptoms of the condition.
• Amplification of alcohol’s effects, particularly on motor function, coordination, and reduced reaction time.
• Increase potential for damage to organs, such as the liver.

Alcohol and medication for diabetes

There are various prescription medication designed to control diabetes, such as insulin for type I diabetes and metformin for type II diabetes. Drinking alcohol in such a situation can lead to all sorts of serious consequences due to the high sugar content of many alcoholic beverages. When combined with diabetes medication, alcohol can lead to effects such as:

• Rapid heartbeat and increased blood pressure;
• Fatigue, weakness, dizziness, headache, nausea, and/or vomiting;
• Potentially dangerous alterations in blood sugar levels;

Alcohol and opiates

The most dangerous combination of alcohol and drugs is with opiates, such as heroin or painkillers.

Opiate painkillers like OxyContin, Hydrocodone and Vicodin depress the central nervous system to dampen pain, as well as inhibit breathing. When mixed with alcohol, the risk of overdose spikes. About 22% of prescription painkiller fatalities involve alcohol.

Alcohol and stimulants

While alcohol suppresses the functions of the central nervous system (CNS), there are numerous drugs that stimulate CNS functions. Some examples of such stimulants include:

• Amphetamines;
• Prescription medications for the treatment of ADHD (attention deficit hyperactivity disorder), such as Ritalin and Concerta (methylphenidate) or Adderall (amphetamine and dextroamphetamine);
• Caffeine and several drugs classified as antihistamines or decongestants;
• Illicit drugs, particularly cocaine and methamphetamine (crystal meth).

People mix alcohol with stimulants in order to ‘take the edge off’ of the stimulant. This practice is particularly common among college students who abuse ADHD medication to help with studying and people who use cocaine at parties. The main problem is that stimulants conceal the effects of alcohol, which means people can no longer gauge their level of intoxication, leading to overconsumption. Some common problems associated with mixing stimulants and alcohol include:

• The effects of stimulants are negated by alcohol.
• Taking stimulants and alcohol in combination leads to a significant reduction in the overall effects of both drugs. This makes it easier to overdose on one or both drugs.
• Higher risk of developing seizures, psychotic behavior, hallucinations, or delusions.
• Emotional problems, such as increased symptoms for depression, anxiety, loss of motivation, etc.
• Damage to organs such as the liver, gastrointestinal system, and cardiovascular system if alcohol and stimulants are mixed chronically.

Alcohol and over-the-counter medication

Just because some medication doesn’t require a prescription, that doesn’t make it harmless. Tylenol, for instance, contains acetaminophen which can cause liver damage if a user takes too much or combines it with alcohol. Other medications, such as cough syrup and laxatives, already contain as much as 10% alcohol, which can interact with just a drink or two.

In conclusion, the safest thing is to avoid combining drugs and alcohol. Always contact your doctor or local pharmacist before you mix any kind of drugs, legal or not, with alcohol.