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Heroin and Alcohol
Author: Phil Kosanovich
Published: October 20, 2022
Heroin and Alcohol

We will discuss how heroin and alcohol work and the increased risk of overdose and other health factors when you mix the two. We will also discuss why people mix them and factors which put you at risk of developing a substance use disorder. Finally, we will discuss the recovery process and treatment options available.

What is Heroin?

Heroin is a semi-synthetic opioid drug which means that it is synthesized from a naturally occurring opioid. In the case of heroin, it is synthesized from morphine, which is extracted from opium poppy seeds. Heroin enters the bloodstream directly by injection, by crossing through the lungs if smoked, or through the gut wall if ingested.

It crosses the blood-brain barrier rapidly, quicker than morphine which is why it is more addictive and dangerous. Once in the brain heroin is metabolized into morphine which acts on opioid receptors. By acting on these receptors, heroin causes feelings of euphoria, disassociation from physical and emotional pain, and relaxation.

Heroin and Drug Abuse in the USA

Heroin is a Schedule I controlled substance which means that it has a high potential for abuse and for physical and psychological dependence to develop. Unlike morphine, it is not considered to have any medical use. This means that there is no legal way to produce, sell, buy, or possess heroin. When pure it is a white powder, but it can also be brown depending on impurities. For example, heroin is commonly mixed with baking soda or quinine, as well as other drugs such as fentanyl and crack cocaine.

In 2017, the Department of Health and Human Services announced an opioid crisis in the US in response to the rising number of opioid-related deaths. This was in part fuelled by the increasing amounts of synthetic opioids produced by pharmaceutical companies. Some people feel that the dangers and addictiveness of these prescription drugs were not made clear enough. While synthetic opioids such as fentanyl are the biggest worry in the opioid crisis, heroin is also responsible for many deaths, and the risk increases when you mix it with alcohol.

What is Alcohol?

Alcohol is a psychoactive drug that is commonly consumed across the US. In the 2019 National Survey on Drug Use and Health, two-thirds of Americans reported drinking alcohol in the last year, twenty-five percent reported binge drinking in the last month, and six percent reported consistent excessive drinking in the last month.

When you drink alcohol it also enters the brain through the blood-brain barrier. It works by increasing the activity of gamma-aminobutyric acid (GABA) which is the main inhibitory neurotransmitter in the nervous system. Like heroin, this causes depression of the nervous system which is why a lot of alcohol can cause sedation. In addition, alcohol causes the increased activity of dopamine and endogenous opioids causing feelings of happiness and relaxation.

Substance Abuse

Substance Abuse

Both heroin and alcohol have the potential for causing dependence and addiction to develop, though heroin carries a higher risk. As mentioned, alcohol consumption is seen as socially acceptable, in fact it is often seen as the social norm and some people may even experience peer pressure to drink.

Many people will start drinking alcohol when they are teenagers and this may increase as they reach their late teens and early twenties. While many people will be able to drink frequently and even heavily without developing dependence or addiction, others will not. Depending on your personal risk factors, alcohol abuse can quickly lead to dependence and addiction.

Heroin use is not generally seen as socially acceptable, and it is not a common drug for teens to experiment with. However, most people who use heroin report to have started by using prescription drugs. When they are unable to get the quantity they want or need by prescription, they often move on to other drugs such as the cheaper and more accessible opioid, heroin.

Alcohol or heroin dependence tends to start with alcohol abuse, as your tolerance increases you need to take higher quantities to achieve the same effects. Dependence occurs when your body and brain think that they cannot function normally without the substance. When you stop taking it you experience extremely unpleasant and potentially fatal withdrawal symptoms.

Alcohol or heroin addiction is usually close behind. The National Institute on Drug Abuse defines addiction as the compulsive seeking out and taking of the substance to which you are addicted. Addiction is a brain disease but is sometimes treated as a moral or personal failing. This is due to the stigma which surrounds substance use and addiction. One of the biggest barriers to seeking treatment comes from this. Is leads to underfunding of addiction treatment services as well as shame about seeking support.

Risk Factors for Addiction

Addiction is not simply a matter of taking the most addictive substances and being hooked. Some people will be able to try heroin and never take it again while others will take it once and never stop. To treat addiction as simply a matter of abstaining from particular substances would be to simplify the underlying causes of it. You can also become addicted to behaviors such as shopping, sex, or eating sugar. So why do some people develop addictions and others do not?

