According to 2016 data from the Substance Abuse and Mental Health Services Administration (SAMHSA), it is estimated that among people over the age of 12:
- The only drugs that were more commonly used and misused than alcohol were nicotine products, such as tobacco.
- Over 216 million individuals were estimated to have used alcohol at least once over their lifetime.
- More than 65 million Americans were estimated to engage in binge drinking on at least one occasion (four drinks for women or five drinks for men within a few hours).
- Over 16 million Americans were estimated to engage in heavy alcohol use (binge drinking on five or more occasions within a month).
- More than 90 million Americans were estimated to have used marijuana once or twice a week.
People commonly combine marijuana and alcohol, and as marijuana becomes legal for recreational purposes in many states, this practice is likely to increase. Both of these drugs have many similar effects, but act through different mechanisms. Both result in sedation, alterations in judgment, perceptual effects that include time distortions and even minor hallucinogenic effects, and physical effects that include slowed reflexes and decreased motor coordination. Marijuana affects the cannabinoid receptors in the brain, whereas alcohol primarily affects the neurotransmitters gamma aminobutyric acid (GABA, an inhibitory neurotransmitter) and NMDA (N-methyl-d-aspartate, an excitatory neurotransmitter). When these drugs are combined, particularly at high doses, the effects of both drugs are enhanced, and this can lead to some significant issues.
Combining Alcohol and Marijuana
Surprisingly, the body of research that investigates chronic use of mixing cannabis products with alcohol is not well developed. However, as marijuana becomes legalized in many different states, research studies looking at the frequency of mixing these two drugs as well as the potential long-term effects of combining them will evolve. There are several important generalizations that can be made concerning combining these two drugs based on what is known about the effects of them individually from some research studies.
- Enhanced effects of THC: First, mixing alcohol with any drug results in that drug remaining in a person’s system longer than it normally would. This is because alcohol is metabolized first by the liver. The liver assigns priority to metabolizing alcohol despite any other substances being taken at the same time. As a general rule, the liver can metabolize about one ounce of pure alcohol per hour. This means that until the levels of alcohol in the system have been metabolized, other substances remain relatively unchanged. The THC in a person’s system would remain in their system, and the effects would continue to accrue until it can be metabolized properly. There is even scientific evidence to suggest that this occurs.
- Overdose potential: It is a well-known fact that when combining drugs of any kind with alcohol, there is an increased potential to overdose on either substance. Overdose on THC can very harmful, especially in younger people, but the overdose effects associated with alcohol are far more dangerous. Combining cannabis products and alcohol can result in an increased potential for developing alcohol poisoning or suffering an overdose of alcohol. An overdose on alcohol is very serious and can obviously be fatal.
- Decreased judgment: Both alcohol and cannabis products can reduce one’s ability to think rationally. Because these drugs have synergistic effects, combining them can result in an increased potential to act impulsivity, have poor judgment, or engage in behaviors that can lead to accidents and serious consequences. One would also expect that combining these two drugs increases the potential for drug-related blackouts, memory issues, and long-term cognitive problems that are associated with the use of either drug.
- Increased dehydration: Alcohol acts as a diuretic, meaning that it makes people lose water in their system. This happens due to numerous factors but one of the most well-known is that individuals who drink lots of alcohol urinate more frequently. Combining alcohol with cannabis could potentially exacerbate this effect.
- Potential issues with elimination: Cannabis products are known to be antiemetic, indicating that cannabis use makes it more difficult for an individual to vomit. This is actually a medicinal effect that can be used for individuals in chemotherapy or who are being treated for HIV; however, it could potentially lead to serious effects when combined with alcohol that could increase the potential for overdose and/or alcohol poisoning due to a disruption in an individual’s ability to rid excess alcohol from their system via vomiting.
- Intensified side effects: It is well known that using alcohol in conjunction with any drug intensifies the side effects that occur with that drug. Cannabis side effects can be numerous, including anxiety, hallucinations, and other issues mentioned above. Combining alcohol with cannabis products can result in increased potential for deleterious effects associated with cannabis, including a potential increase in allergic reactions.
