Reading Time: 9 minutes
The combination of Xanax and alcohol creates a risk of short-term side effects and can increase your risk for major long-term side effects, including depressed cardiac and respiratory functions. Whether you take your prescription Xanax unthinkingly after a night out with friends or have ever intentionally used Xanax and alcohol together, mixing the two substances can also lead to overdose, coma, or other life-threatening outcomes.1
Why Do People Mix Xanax and Alcohol Together?
Xanax (alprazolam) and other benzodiazepines are prescribed to relieve acute anxiety symptoms or help regulate sleep. 2 Individuals who have a prescription for Xanax may not realize the potential effects of mixing drugs and alcohol, since these effects can occur even when the medication and alcohol are consumed at different times.
One year-long study suggests that there may be a correlation between filling long-term, daily-use benzodiazepine prescriptions and “unhealthy alcohol use.” Researchers noted that men under 65 who had 15 or more drinks a week, and women and men over 65 who had eight or more drinks a week were 15% more likely to use daily benzodiazepines than individuals with moderate alcohol use habits.2 It is unknown if the prescribers were aware of the patients’ alcohol use or if the individuals studied had been made aware of the effects of mixing drugs and alcohol in this way. The study does not make conclusions about which patients, if any, were intentionally misusing their prescriptions.2
While Xanax is a common prescription for anxiety disorders and insomnia, some individuals use theirs or other individuals’ prescriptions for recreational purposes. Xanax depresses the central nervous system rapidly by attaching to the GABA receptors in the brain, reducing heart rate, respiration, blood pressure, and body temperature to counter the high brain activity associated with irrational anxiety symptoms, stress, racing thoughts, and so on. Xanax works more quickly than many benzodiazepines, reaching peak concentration in the body within one to two hours.3
When the brain activation associated with anxiety and insomnia is not present when a person takes Xanax, they may feel profound sedation, relaxation, or euphoria caused by the medication-induced chemical imbalance in the brain.4
Risk Factors for Polysubstance Use
Anyone can develop substance abuse, including polysubstance—or multiple substance—misuse. However, an increased risk of developing a habit of intentional substance abuse is associated with certain factors, including:5
- Underlying medical issues, such as untreated anxiety or chronic pain
- Exposure to substance use in your childhood home, your friend group, or where you live currently
- Previous substance use, especially in adolescence or childhood when the brain is still developing
- A history of trauma, food or housing instability, social stress, or abuse
- Substance abuse in your immediate family, which may have led to those behaviors being modeled to you as normal or may indicate genetic influence that would make you more susceptible to developing physical dependence and addiction
What Are the Side Effects of Mixing Xanax and Alcohol?
While Xanax and benzodiazepines can be useful for managing certain conditions, they can have unwanted side effects. These effects are more likely to occur with frequently daily use that lasts over a long period of time, but can occur even when following your prescription. Some of these side effects are similar to the effects of alcohol use. Undesirable side effects of Xanax include the following:4
- Irritability or hostility
- Vivid dreams
- Profound muscular relaxation affecting movement
- Slow breathing
- Slow heart rate
Report any unwanted side effects of Xanax to your prescribing doctor.
Like Xanax, alcohol also attaches to the GABA receptors in the brain, depressing the central nervous system. Alcohol mixed with Xanax can also lead to:6
- Loss of motor control
- Loss of control over bodily functions
- Unusual behavior
When mixed, you can potentially experience the effects of both substances at the same time, which can overwhelm your brain and body, and lead to more harmful consequences.6
Dangers of Mixing Xanax and Alcohol
The short-term risks of combining Xanax and alcohol by accident or intentionally include:7
- Accidents and injuries, typically involving falls but potentially also resulting from impaired behavior while driving, cooking, swimming, and so on
- Increased risk of physical harm or legal consequences due to the agitation related to use of Xanax and alcohol, which may lead to arguments or escalating fights
- Alcohol and drug toxicity, which is a medical emergency
Long-term risks of combining Xanax and alcohol include a number of potential health conditions, such as:7
- Alcohol-related heart disease
- Liver disease related to overburdening of the liver
- Immune system weakness
- Mental health problems
- Certain cancers
- An increased risk of certain types of progressive memory issues and dementia
Xanax and Alcohol Overdose
An overdose happens when parts of your brain controlling life-supporting functions start to shut down due to the amount of a substance or substances in your body.8
Symptoms of an overdose from mixing Xanax and alcohol can include:8
- Confusion and disorientation
- Loss of consciousness or fading in and out of consciousness
- Drop in body temperature
- Skin changes, including visible changes in color and observable changes in temperature
- Slow heart rate or loss of heartbeat
- Slow breathing or loss of breath
During an overdose, natural responses like the gag reflex are dulled, which can cause a person to choke if they vomit.
Overdoses can occur the first time you mix drugs or alcohol and anytime after that. If you suspect an overdose, call 911 immediately.
