Mixing Xanax and Alcohol
Combining Xanax and alcohol can be risky, even when taking Xanax as prescribed. 1 Xanax and alcohol can intensify the effects of each other, posing both short- and long-term effects to your health. 2 Misusing either alcohol or Xanax, especially together, can amplify the severity of these interactions. 1
In this article:
Why Do Xanax and Alcohol Interact?
Xanax is a prescription medication. It is the brand name for alprazolam, a drug classified as a benzodiazepine. Benzodiazepines are mild tranquilizers and are commonly prescribed to relieve symptoms of anxiety, seizures, and sleep disorders.1 Using Xanax in any way not prescribed by your doctor—such as taking more than prescribed or taking someone else’s prescription—is inherently risky and potentially dangerous. 1
Xanax decreases activation in the brain by causing a temporary increase in GABA neurotransmitters. GABA neurotransmitters regulate how the brain communicates with the nervous system. Xanax takes effect quickly after you take it—in less than an hour for most people with a peak concentration in the body after one to two hours. The addition of more GABA neurotransmitters suppresses the central nervous system, which can reduce the severity of anxiety attacks and seizures as well as modulate sleep disorder symptoms in people with these conditions. 3
Even when taken as prescribed, Xanax can produce unwanted side effects, including:3
- Sedation or drowsiness
- Slurred speech
- Trouble concentrating
- Impaired coordination
- Impaired memory
- Decreased libido
This is not a complete list of side effects but is common among those who take Xanax.
Xanax is recommended as a short-term solution for medical and behavioral health issues due to the high risk of developing a tolerance, dependence, and addiction to it. Within a few weeks of taking Xanax, you can start to develop a tolerance to your current dose. When you develop a tolerance to Xanax, your current dose will no longer produce the same desired effect. Your doctor may talk to you about increasing your dose or may suggest transitioning to another medication with a lower risk of physical dependence and addiction. Physical dependence occurs when you begin to feel withdrawal symptoms if you do not take Xanax as much or as often as usual. 3
You may feel these symptoms immediately after missing a dose or even a few days after. Benzodiazepines take a long time to be eliminated entirely from the body and you may not feel withdrawal symptoms until the level of Xanax in your body is no longer high enough to prevent them. The accepted half-life of Xanax—or the amount of time it takes for the average adult to metabolism half a dose of Xanax—is 11 hours. However, how long Xanax stays in your system depends on a variety of other factors. You will stop feeling the sedative effects of Xanax before the half-life mark. 4
Continual use of a benzodiazepine like Xanax over a long period of time changes your brain chemistry. Taking a dose of Xanax may no longer produce that sudden increase in GABA neurotransmitters, which can lead to challenging physical and psychological effects, including: 3
- Irritability that increases to angry outbursts, sometimes escalating to violent reactions
- Cognitive decline
- Respiratory depression
- More severe memory problems
- Major depression
- Increased risk for Alzheimer’s disease and dementia
- Increased risk of suicidal thoughts
- Liver damage
Long-term effects can also increase the symptoms you were trying to eliminate initially, like anxiety and panic attacks. Because your body quickly metabolizes Xanax, you can experience increased anxiety and nervousness between doses.3 Addiction, overdose, coma, and death are also possible.3
Alcohol is also a central nervous system depressant. How alcohol affects you depends on many factors, including the number of drinks, type of drinks, the health of your liver, age, gender, and even how much food you eat before you drink. For many, it takes about one hour to metabolize one standard drink.5
Drinking more than one drink per hour can lead to intoxication and the following short-term effects:5
- Happy mood, elation
- Lowered inhibitions
- Loss of coordination
- Slurred speech
- Loss of decision-making skills and judgment
- Trouble concentrating
- Blurred vision
- Mood swings
- Raised blood pressure
Chronic misuse of alcohol can lead to tolerance, physical dependence, and addiction. 5
Both your physical and mental health can be affected by chronic alcohol misuse, even if you have not yet become physically dependent on or addicted to alcohol. However, chronic alcohol misuse is the highest risk factor for developing dependency and addiction. Severe side effects of long-term alcohol misuse include:5
- Changes in brain chemistry and functioning
- Learning problems
- Memory loss
- Liver damage and failure
- Acid reflux caused by erosion of the stomach lining
- Increased risk of ulcers
- Cancer in the throat, liver, stomach, mouth, and breast
- High blood pressure
- Irregular heartbeat
- Mood swings
Xanax and alcohol affect the body in similar ways, especially in how they can suppress the central nervous system. When you consume Xanax and alcohol together, you are highly likely to amplify the effects of one or both substances because the central nervous system is told from two sources to slow all your mental and physical functions. Major bodily functions can slow too much and can even stop.5
This means you are in danger of the following:5
- Slowed heart rate
- Slowed breathing
- Oxygen deprivation
- Neurological malfunction
- Changes in mood
What Are the Risks of Mixing Xanax and Alcohol?
