Mixing Alcohol and Vicodin

Vicodin is a prescription painkiller that combines an opioid (hydrocodone) with an analgesic/fever-reducer (acetaminophen) to help manage moderately levels of pain.1 This medication is commonly prescribed after surgical procedures or injury, such as breaking a bone. It is not intended for long-term use. The Drug Enforcement Administration lists hydrocodone as a Schedule II controlled substance, meaning that though it has medical use, it also has high abuse liability.2

Hydrocodone—the primary active component of Vicodin—binds to and activates opioid receptors in our bodies. In doing so, the perception of pain signals is decreased. In addition to this therapeutic effect, however, opioids like Vicodin can also result in adverse effects such as profound drowsiness, impaired cognition, slowed gastrointestinal motility and constipation, and dangerously slowed breathing.3

Misusing Vicodin, such as by consuming larger-than-prescribed doses or mixing with alcohol, can result in dangerously magnified levels of intoxication and an increased risk of severe respiratory depression and death.1,3 Beside the increased risk of overdose, there is an additional danger involved with combining alcohol and Vicodin in the form of an increased likelihood of acetaminophen toxicity and associated liver injury.4

The Dangers of Mixing Alcohol and Vicodin

Mixing Vicodin and alcohol may increase the risk of:3,5,6,7

  • Polysubstance addiction.
  • A potentially complicated polysubstance withdrawal syndrome.
  • Over-sedation.
  • Loss of coordination and associated increased risk of accidental injury.
  • Gastrointestinal issues (e.g., stomach upset, nausea, vomiting).
  • Respiratory depression, or irregular or stopped breathing.
  • Irregular heart rate and changes in blood pressure.
  • Loss of consciousness.
  • Coma.
  • Death.

Used alone in high enough doses, either of these substances can result in many of the above side effects; together, they may compound the severity of these effects, to potentially dangerous levels.

The most immediately life-threatening effect of this dangerous combination is respiratory depression. Opioid drugs are known to impair our respiratory drive; at certain doses, this can result in slow, shallow, or altogether stopped breathing.3 Decreased respiratory drive can potentially result in impaired oxygen delivery throughout the body, which can lead to anoxic brain injury and other organ system damage.

Both of these can negatively impact liver health, and the risk of liver damage may be higher in people who struggle with problematic use of both alcohol and acetaminophen-containing opioid formulations. Long-term alcohol abuse is linked to cirrhosis and liver failure, while too much acetaminophen—the other active ingredient in Vicodin—can cause liver toxicity and failure.4

Alcohol and opioid painkillers, like Vicodin, both have neurochemical effects that reinforce their continued use. Such reinforcing or rewarding effects become even more pronounced when opioids are used at higher than prescribed doses or when alcohol is consumed in large amounts. Alcoholism is by far the most prevalent substance use disorder in the United States, with an estimated 14.8 million Americans having an alcohol use disorder in 2018.8 Survey results from that same year indicate that an estimated 1.7 million Americans struggled with a substance use disorder involving prescription painkiller misuse, including Vicodin.8

Past estimates have placed alcohol as the third leading cause of preventable death in the United States.9 Nonmedical misuse of opioid painkiller is a significant cause of death as well, with more than 31,225 overdose deaths reported in 2018.10

Who Is at Risk of Mixing Alcohol and Vicodin?

Though there is limited data on people who specifically abuse Vicodin and alcohol together, there are some people who may be more at risk than others. For example, people who have received a prescription for Vicodin and are unaware of the potentially severe health outcomes to come of combining opioids with alcohol might be at greater risk of ingesting alcohol while Vicodin is still in their system.

A 2008 report from researchers at the University of Michigan indicated that people who struggled with alcohol use disorders were 18 times more likely to abuse prescription medications, including Vicodin, for recreational or nonmedical reasons. In that study, the largest group of prescription drug and alcohol abusers were between the ages of 18 and 24. Of 4,580 study participants, 12 percent of those individuals had abused both alcohol and prescription drugs together in the past year.11

Get Help for Alcohol and Vicodin Abuse

Although it can be dangerous to combine alcohol and opioid medications like Vicodin, and may give rise to life-threatening health effects, the practice is alarmingly common. People who struggle with polydrug abuse, alcoholism, painkiller abuse, or other substance addiction are encouraged to seek treatment sooner than later, as poor health outcomes such as overdose may be prevented through successful recovery. With the right help, health and wellness can be restored and preserved. Call to speak with an Admissions Navigator about your treatment options at Greenhouse or any other American Addiction Center facility.



  1. U.S. Department of Health and Human Services—Food & Drug Administration. (2006). Labelling-Medication Guide: Vicodin.
  2. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
  3. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs—What classes of prescription drugs are commonly misused?.
  4. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  5. U.S. National Library of Medicine—MedlinePlus. (2019). Hydrocodone.
  6. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  7. National Institute on Drug Abuse. (2020). Commonly Used Drugs Charts—Prescription Opioids.
  8. Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
  9. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Facts and Statistics.
  10. National Institute on Drug Abuse. (2020). Overdose Death Rates.
  11. National Institute on Drug Abuse. (2008). Alcohol Abuse Makes Prescription Drug Abuse More Likely.
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