Mixing substances is when someone takes more than one substance at the same time and many people don’t realize that mixing any combination of alcohol, over-the-counter drugs, prescription drugs, or illicit drugs can have dangerous health effects.

There are many combinations of substances that people use. Most often alcohol is one of these. Some people may be unaware that their prescription medication should not be taken with additional substances (like alcohol) and that these interactions can be fatal.

Prevalence

• The 2012 National Survey on Drug Use found that millions of people each year use more than one substance at the same time. Specifically, the survey reported the following statistics regarding combining substances (SAMHSA, 2016):
  • 16.2 percent of illegal drug users had used marijuana along with one or more drugs.
  • A third of the 17 million people who identified themselves as heavy alcohol drinkers were also currently using illegal drugs.
  • Almost a quarter of the 57.5 million people who were current cigarette smokers had used an illegal drug in the previous month.
• About 200,000 emergency room visits a year involve a combination of benzodiazepines and alcohol, or alcohol and opioid pain medications (SAMHSA, 2014)

• Mixing more than one type of substance can impact our bodies in different ways. For example, mixing alcohol and marijuana can increase chances of nausea, vomiting, panic, anxiety, and much more. Mixing alcohol and Vicodin can lead to coma and death (NIH, 2014)
• Effects of mixing substances can vary depending on the types of substances used, dosages, and interactions between your body and the substances used. Some potential effects include anxiety, mood changes, impacts on organs including your liver, overdose and health problems like liver or other organ damage (McCabe, Cranford, Morales, & Young, 2006 and European Monitoring Centre for Drugs and Drug Addiction, 2009).
• Mixing alcohol with ADHD medication like Adderall can lead to Dizziness, drowsiness, impaired concentration, increased risk for heart problems and liver damage (NIH, 2014).
• When alcohol and caffeine are mixed (drinking an energy drink with alcohol) the caffeine can mask alcohol’s depressant effects making people feel more alert. They may drink more and become more impaired. People who mixed alcohol and energy drinks reported more unwanted/unprotected sex, drunk driving, and alcohol-related injuries (CDC, 2018).
• Many cocaine users also use alcohol, and this combination can be particularly dangerous. The two substances react to produce cocaethylene, which may potentiate the toxic effects of cocaine and alcohol on the heart. 
• The combination of cocaine and heroin is also very dangerous. Users combine these drugs because the stimulating effects of cocaine are offset by the sedating effects of heroin; however, this can lead to taking a high dose of heroin without initially realizing it. Because cocaine's effects wear off sooner, this can lead to a heroin overdose, in which the user's respiration dangerously slows down or stops, possibly fatally.
• When you stop taking one or more substance, it may be more difficult and/or painful to do. Withdrawal can be drawn out or made worse due to the complex interactions of substances.  Treatment, if needed, may be more difficult (but not impossible).

What does it mean to be Safe, Smart, and Responsible?

• ​​​​​​Mixing substances can be incredibly dangerous. We want you to make safe choices. Please remember that if you intend to use substances, check with your doctor about any interactions substances may have with your already prescribed medication. 
• Being smart may mean knowing that mixing substances is potentially life-threatening.
• Being responsible may be choosing an activity that does not involve the use of substances.