The more you mix Xanax with alcohol, the short-term effects will increase and become severe. For example, slowed heart rate can turn into severe cardiac depression or cardiac arrest. Other long-term effects include:6
- No longer feeling the Xanax and alcohol “high”
- Severe respiratory depression or stopped breathing
- Oxygen deprivation that causes brain damage, which may be irreversible
- Severe depression, anxiety, or other mental illness
- Cirrhosis of the liver
- Increased risk for accidents, injuries, suicidal thoughts
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If you have become physically dependent on using alcohol and Xanax, you may experience symptoms of withdrawal when you do not use them. Symptoms of withdrawal from a mixture of Xanax and alcohol can be severe. You can experience:9
- Delirium tremens
- Uncontrollable vomiting
- Muscle spasms
- Heart rate irregularities
- Flu-like symptoms
- Digestive problems
- Impaired vision, mental cognition, and breathing
Withdrawal symptoms can begin within 6 to 8 hours after your last Xanax and alcohol mixture.9
Because the symptoms are so dangerous, you must detox under medical supervision. Doctors can treat your withdrawal symptoms and monitor your vital signs. Beginning your recovery this way decreases the time you spend in withdrawal and enables you to focus on sobriety.
Mixing Xanax and alcohol also has a high risk of overdose. Drug overdoses need immediate medical attention. If you or someone you know overdoses, call 911. Signs of an overdose can include uncontrollable vomiting, going in and out of consciousness, becoming unresponsive, and shallowed or stopped breathing.6
Overdose symptoms also include significant confusion, inability to remember important personal details, and loss of coordination. Overdoses can sometimes lead to fatalities.6
Certain factors can increase your risk of short- and long-term effects of mixing Xanax and alcohol. You may be at increased risk:7
- If you are using Xanax in a way that has not been prescribed by your doctor
- If you are misusing alcohol, such as by binge drinking, drinking to excess on a daily basis, or drinking against a medical recommendation
- If you have an underlying medical issue
- If you are taking other prescribed medications that could interact with Xanax and alcohol
- If you are taking other illicit drugs in addition to Xanax and alcohol
- If you have a mental health disorder
Your risk for serious side effects also depends on the amount of Xanax and alcohol you consume and for how long. 7
Can I Become Addicted to Xanax and Alcohol?
Xanax and alcohol are both addictive substances. Certain factors make you more likely to become dependent on mixing Xanax and alcohol and lead to an addiction. The top two risk factors are:8
- Genetics—Just like all other hereditary traits, a predisposition to addictive behavior can be inherited. However, just because you have a family history of addiction does not mean you will become addicted to a substance you use.
- Environment—The environment in which you live contributes to the development of an addiction and can contribute to the development of addiction in people with no family history of substance misuse. For example, if you live with a person who uses alcohol daily, you may be influenced to do the same even if you know alcohol interacts with your Xanax prescription.
Other risk factors include your body’s metabolism, stress, how you use Xanax and alcohol or method of delivery, and how young you were when you first mixed the two substances.9
Someone addicted to mixing Xanax and alcohol may experience:8
- Changes in eating habits
- Changes in weight
- Decreased focus on personal hygiene
- Skin problems
- Bruising or injuries from falls or accidents
In addition to the emotional symptoms using Xanax and alcohol can cause, you may also exhibit emotional signs of addiction like:8
- Becoming easily agitated and angered
- Feeling unable to cope with stress
- Rationalizing your use of Xanax and alcohol
- Losing interest in people and activities you once enjoyed
- Denying that you have a substance use disorder to others or yourself
- Experiencing rapid changes in mood
- Experiencing increased anxiety or rebound anxiety
- Experiencing intense cravings for either or both substances
Polysubstance use disorder can happen to anyone at any time. While there is no immunity against addiction, knowing if you are at risk can help you decide to get help or learn how to avoid developing a substance use disorder.
No matter what stage of addiction you are in, you can get help. Call 800-839-1686Who Answers? to speak with a treatment specialist at any time.
- S. National Library of Medicine. (2021). Alprazolam. MedlinePlus.
- Substance Abuse and Mental Health Services Administration. (2014). The DAWN Report. Benzodiazepines in Combination with Opioid Pain Relievers or Alcohol: Greater Risk of More Serious ED Visit Outcomes.
- Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner Journal, 13(2), 214–223.
- US Food and Drug Administration. (2011). Xanax.
- National Institutes of Health. (2007). NIH Curriculum Supplement Series [Internet] – Information About Alcohol. Bethesda (MD): National Institutes of Health.
- Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and alcohol dependence, 200, 95–114.
- Krawczyk, N., Eisenberg, M., Schneider, K. E., Richards, T. M., Lyons, B. C., Jackson, K., Ferris, L., Weiner, J. P., & Saloner, B. (2020). Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study. Annals of emergency medicine, 75(1), 1–12.
- Lerner, A., & Klein, M. (2019). Dependence, withdrawal, and rebound of CNS drugs: an update and regulatory considerations for new drug development. Brain communications, 1(1), fcz025.
- gov. (2019). Mental Health and Substance Use Disorders.