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What Happens When You Mix Heroin and Alcohol?

Heroin and alcohol are both highly addictive drugs.1 When combined, these two substances have a greater likelihood of causing numerous negative effects, including overdose, coma, brain damage, and death.2

Both heroin and alcohol are central nervous system (CNS) depressants that can significantly impact a person’s breathing and decrease their oxygen intake. In addition, consuming alcohol and heroin can lead to lowered heart rate and blood pressure, deep sedation, and coma. Because of their effect on the brain, the intoxication resulting from heroin and alcohol combinations can be markedly more intense and dangerous than using either substance on its own.2 

Mixing heroin and alcohol can raise the odds of a person experiencing adverse effects, including an increased risk of developing dependency, having various health complications, and causing fatal overdose.3  In fact, a vast majority of overdoses caused by heroin result from mixing the substance with depressants such as alcohol.4  

Heroin and alcohol combination effects

Is It Common to Mix Heroin and Alcohol?

The use of heroin and alcohol in combination is an increasingly common occurrence.5 According to the data from the Centers for Disease Control and Prevention, individuals who abuse alcohol are twice as likely to develop a heroin addiction in their lifetime. People who are addicted to either of these substances often start to mix with the other with the aim of increasing the sedative effects and achieving a more powerful high.6 

The Effects of Mixing Heroin and Alcohol 

Both alcohol and heroin have similar overall effects, since both are CNS depressants, although each of them affects different neurotransmitter systems. Heroin, on the one hand, affects the brain’s endogenous opioid receptors, while alcohol decreases the release of excitatory neurotransmitters and increases the effects of inhibitory neurotransmitters.7,8 When heroin is mixed with alcohol, the effects of each drug are enhanced, which can result in a variety of complications, including:9  

  • Increased physical effects. The effects of combining heroin and alcohol on the nervous system can result in significant decreases in heart rate, blood pressure, and breathing rate, substantial problems with motor coordination and balance, and extreme lethargy. 
  • Increased cognitive effects. Mixing alcohol and heroin can lead to a substantially slowed down rate of thinking, inhibition loss, decreased rational thinking ability, attention and concentration issues, new memory development, and a severe decrease in problem-solving abilities. 
  • Increased emotional effects. When the two substances are combined, the person may lose the ability to control spontaneous feelings (emotional inhibition loss), as well as experience heightened negative emotions such as sadness, depression, anxiety, and potential psychosis (delusions and/or hallucinations). 

Long-term Effects 

Using an alcohol and heroin mix on a regular basis can cause a variety of long-term effects. The potential for developing organ damage increases, both as a direct effect of mixing these drugs and the respiratory depression they cause. Here are some examples of long-term damage caused by using alcohol along with heroin:9 

  • Chronic hypoxia issues (decreased oxygen) leading to tissue damage to major organs, especially the brain. 
  • Heroin and alcohol increase the risk of developing liver damage resulting from cirrhosis. 
  • Decreased immune system efficiency can also occur, resulting in increased susceptibility to various infectious diseases. 
  • There is a heightened risk of developing other chronic conditions, such as cancer, kidney, cardiovascular, and gastrointestinal issues. 
  • The potential to develop a substance use disorder to one or both of these drugs is substantially increased in chronic heroin and alcohol users. 

What Are the Risks of Mixing Heroin and Alcohol?

When heroin and alcohol are consumed simultaneously, the double-depressant combination may lead to a variety of complications, as the effects of each drug become heightened.2

Increased Overdose Risk  

Using heroin and alcohol together is a deadly combination.3 In fact, data shows that combining two substances can significantly increase the risk of overdose. In particular, the statistics indicate the following: 

The higher potential for heroin and alcohol overdose can be attributed to the heightened effects of each drug and the respiratory depression symptoms that may occur. Mixing alcohol and heroin can cause irregular and shallow breathing, leading to decreased oxygen intake, lowered heart rate, and decreased blood pressure.2 

With regular use, heroin and alcohol can lead to long-term organ damage and possible death. Each of these depressants can cause an overdose on its own, but the risk is substantially increased when the substances are combined. Additionally, mixing these drugs can also lower the threshold at which a person can overdose on either drug.2 

