The Link Between Excessive Alcohol Consumption And Opioid Misuse

There has been a lot of media coverage of the ongoing opioid epidemic in the United States—with good reason. Opioids are the main reason drug overdose deaths keep reaching new record levels year after year. Yet, alcohol remains the most commonly used addictive substance in the US, causing even more fatalities. And there are no indications that this is about to change.

A study published in JAMA Psychiatry in 2017 suggests that alcohol misuse in the US has actually increased significantly in recent years. The authors compared data from 2001–2002 and 2012–2013 and documented substantial increases in the prevalence of past-12-month drinking, high-risk drinking, and alcohol use disorder. Overall, cases of AUD shot up by almost 50 percent, from 8.5 percent in 2001–2002 to 12.7 percent only eleven years later.

Is there possibly a correlation between the widespread misuse of alcoholic beverages and opioid pain relievers (OPRs)? They certainly make a very dangerous combination when taken together. “When taken with OPRs or benzodiazepines, alcohol increases central nervous system depression and the risk for overdose,” warn the Centers for Disease Control and Prevention.

Deadly Duo

“Prescription drugs and alcohol can be a dangerous combination,” the director of the National Institute on Drug Abuse, Nora Volkow, told Scientific American. “Painkillers and booze are perhaps the worst to mix, because both slow breathing by different mechanisms and inhibit the coughing reflex, creating a ‘double-whammy’ effect, that can stop breathing altogether,” Dr Volkow said.

This ‘double-whammy’ effect not only increases the risk of a potentially fatal overdose, it also decreases the ability of medical professionals to successfully treat the patient. For example, the drug naloxone—also known by its trade name Narcan—is now frequently administered by first responders to reverse the effects of an opioid overdose, but if alcohol, benzodiazepines, or other substances have been used as well, naloxone can be ineffective. Central nervous system depressants, like alcohol, benzodiazepines, sleep medications, opioids, and other drugs, can enhance each other’s effects, thus dramatically increasing the risk of overdose.

New research funded by the National Institute on Alcohol Abuse and Alcoholism will now take a closer look at the probability that problem drinking can precipitate opioid misuse in some individuals. Among other things, the researchers will look at the prevalence of people with AUD experiencing events that can cause pain, such as falls or fights. They will also study how alcohol use can exacerbate certain conditions, such as post-surgical complications and how alcohol's analgesic properties may result in users' developing tolerance to these effects over time.

Gateway to Addiction

We also have to consider the traditional popularity and easy availability of alcohol. Despite the existing minimum legal drinking age of 21, it frequently functions as an initiation substance for teenagers.

A 2012 study found “that alcohol represented the ‘gateway’ drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs.”

While many teenagers engage in underage drinking at some point, a much smaller percentage escalates their substance use to illicit drugs like cocaine or opioid pain relievers that were not prescribed to them. The reasons are complicated. Most people who develop a severe substance use disorders are struggling with serious co-occurring mental health conditions like trauma, anxiety issues or depression that are driving the substance misuse.   

There are many prominent examples. In September, Rapper Mac Miller died from an accidental overdose caused by a combination of cocaine, alcohol, and the powerful opioid fentanyl. The 26-year-old Pittsburgh native, whose real name was Malcolm James Myers McCormick, openly discussed his depression and addiction in his rhymes and had a history of recurring drug and alcohol misuse.

Last year, the lead singer of the rock band Linkin Park, Chester Bennington, committed suicide in his home near Los Angeles. The 41-year-old musician had also been open about his battle with drug and alcohol addiction. And Bennington, too, tried to cope with trauma and chronic depression. An autopsy revealed that he had alcohol in his system at the time of his death.

In most cases, addiction is not really about any particular substance or a combination of substances but about social setting, co-occurring circumstances, genetic makeup, and the emotional state of the user. That doesn’t mean that using multiple, addictive substances concurrently and recklessly isn’t a serious problem. It signifies that the torment of users has reached a point where their maladaptive coping mechanism put their life in immediate danger. Such individuals need comprehensive addiction treatment.

If you or someone you know is struggling with substance use and could benefit from addiction treatment services, please contact The Farley Center at Williamsburg Place.