There are particular risk factors that increase your chances of developing an addiction. These include:

  • Genetics – according to the National Institute on Drug Abuse, genetics accounts for up to half of your risk for developing an addiction
  • Mental health – some people will use substances to ease symptoms of mental health problems such as anxiety, depression, or PTSD
  • Childhood abuse such as neglect or assault – being traumatized can affect your mental health and lead to unhealthy coping mechanism
  • Exposure to substances – family or friends using substances around you increases your risk of developing an addiction
  • Previous substance use disorder
  • Prescription of opioids

Signs of Addiction

Recognizing the signs of addiction can help you get support or support a loved one. Common symptoms of addiction include:

  • Obsession with getting your next dose or drink
  • Losing control over substance use
  • Losing interest in activities that were once enjoyable
  • Secretiveness
  • Withdrawing from family and friends
  • Neglect of personal hygiene and self-care
  • Lowered inhibitions
  • Neglecting responsibilities at school, work, or in the home

Mixing Heroin and Alcohol

People tend to mix drugs to either enhance the effects of one or to balance the unpleasant side effects of one. Those who mix substances will often have been using one of them for a while. For example, you may have an alcohol use disorder and as time goes on you feel you need more to get the same feeling you used to and therefore mix heroin with alcohol. However, this can be a dangerous mix. Mixing the two can cause the depression of some bodily functions to the point where they no longer function.

Effects of Mixing Heroin and Alcohol

While different people will experience different effects when mixing the two substances here are some common symptoms:

  • Nausea and vomiting
  • Shakes and tremors
  • Poor coordination
  • Decreased blood pressure and heart rate
  • Shallow breathing
  • Loss of consciousness

These symptoms are not always dangerous or fatal, however, it is very hard to predict the outcome when you are mixing substances. In addition, the more you take them and mix them, the more at risk you are of developing more severe problems. We will discuss some of these.

Physical and Mental Health

Harmful use of alcohol can cause more than two hundred diseases and injury conditions according to the World Health Organization (WHO). These include liver and cardiovascular diseases, particular cancers, mental health conditions, and behavioral disorders. If you also mix alcohol with heroin this increases your risk.

Heroin puts additional strain on your respiratory system which can lead to irregular breathing, reducing the quantity of oxygen reaching your organs and therefore causing organ damage. Since it also affects the heart, it may also increase your risk of developing cardiovascular diseases.


As mentioned, having a previous substance use disorder increases your risk of developing an addiction to a different substance. Mixing alcohol and heroin can increase your risk of developing an addiction to one or both substances. Someone who has an addiction to heroin may use alcohol to increase the effects of heroin, but this will in turn increase the risk of them developing an additional addiction and dependency to alcohol.


Mixing substances significantly increases your risk of overdosing. If you are used to taking certain quantities of one of the substances and mix this quantity with another drug this intensifies the sedating effects of both. Therefore, your usual dose of heroin mixed with drinking alcohol may lead to an overdose and vice versa. Mixing substances can not only increase the effects of heroin but can also lead to unpredictable effects, therefore, each time you mix you risk having unexpected side effects.

Due to it being an unregulated substance, it is impossible to know the strength of the heroin you are buying or whether it has been mixed with other substances unless you can test each sample. It is common for heroin to be mixed with other drugs such as baking soda, fentanyl, and ketamine. This can be dangerous in terms of not knowing the dose of heroin you are taking but also because you may be taking substances you are not aware of.

For example, if you are used to taking heroin that is not pure due to being mixed with substances like baking soda and you then take a particularly pure dose, this could increase your risk of an overdose. If it has been mixed with something like fentanyl, one of the most potent synthetic drugs, you may overdose due to the potency of this drug.

Heroin overdoses account for nearly twenty percent of opioid deaths which put the number of heroin-involved overdose deaths at 13,000 in 2020. This is seven times higher than heroin-related overdoses in 1999.

Signs of an Overdose

  • Bluish lips and fingertips
  • Clammy skin
  • Vomiting
  • Irregular heart rate
  • Respiratory depression and respiratory failure
  • Extreme drowsiness
  • Loss of consciousness

If you see someone experiencing an overdose you should call 911 for emergency assistance immediately. You should put the person in the recovery position while you wait for them to arrive so that they cannot choke if they vomit.