Consequences of Long-Term Use
Xanax and Alcohol Tolerance
Tolerance refers to the need to use more of a substance to achieve the same effects felt when you first started using it.9
For most drugs, tolerance is linked to the development of physical dependence—or the need to continue taking the substance to avoid withdrawal symptoms. Studies on benzodiazepines, however, show that tolerance to benzodiazepines does always develop before physical dependence and that tolerance to this drug class can happen without physical dependence.10
Xanax and Alcohol Withdrawal Syndrome
Withdrawal syndrome refers to the negative symptoms you experience when you stop taking Xanax and alcohol. Xanax withdrawal symptoms have been observed by researchers to be more severe than other benzodiazepines.11
Symptoms may include:11
- Blurred vision
- Muscle pain
- Digestive issues
- Heart palpitations
- Increased panic attacks
- Dissociate symptoms
- Suicidal ideation
The above withdrawal symptoms may also appear when you stop drinking, as well as the following:11
- Hallucinations, or sensations that you feel, see, or hear that do not match reality
- Delusions, or new strong beliefs that do not match reality
- Illusions, or being unable to process what you feel, see, or hear correctly
- Hyperreflexia, or extremely overreactive reflexes that may present as tics or twitching
- Gait disturbances
- Body shakes
- Delirium tremens (DTs), which is marked by involuntary movements, pain, and intense psychological symptoms
Symptoms like this can range from mild to severe. DTs specifically is observed only in individuals with severe substance use disorders, such as those who have used alcohol over a period of many years.
For some, avoiding withdrawal symptoms may be the main reason they cannot stop mixing drugs and alcohol without external help. This is a sign of polysubstance addiction, clinically known as polysubstance use disorder.13
What Is Polysubstance Use Disorder?
The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) is a guide used by clinicians for evaluating and diagnosing mental health conditions, including identifying misuse, dependence, and addiction to drugs and alcohol. A qualified mental health professional evaluates polysubstance use disorders based on the presence of certain criteria within the last 12 months.13
The criteria encompass signs of alcohol and Xanax addiction like:13
- Spending a significant amount of your time obtaining substances or using them
- Participating in risky behaviors while using drugs and alcohol (e.g., driving while intoxicated, frequenting unsafe areas alone)
- Experiencing social or interpersonal problems related to use (e.g., becoming estranged from loved ones, joining a social circle where most individuals also use substances, avoiding social outings to drink or use drugs)
- Neglecting major roles due to alcohol and drug use (e.g., missing work; missing activities with loved ones; becoming unable to complete tasks such as cleaning, cooking, and household chores)
- Experiencing legal problems due to drugs or alcohol (e.g., getting a DUI, being brough up on charges relating to behavior while intoxicated, becoming unable to comply with court-mandated restrictions such as those set by a parole officer)
- Trying to stop using substances multiple times unsuccessfully
- Experiencing polysubstance withdrawal symptoms when you try to stop using substances
- Using larger amounts of substances or using substances more frequently
- Having physical and psychological problems directly related to substance use (e.g., new or worsening depression or anxiety, injuries, progressive health problems related to substance use such as liver damage)
- Giving up activities you once enjoyed due to substance use
- Experiencing intense cravings to use substances
How Is Polysubstance Use Disorder Treated?
The treatment plan schedule shown to produce the best overall recovery outcomes for individuals with polysubstance use disorder includes the following components.14
Medication is used to eliminate cravings and other psychological withdrawal symptoms for drugs or alcohol. Physical withdrawal symptoms are treated based on your specific experience. For example, if you have trouble sleeping, your doctor can prescribe a non-benzodiazepine sleep aid. Medication management can start while you are in detox and continue through inpatient and outpatient treatment programs.
Recovery Skills Education
Education on early recovery and relapse prevention skills help you identify triggers and navigate your recovery outside of intensive addiction programming. Recovery skills education is provided in individual and group education. You may participate in these courses in inpatient or outpatient settings.
Counseling in individual and group settings helps you change your thinking so that you can ultimately change your behaviors. Cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), trauma-focused, and motivational enhancement therapy are examples of evidence-based therapies used in polysubstance use disorder recovery. You can receive these treatments while in inpatient rehab, intensive outpatient (IOP), and outpatient counseling.
Treatment for co-occurring disorders—or having both a mental health condition and a polysubstance use disorder—starts in detox and continues through inpatient rehab, outpatient counseling services, and aftercare services such as sober living accommodations.
Your treatment plan may look different than someone else’s. Your treatment plan may also include alternative therapies like meditation, equine therapy, or vocational counseling. Before entering detox, you will be able to talk to a licensed treatment specialist who will complete an extensive evaluation to determine all your needs.
This evaluation process can begin today by calling our treatment specialists at 800-926-9037 (Who Answers?) . They are available 24/7.
- Rochester University. (2013). Mixing Medicine and Alcohol: The Risks and Effects. The Health and Wellness Educators.
- Benzodiazepine and Unhealthy Alcohol Use Among Adult Outpatients (2019). The American Journal of Managed Care, 25(12).
- U.S. Food and Drug Administration. XANAX®.
- U.S. Drug Enforcement Agency. (2020). Drug Fact Sheet: Benzodiazepines.
- National Institute of Health. (2015). Biology of Addiction: Drugs and Alcohol and Hijack Your Brain. NIH News in Health.
- National Institute on Alcohol Abuse and Alcoholism. (2021). Harmful Interactions: Mixing Alcohol with Medicines.
- Centers for Disease Control and Prevention. (2021). Alcohol and Public Health.
- National Institute on Alcohol Abuse and Alcoholism. (2019). Understanding the Dangers of Alcohol Overdose.
- Schmitz, A. (2016, May 6). Benzodiazepine use, misuse, and abuse: A review. The Mental Health Clinician, 6(3), 120-126.
- Vinkers, C. H., & Olivier, B. (2012, March 29). Mechanisms underlying tolerance after long-term benzodiazepine use: a future for subtype-selective GABA(A) receptor modulators? Advances in Pharmacological Sciences, 2012,
- Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018, March 12). A Review of Alprazolam Use, Misuse, and Withdrawal. Journal of Addiction Medicine, 12(1), 4-10.
- Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta neurologica Scandinavica, 135(1), 4-16.
- Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American Journal of Psychiatry, 170(8), 834-851.
- National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction DrugFacts.