Increased Risk of Injury 

Due to the detrimental effects of mixing alcohol and heroin on a person’s cognitive and emotional abilities, the likelihood of engaging in risky behaviors is increased.9 This may include activities such as needle sharing, engaging in criminal activities or becoming a victim of a crime, operating machinery, and developing suicidal ideation. Additionally, since opioids like heroin tend to have an inhibiting effect on the vomiting reflex, there is a higher risk of overdosing on alcohol or experiencing alcohol poisoning.14 

Detox Complications 

CNS depressants such as heroin and alcohol are associated with substantial psychological dependence. When an individual tries to stop using these substances, there is a risk of experiencing potentially life-threatening complications.15 

If a person’s brain has long been sedated by heroin and alcohol or other depressants, it may not be ready for their sudden removal. Withdrawal symptoms, such as seizures, anxiety, fever, shakes, hallucinations, heightened blood pressure, heart rate, and temperature, often develop as early as a couple of hours after the last dose of the drug was taken. These withdrawal symptoms can be severe and even life-threatening. Because of this, a slow and safe heroin and alcohol detox in a controlled environment is required.16 

How to Choose a Rehab Center That Treats Heroin and Alcohol Abuse?

If you are looking for heroin and alcohol treatment programs for yourself or a loved one, know that there are various options available for assisting you and your family with the problems you face.17 However, there are several factors that should be considered when choosing heroin and alcohol inpatient rehab centers: 

  • Types of treatment. The facility you choose should offer research-based heroin and alcohol treatment programs that include safe medically-assisted detox, comprehensive therapy, and aftercare planning.18
  • Accreditations. Good treatment centers for substance abuse are accredited by authoritative state and national organizations, such as CARF and the Joint Commission
  • Medical staff. In order to provide you or your loved one with adequate care, the treatment center should have a compassionate and experienced medical and psychiatric staff. 

The AAC Treatment Philosophy 

If you choose American Addiction Centers for heroin dual diagnosis treatment or any other of our substance abuse programs, you will be treated as much more than your addiction. It is our goal to treat the whole person and create a unique, constantly evolving treatment plan for each individual.

Our knowledgeable and compassionate team of doctors, counselors, and clinicians will work with you or your loved one throughout your recovery, addressing any co-occurring mental and physical health issues and other challenges unique to you. 

Frequently Asked Questions 

Does Heroin and Alcohol Cause Withdrawal Once Quit Cold Turkey?

After an individual stops using heroin and alcohol, they may experience intense and potentially life-threatening withdrawal symptoms such as anxiety, irritability, depression, severe cravings, nausea, headaches, and seizures. Additionally, withdrawing from alcohol and heroin can also lead to dehydration caused by diarrhea and vomiting.16 

These symptoms can be heightened when both substances are taken simultaneously and may be too overwhelming for the person to handle.2 Because of this, people often resume drug use in order to make these symptoms go away. What is more, when an individual stops using heroin and alcohol, their tolerance for the substance lowers, meaning that they will need less of the drug to get high. Unfortunately, this can increase the risk of overdose because the individual is not aware that their tolerance is lower than it used to be.2 

How Treatment Can Help 

The physical and psychological aspects of heroin and alcohol withdrawal can be too much for an individual to handle alone. This is particularly the case if the individual quits heroin and alcohol cold turkey without having adequate emotional support throughout the withdrawal process. In fact, about 40-60% of individuals addicted to illicit substances will relapse at some point due to the physical and psychological withdrawal symptoms.19 

Because of this, medically-assisted detox is often required to reduce the symptoms of withdrawal and ensure a safe detoxification process. Additionally, the staff at a treatment facility will also help the person deal with the difficult emotions involved in heroin and alcohol withdrawal, reducing the risk of relapse.16 

Do Dual Diagnosis Treatment Centers Cover Heroin and Alcohol Addiction?