- Long-term effects: The long-term effects of drug abuse of any type include increased risk to develop cardiovascular issues, liver disease, kidney disease, gastrointestinal issues, cancer, and decreased functioning of the immune system. It can be surmised that chronically combining alcohol with cannabis products would be a viable risk factor that can increase the potential to develop any one or several of these specific conditions.
- Complicated physical dependence: The development of physical dependence on alcohol is well documented. In addition, the American Psychiatric Association (APA) recognizes a withdrawal syndrome associated with chronic use of cannabis products; though probably relatively rare, it still occurs. Chronically abusing both drugs together can exacerbate physical dependence on either drug and produce complicated issues with withdrawal.
- Psychological effects: According to APA, chronic use of either of these drugs is strongly associated with having some other form of mental illness. One would expect that chronic abuse of both drugs in conjunction would also be associated with increased potential to be diagnosed with some other form of mental illness, such as depression, an eating disorder, or an anxiety disorder.
Concerns of Mixing Alcohol with Other Drugs
- Crystal Meth
- Crack Cocaine
- Bath Salts
Treatment for Polydrug Abuse
Whenever a person chronically combines different substances, there is the potential for serious complications in treating the individual’s abuse issues. Individuals with alcohol use disorders are notoriously difficult to treat, often require initial residential or inpatient treatment, typically require long-term involvement in treatment-related activities, and remain at an increased risk for relapse throughout their life. Chronically combining alcohol with another drug only increases these complications. Individuals who chronically use cannabis products in conjunction with alcohol generally present with more challenging issues in recovery. Moreover, having a substance use disorder related to either drug increases the risk that a person will be diagnosed with some other mental health disorder.
It is recognized that when treating an individual for any substance use disorder, all mental health conditions must be treated at the same time as the treatment for the substance abuse issue. People with polysubstance abuse present with more complicated treatment issues because numerous interventions are required, numerous treatment providers are needed, and these individuals can relapse on both drugs by starting the use of one drug. For many of these individuals, this results in a long, complicated, and intense treatment program.
The aspects of successful treatment should be strictly adhered to in these cases, including:
- Withdrawal management participation (medical detox): A withdrawal management program would most likely focus on alcohol withdrawal. Even though there is a recognized withdrawal syndrome associated with cannabis use, it is relatively mild compared to alcohol withdrawal. Nonetheless, individuals may be treated for withdrawal symptoms from cannabis as well. Initial treatment in an inpatient or residential setting is required for alcohol withdrawal.
- Comprehensive therapy: Following withdrawal management, immediate enrollment in a long-term treatment and aftercare program is required.
- The cornerstone of the long-term treatment program should be substance use disorder therapy for both marijuana and alcohol abuse.
- The person should receive continued medical management of any ongoing conditions as needed.
- Treatment for any co-occurring mental health conditions should be instituted in conjunction with substance use disorder treatment.
- The person should participate in peer support groups, such as Alcoholics Anonymous and Marijuana Anonymous. This participation should be ongoing, even after the individual has successfully completed and been released from their formal substance use disorder therapy program.
- Other types of social supports should be instituted as needed.
- Different types of treatment interventions should be instituted as needed and as identified by the initial assessment.
- Accountability: The individual should be held accountable and be subject to periodic or random drug and alcohol testing (often this is a crucial factor in recovery).
- Staying in treatment: Long-term involvement in treatment is required.
Individuals who have recovered from any type of substance use disorder are always at an increased risk for relapse; however, the risk for relapse decreases sharply after the individual has been abstinent for 5-7 years and maintained active participation in treatment-related activities. Nonetheless, it is still common to hear stories of individuals who have been abstinent from alcohol or marijuana for more than a decade and then relapsed. For these reasons, lifelong participation in some form of treatment-related activities, such as peer support groups, is strongly recommended for individuals who are recovering from any form of substance use disorder.