Xanax & Alcohol: Understanding the Risks

What Is Xanax & How Does it Work?

Xanax is the brand name for alprazolam, a controlled substance used to treat anxiety and panic disorders.¹ Given its potential for abuse and dependency, it is a schedule 4 controlled substance.¹ Xanax is in a class of drugs known as benzodiazepines, which also include diazepam (Valium) and lorazepam (Ativan).

Xanax produces a calming effect by enhancing the effects of gamma-aminobutyric acid (GABA), a naturally occurring chemical in the brain that acts on the central nervous system (CNS). Typical oral dosage prescribed varies between 0.25 mg and 0.5 mg up to three times daily, with dosage rarely exceeding 10 mg.

Side Effects of Xanax & Alcohol

Xanax has a warning from the FDA to avoid combining it with alcohol. There is adequate research to know that combining Xanax with alcohol is extremely dangerous. Alone, either alcohol or Xanax can have serious side effects. In combination, side effects can be increased.¹ First, it is important to understand the risk factors of each consumed individually.

Side Effects of Xanax

Some common side effects of Xanax include:¹

• Problems with coordination
• Hypotension
• Trouble saying words clearly
• Changes in sex drive (libido)

Some serious side effects include:¹

• Seizures: stopping Xanax can cause seizures, including epilepticus
• Mania: in those who have depression, Xanax may cause an increase in activity and talking (hypomania and mania)
• Dizziness/drowsiness: Xanax can make you sleepy or dizzy and can slow your thinking and motor skills. Do not drive, operate heavy machinery, or do other dangerous activities until you know how it affects you.
• Risk of abuse, misuse, and addiction: this can lead to overdose and serious side effects including coma, death, delirium, paranoia, suicidal thoughts or actions, seizures, and difficulty breathing. You can develop an addiction even if you take Xanax as prescribed by your healthcare provider.
• Physical dependence and withdrawal: do not suddenly stop taking Xanax as it may lead to serious and life-threatening side effects, including unusual movements, responses, or expressions, seizures, sudden and severe mental or nervous system changes, depression, seeing or hearing things that others do not, an extreme increase in activity or talking, losing touch with reality, and suicidal thoughts or actions.¹

This is not a comprehensive list of mild or serious side effects. A doctor should be consulted about risks and benefits with Xanax before starting treatment.

Side Effects of Alcohol

Immediate side effects of alcohol include vomiting, loss of consciousness, impaired coordination, blackouts, and more.

Side effects of alcohol can include:^2,3

• Vomiting
• Loss of consciousness
• Impaired coordination
• Blackouts
• Alcohol poisoning
• Risk-taking behaviors
• Coma
• Seizures
• Death

Long-term alcohol consumption may present the following health complications:^2,3

• Alcoholism
• Liver disease
• Digestive problems
• Heart problems
• Diabetes complications
• Sexual dysfunction and menstruation issues
• Eye problems
• Birth defects
• Bone damage
• Neurological complications
• Weakened immune system
• Increased risk of cancer
• Medication and alcohol interactions

Given the serious risks associated with misuse of Xanax or alcohol independently, it cannot be stressed enough the increased danger associated with using both in combination. When used in combination, the individual effects of each become enhanced.

Given that the physiology of every person is different, it is true that some people may not readily experience the more devastating effects as quickly as others. Still, each experience presents unwarranted risk, and is the equivalent of playing Russian roulette with one’s life.

Alcohol & Xanax Interactions

As depressants, both alcohol and Xanax serve to suppress the respiratory system and CNS. While this sedating effect may be desirable to some, it poses serious risk of affecting someone’s breathing. Minimal consumption of both may be all it takes for serious consequences, even after an extended history of abusing the two in combination.

Xanax and alcohol both break down in the liver, which serves to remove toxins from the body (when functioning properly). The more one consumes of any given substance, the longer it takes to break down. This is especially true when substances are consumed in combination. The longer it takes for the liver to remove said toxins, the longer one is essentially at risk.

Drinking on Xanax can have the following negative effects:

Sedation

Sedation is often the desired effect by those consuming Xanax and alcohol in combination. The more sedated one feels, the easier it may seem to escape problems, relieve anxiety, lower inhibitions, and achieve relaxation. This does pose danger, however, as the sedation one experiences comes at the cost of slowed down breathing, heart rate, reflexes, motor skills, speech, cognition, and most everything else one relies on to function.³

Mood & Behavioral Effects

Xanax, itself, can lead to depressed mood, irritability, rage, aggression, hostile behavior, and even suicidal thoughts.

Alcohol, which presents with similar mood and behavioral effects, also lowers inhibitions and impairs judgment, complicating the effects further. Accordingly, when combined, any combination of the aforementioned symptoms may occur in increased severity.⁴

Memory

Xanax and alcohol, individually or in combination, may lead toward memory impairments—short- and long-term. With Xanax, memory issues tend to entail anterograde amnesia in which one struggles to commit short-term memories to long-term storage. Types of memory loss associated with alcohol include brownouts, blackouts, and alcohol dementia. Brownouts are marked by periodic memory lapses occurring throughout an evening of heavy drinking.