Dual diagnosis treatment, also known as co-occurring disorder treatment, is the suggested approach for individuals who meet the criteria for one or more substance use disorders along with being diagnosed with one or more mental health conditions.18 Integrated co-occurring treatment programs are designed to address the symptoms caused by SUDs and mental illnesses simultaneously. Since it provides comprehensive care tailored to the unique needs of the individual, this approach to treatment has been linked with various positive outcomes.20 

Treatment centers that offer treatment for heroin and alcohol abuse often provide personalized programs that also treat any identified co-occurring mental health conditions. An individual who has chronically abused alcohol and heroin should have access to research-based withdrawal management programs, medical management of physical and psychiatric issues, comprehensive therapy, and carefully planned aftercare. An integrated dual diagnosis approach can decrease the risk of relapse and help the individual achieve long-term recovery.21  

What Is the Length of Heroin and Alcohol Treatment Programs?

The duration of heroin and alcohol treatment programs depends on several factors unique to the individual, including the severity of their addiction, their recovery environment, and any behavioral and emotional complications. There is no single formula for heroin and alcohol treatment, as each individual is unique. Overall, however, research shows that longer treatment lengths tend to result in better long-term outcomes in recovery.18 

Which Heroin and Alcohol Rehab Programs Are Best?

Dealing with heroin and alcohol addiction can be fatal without appropriate help. Because of this, finding a treatment program that includes safe medical detoxification, behavioral therapy, group therapy, and post-treatment support can be essential for achieving lasting sobriety.18  

If you have established that you or a loved one is dependent on alcohol, heroin, or both, you’ve taken the first step to recovery. The next step is to find a treatment facility that can provide individualized care designed to address the difficult physical and psychological effects of heroin and alcohol addiction. A compassionate, research-based treatment approach can enable you or someone you love to look forward to lasting recovery and a more hopeful future. 


  1. National Institute on Drug Abuse. (2020). Other Commonly Used Addictive Substances
  2. Singh A. K. (2019). Alcohol Interaction with Cocaine, Methamphetamine, Opioids, Nicotine, Cannabis, and γ-Hydroxybutyric Acid. Biomedicines, 7(1), 16. 
  3. Hickman, M., Lingford-Hughes, A., Bailey, C., Macleod, J., Nutt, D., & Henderson, G. (2008). Does alcohol increase the risk of overdose death: the need for a translational approach. Addiction (Abingdon, England), 103(7), 1060–1062. 
  4. Centers for Disease Control and Prevention. (2021). Other Drugs
  5. Karjalainen, K., Kuussaari, K., Kataja, K., Tigerstedt, C., Hakkarainen, P: Measuring Concurrent Polydrug Use in General Populations: A Critical Assessment. Eur Addict Res 2017;23:163-169. 
  6. Centers for Disease Control and Prevention. (2015). Today’s Heroin Epidemic.
  7. Le Merrer, J., Becker, J. A., Befort, K., & Kieffer, B. L. (2009). Reward processing by the opioid system in the brain. Physiological Reviews, 89(4), 1379–1412. 
  8. Valenzuela C. F. (1997). Alcohol and neurotransmitter interactions. Alcohol Health and Research World, 21(2), 144–148.
  9. Blum, K. (2012). Alcohol and Opiates: Neurochemical and Behavioral Mechanisms. New York (US): Academic Press. 
  10. U.S. Department of Health and Human Services (HHS). (2016). Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. 
  11. National Institute on Drug Abuse. (2020). Opioid Overdose Crisis.
  12. Centers for Disease Control and Prevention. (2015). Alcohol Poisoning Deaths
  13. Jones, C. M., Einstein, E. B., Compton, W. M. (2018). Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA, 319(17):1819–1821. 
  14. National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding the Dangers of Alcohol Overdose.
  15. National Institute on Drug Abuse. (2018). Prescription CNS Depressants DrugFacts
  16. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. 4, Withdrawal Management. Geneva: World Health Organization.
  17. Substance Abuse and Mental Health Services Administration. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Chapter 4, Early Intervention, Treatment, and Management of Substance Use Disorders. Washington (DC): US Department of Health and Human Services. 
  18. National Institute on Drug Abuse. (2020). Principles of Effective Treatment
  19. National Institute on Drug Abuse. (2020). Treatment and Recovery
  20. National Institute on Drug Abuse. (2018). Comorbidity: Substance use and other mental disorders.
  21. Kelly, T.M., & Daley, D.C. (2013). Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health, 28(3-4), 388-406.

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