If you or a loved one has been mixing alcohol and heroin and you wish to stop, you should be aware of the withdrawal process and how to make it as safe as possible. Both alcohol and heroin can cause physical and psychological dependence which can cause extremely unpleasant symptoms and even death. Treatment centers are equipped to help mitigate many of these symptoms. They include:

Physical Symptoms

  • Nausea and vomiting
  • Diarrhea
  • Chills
  • Muscle spasms
  • Stomach pain and cramps
  • Muscle and joint aches and pains
  • Increased heart rate
  • Insomnia
  • Seizures
  • Delirium tremens (specific to alcohol withdrawal)

Psychological Symptoms

  • Restlessness
  • Anxiety
  • Depression
  • Hallucinations
  • Cravings

Acute Withdrawal

You will start to experience withdrawal symptoms when the concentration of the substance or substances to which you are addicted blood decrease below what is normal for you in your blood. Symptoms will usually start within twenty-four hours of your last dose or drink. They increase in intensity over the first few days peaking at about day three to four and then decreasing. For most people, acute withdrawal will end after about seven to ten days

However, withdrawal is different for everyone. Some people may find that acute withdrawal lasts for ten days or even more, and some may find that it lasts for five days. Factors that affect how long or intense withdrawal will include:

  • Which substance you use
  • How long you have been using it, as well as the quantity and frequency of your doses or drinks
  • Individual factors such as genetics, weight, metabolism, and physical and mental health

Post-Acute Withdrawal

Following acute withdrawal, some people will experience post-acute withdrawal symptoms. These are typically a continuation of psychological symptoms such as anxiety, depression, and/or cravings. It is more likely that you will experience this if you have been taking substances heavily or for a long time. Post-acute symptoms can last for weeks or even months, so it is important you have a good support network and professional medical care to help you through this.

Addiction Treatment

The first step to addiction treatment is detox which is when you will experience acute withdrawal symptoms. This is where the body gets rid of the toxins of the substance and deals with no longer having the substance it feels it needs. Withdrawing from both alcohol and heroin can be very difficult and even fatal so it is recommended that you seek professional treatment advice before you detox, especially if you have been mixing substances.

Treatment Options

There are two main ways to detox, tapering or all at once. Tapering is where you reduce the amount of the substance you are taking until you are no longer taking any. This is often combined with a substitute drug, taking something which acts in a similar way to the substance you have been using so that your body and brain are less shocked by stopping and withdrawal symptoms are less intense. In contrast, some people also stop taking the substance in one go. This is not recommended for alcohol and heroin withdrawal due to the dangers associated with it.

Most addiction treatment centers will offer both inpatient and outpatient rehab. With inpatient care, you receive twenty-four-hour observation and care so that your withdrawal symptoms and comfort can be tended to as they occur. If you have any particularly negative withdrawal symptoms a medical professional will be able to make sure that you are treated. With outpatient treatment, you remain at home but go to the treatment facility in the days or evenings. You may still be given medication to deal with withdrawal symptoms and you will have a twenty-four-hour phone number if you have any problems. Common medication you might be prescribed include:

  • Benzodiazepines (for alcohol withdrawal) – like alcohol, act by increasing the activity of GABA in the brain which can help to reduce withdrawal symptoms. Since benzodiazepines are also addictive you should be tapered off them quickly.
  • Methadone (for heroin withdrawal) – is an opioid and is very effective at preventing heroin withdrawal symptoms. Since it is also addictive it is also an opioid it can be difficult to taper off it when treatment is over, and it allows carries the risk of overdose.
  • Buprenorphine (for heroin withdrawal) – blocks the effects of other opioids and can be injected once a month so that you do not need to take frequent tablets. A downside of it is that you may still experience withdrawal symptoms when you first start taking it. However, it is less likely to cause an overdose and is easier to taper off at the end of treatment.

Since withdrawing from alcohol and heroin can be dangerous, it is generally recommended to undergo inpatient care. This also decreases your risk of relapsing which may be tempting when you are suffering from withdrawal symptoms. However, some people are not able to get the time off work or other responsibilities so will need to take part in outpatient care. Either way, having the support of a certified addiction professional can make all the difference.

Get Support Today

Accepting you have an alcohol or drug addiction can be very difficult due to the shame and stigma which surrounds addiction. At Cornerstone, we understand this struggle and we are here to make the process as easy as possible for you. We know that the recovery journey is different for everyone and therefore offer a wide range of treatment options so that your treatment program can be tailored to your individual needs.

If you are mixing heroin and alcohol this may make recovery more difficult. As professional treatment providers, we focus on creating a strong basis for recovery so that you stand the best chance of long-term recovery. Part of this is working through the reasons for your substance use whether that is an underlying mental health condition or previous trauma. Our treatment options include:

  • Medically supervised detox
  • Individual and group therapy
  • Educational seminars
  • 12-step program support groups
  • Relapse prevention
  • Aftercare

You can find out more by visiting our website or calling us on 800-233-9999. We offer a free consultation and insurance verification service so that you can make sure you are covered before you commit to treatment.