Blackouts are marked by a complete absence of memories throughout a heavy drinking episode. Alcohol dementia (associated with Wernicke’s disorder and Korsakoff syndrome) is the result of chronic alcohol abuse, which significantly impairs memory, judgment, speaking, and performance. In combination, any one or number of the abovementioned memory issues is possible.⁶

Physical Side Effects

Some physical side effects are more common and well-known than others. With differing physiology between people and over time, there is no guarantee as to if or when said side effects may occur.

Potential physical side effects can include:³

• Cardiovascular and respiratory effects
• Increased potential for unconsciousness or comatose states
• Increased potential for liver and kidney damage
• Increased risk for overdose
• Increased potential for psychosis or neurological effects
• Increased potential for the development of physical dependence
• The development of a substance use disorder

There are also individual physical effects that occur with some people. These are lesser known and relatively rare. Should these occur and warrant medical attention, it is imperative to inform a medical professional of having consumed alcohol and Xanax as to provide some direction for clinical exploration.

Long-Term Side Effects

Short-term side effects while actively under the influence may range from minimal to more severe (even causing death in some instances); however, long-term side effects have the potential to build up over time.

Long-term side effects can include:^4,5

• Wernicke’s disorder and Korsakoff syndrome
• Heart disease
• Stroke
• Kidney damage or complete failure
• Liver damage or complete failure
• Chemical dependence
• Addiction
• Mental health disorders (e.g., depression)

Symptoms of an Overdose

Typical assumptions regarding tolerance by those who consume alcohol regularly are significantly compromised when Xanax is involved.⁶ The number of drinks one normally consumes to attain a desired effect are dramatically reduced, leading toward an increased likelihood of overdose.

It’s important to note that the liver metabolizes alcohol first, which leaves Xanax in the system for an extended period as compared to prescribed consumption.⁶ Should one continue taking Xanax while under the influence of alcohol, it is possible to build dangerous levels of it in the system, which may lead to overdose.

Consequent to respiratory suppression, which reduces breathing, one may suffer from significant organ and/or brain damage.⁶ Again, overdose may be fatal.

When to Get Help

Given the addiction potential for Xanax and alcohol in combination, as well as the severity of side effects, early intervention may prevent significant complications and death. Binging Xanax and alcohol even once may immediately result in overdose. If you or someone you know is in danger of this, it is recommended to intervene immediately.

If the person abusing Xanax is taking it as a prescription under medical advice, this should be reported to the prescribing physician. If one is consuming Xanax illicitly, seeing a medical professional or therapist who specializes in addiction is recommended.

This cannot be stressed enough: If someone is actively under the influence and experiencing severe side effects or overdose, call 9-1-1 or visit the nearest emergency room (ER) immediately. Every moment counts when someone is actively overdosing, and although some of the symptoms may still be irreversible, there is an increased likelihood of survival and minimizing catastrophic effects when treated immediately.

Can Xanax & Alcohol Kill You?

Considering that Xanax and alcohol independently have numerous overdose deaths reported each year, the potential for overdose death in combination is alarming. Although statistics specific to Xanax-related overdose deaths are relatively limited, the Centers for Disease Control and Prevention (CDC) reports numbers for drugs classified within the benzodiazepine family.

Here are statistics from the CDC:⁷

• Benzodiazepines were involved in nearly 7,000 overdose deaths in 23 states from January 2019 – June 2020 – 17% of all drug overdose deaths
• Illicit benzodiazepine deaths increased 520% (from 51 to 317) from Q2 2019 to Q2 2020
• Prescription benzodiazepine deaths increased 22% (from 921 to 1,122) from Q2 2019 to Q2 2020

In a similar timeframe, another report provided by the CDC stated that “[e]xcessive alcohol use was responsible for more than 140,000 deaths in the United States each year during 2015-2019, or more than 380 deaths per day.”⁸

While it is difficult to pinpoint exactly who will experience more severe symptoms leading up to lethal overdose, several common factors including sex, height, weight, age, metabolism, tolerance, dosage, time of consumption, and underlying medical conditions.

Questions to Ask Your Health Team About Mixing Xanax With Alcohol

Before beginning any medical regimen, it is recommended to become as informed as possible, which oftentimes entails asking questions. Introducing any controlled substance into your body poses risks, and the more informed you are of these risks, the more caution you may exercise both with consumption and when undesirable side effects arise.

Specific to Xanax, a great place to begin with learning about the side effects is by visiting the manufacturer’s website. You should also tell your healthcare provider about all your medical conditions. Although consuming any amount of alcohol while taking Xanax is ill-advised, you may still have questions for your doctor, psychiatrist, and/or therapist.

Questions to ask your care team about drinking on Xanax include:

1. In my specific situation, is there any safe amount of alcohol I may consume while taking Xanax?
2. What if I really want to have a drink for a night out or special occasion? Should I just take the day off from Xanax?
3. Are there any other benzodiazepines aside from Xanax that are safer to combine with alcohol?
4. Are there any other medications outside of benzodiazepines that treat anxiety and panic disorder that do not interact as severely with alcohol?
5. What if I decide to just engage in talk therapy for my anxiety and panic rather than take medication? Am I safer to drink then?
6. What should I do if I decide to drink anyway and have an adverse reaction?
7. What are some early warning signs of overdose I should watch for in my situation that warrant immediate attention upon their presence?

Final Thoughts

The bottom line is that abusing Xanax or alcohol alone is dangerous. In combination, the risk increases substantially. Although some people continue taking chances by combining the two, anything can ultimately happen at any time, and by that point, it is usually too late.