Understanding polysubstance use: What happens when alcohol + opioids go together?

People addicted to alcohol are more likely to also become dependent on other substances, such as opioids. Understand polysubstance use disorder and its risks.

Ophelia team
Alcoholic and narcotic substances
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Arthur Robin Williams, MD

Alcohol use is widespread in public life—think about how many ads you see for beer and liquor or how common it is to see TV and movie characters unwinding with a glass of wine—but it’s not without its risks. According to the Centers for Disease Control and Prevention (CDC), nearly 400 people die each day from excessive alcohol use in the U.S., and many more become victims of alcohol-related incidents, such as car accidents. It is also highly addictive, and those who develop a reliance on alcohol are more likely to also become dependent on other substances, like opioids. This is known as polysubstance use disorder, and it poses a number of increased risks.

How opioids and alcohol are linked

For most people, alcohol use starts out as a minor act that may not seem concerning to the person or their family and friends. Use tends to get heavier or more frequent in response to stress or other negative emotions, which can encourage a habit and association to begin forming.

Over time, alcohol use can become more noticeable and increasingly destructive or dangerous. Opioid use disorder generally follows the same pattern and develops from similar stimuli. 

Unfortunately, the nature of addiction makes a person more likely to misuse additional substances, and opioids are a common drug of choice for those who already have a drinking problem. Alcohol misuse can increase the likelihood of other risky behaviors, so people who drink heavily are more susceptible to being pressured into other harmful habits, including using opioids. Without a comprehensive social support network, this can quickly lead to polysubstance use disorder. 

Another factor that leads to overlapping and related addictions is the similarity of the drugs’ effects. Opioids and alcohol are commonly associated or used together because both substances are depressants. This means they cause a person’s body to slow down and reduce activity. In opioid use, this depression is most noticeable in a person’s breathing, which slows significantly during use.

Risk factors of polysubstance use disorder

Among certain groups, rates of polysubstance use disorder are much higher than others; knowing if you or your loved ones are at extra risk can help prevent misuse altogether or catch signs of it earlier. The demographics at the highest risk for polysubstance use disorder are similar to people who are generally at risk for opioid misuse: younger people with lower levels of education, employment, and income. Disabilities and mental health conditions can also be risk factors.

People who fit into more than one of these demographics may have an even higher risk of substance use disorders. Additionally, those who binge drink or are in proximity to binge drinking are more likely to use other substances as well, leading to further risk. 

Opioid and alcohol use’s effect on your health

Individually, opioids and alcohol cause significant damage to the body over time. Alcohol is particularly damaging to a person’s liver, and opioids have been shown to cause cardiac damage in the long term. When used together, these substances can accelerate damage to these critical organs. Health problems in the liver can complicate problems that may develop in the heart and vice versa. 

However, long-term problems aren’t the only worry with polysubstance use disorder. Opioids and alcohol have compounding side effects when used together, and the result can be dangerous or even deadly. As a depressant, opioids cause a person’s breathing and heart rate to slow down considerably as part of the high. Alcohol, another depressant, can further suppress respiratory and cardiac activity. In extreme cases, this leads to overdose, during which the person’s heart or breathing stops. 

Opioid-related overdoses are responsible for over 1,000 emergency room visits and more than 90 deaths per day. Adding alcohol to the situation is a recipe for disaster.

Evidence-based treatment for substance use disorder

If you or a loved one are experiencing polysubstance use disorder, seeking treatment as soon as possible can save a life. Medication-assisted treatment (MAT) is designed to help curb cravings and alleviate withdrawal symptoms. Ophelia uses a virtual clinical model to get people the medication and support they need without the barriers of traditional rehabilitation. Learn more about our process and find out if you’re a candidate for treatment.


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