• Addiction & recovery

What Happens When You Combine Methadone and Alcohol?

Vanessa de la Cruz, MD

January 31, 2022


Methadone is a prescription opioid medication approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder and chronic pain. Methadone is a promising treatment for individuals dependent on prescription and illegal opioids such as heroin, codeine, and morphine. Methadone is currently available in a tablet, liquid, or powder form under brand names such as Dolophine and Methadose. Methadone maintenance treatment (MMT) provides stabilization during the early stages of recovery and lowers the risk of relapse.

Methadone is a Schedule II controlled medication with a high potential for misuse and dependence. As a result, most U.S. states require individuals to visit special clinics to get their prescribed daily doses of methadone. 

Unfortunately, combining methadone and alcohol can have a considerable negative impact on cognitive function and result in severe health complications. When methadone is combined with alcohol, the probability of experiencing severe side effects is exponentially increased.


How Does Methadone Work?

Methadone is an opioid medication that interacts with opioid receptors in the brain to reduce pain and block the effects of other opioids. This function provides both the pain-relieving properties of opioids while also helping prevent withdrawal symptoms and reducing the risk of a relapse. Methadone treatment typically lasts for a minimum of 12 months and is prescribed and administered under the guidance of a licensed practitioner. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), these medications can only be dispensed by a SAMHSA-certified methadone clinic. 

When taken as directed, methadone is very effective. It assists people in achieving and maintaining recovery, as well as reclaiming productive and fulfilling lives. Similar to all other medications used for treating substance use disorders, methadone is a single component of a comprehensive treatment regimen that includes counseling, behavioral therapies, and support groups.


How Does Alcohol Work?

Millions of people drink alcohol on a daily basis all around the world, making it one of the most widely consumed substances on the planet. Even when consumed in moderation, alcohol can have a wide range of effects on one’s health and well-being. Alcohol is a central nervous system depressant (CSN) that slows down parts of the brain. Alcohol disrupts the brain’s communication pathways and can alter the way it appears and functions. These disturbances can alter one’s mood and behavior and make it difficult to think clearly and move in a coordinated manner.

Once consumed, alcohol is quickly absorbed into the bloodstream and distributed throughout the body. It’s then broken down by the liver and excreted from the body. Alcohol will continue to circulate in the bloodstream until the liver has had time to break down all the alcohol in the system. 


What Happens When You Combine Alcohol and Methadone?

Methadone, even when used as prescribed, has the potential to cause physical and physiological side effects. And according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 95,000 individuals die annually from alcohol-related causes, making it the fourth highest preventable cause of death in the United States. 

Consuming alcohol while taking methadone can generate severe side effects due to the negative interaction between the two substances. Both alcohol and methadone directly impact the brain and central nervous system (CNS), and combining them can amplify the effects of both substances. Some individuals simultaneously consume methadone with alcohol to generate stronger sedative effects. This risk is even higher in individuals who struggle with methadone dependence and alcohol use disorder. 


Side Effects of Combining Alcohol and Methadone

Mixing methadone with alcohol can amplify the negative effects of both substances and increase the risk of an overdose. 

Potential side effects of mixing methadone and alcohol include: 

  • Fatigue
  • Insomnia
  • Vomiting
  • Changes in behavior
  • Inhibited motor skills
  • Difficulty breathing
  • Weak heart rate
  • Irregular heartbeats
  • Drowsiness
  • Low blood pressure
  • Coma
  • Death

The more methadone and alcohol a person consumes, the higher the risk of experiencing severe side effects, including a fatal overdose. Misusing these substances over a prolonged period can also result in severe health complications such as liver damage. Seek immediate medical attention if you are vulnerable to these complications. 

In the event of a methadone overdose, Narcan/naloxone should be administered to the person who has overdosed immediately. The next step would be to call 911 (even if the person appears to wake up or come out of it because the effects of naloxone could wear off) and wait with the person for an ambulance to arrive. Check with your prescriber or pharmacist for information on how to obtain Narcan/naloxone.


Interaction Between Methadone and Other Medications

Methadone has the potential to interact with a wide range of medications. Although some interactions don’t pose any considerable risk, some can exacerbate one or both medications’ negative effects or lead to severe health complications. Methadone is known to interact with a total of 661 medicines.

The following are a few medications that interact with methadone:

  • Adderall 
  • Ambien 
  • Ativan 
  • Cymbalta 
  • Dilaudid 
  • Flexeril 
  • Klonopin 
  • Lasix 
  • Lexapro 
  • Lyrica 
  • Neurontin 
  • Norco 
  • Prozac 
  • Seroquel 
  • Synthroid 
  • Valium 
  • Vitamin D3 
  • Xanax 
  • Zofran 
  • Zoloft 

The combined use of methadone with other CNS depressants can increase the risk of respiratory depression, profound sedation, coma, and death. Hence, it’s important to talk to a healthcare provider before taking prescription or over-the-counter medications while on methadone. 


Alcohol Consumption During Methadone Maintenance Treatment

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly half of the individuals in methadone maintenance treatment also have an alcohol use disorder. And since methadone is only used to treat OUD, people with alcohol use disorders may continue drinking during treatment. As a result, during treatment, all substance use disorders must be addressed simultaneously. And due to the difficulty of treating two substance use disorders concurrently, a comprehensive treatment plan with appropriate follow-up care is also essential.


How Does Alcohol Use Influence Methadone Treatment Outcomes?

Alcohol use can negatively influence methadone treatment outcomes by affecting methadone metabolism and the efficacy of the medication. Alcohol use during methadone treatment can also contribute to:

  • Non-adherence to MMT
  • Criminal activities
  • Higher relapse rates
  • Physical and mental morbidity 
  • Increased risk of an overdose

Inform your healthcare provider if you’re struggling with an AUD before starting methadone treatment to mitigate the risks associated with the interaction of both substances.


Alternative Medications to Methadone

While methadone has been successfully used to treat opioid addictions in the U.S. since the 1970s, various alternative medications are available. Some of such FDA approved medications that are utilized in opioid addiction treatment programs are:

It’s vital to note that MOUD encompasses more than just the use of medications. It requires a multifaceted approach that involves counseling, vocational training, psychosocial therapy, family support, and establishing connections to community resources to be fully effective. 

However, the right medication can make it easier for you to get through the difficult stages of recovery. And Eleanor Health’s program is designed to meet the highest clinical safety and standard of care.

If you are seeking help with your loved one’s addiction, contact us today or complete our quick contact form below, to speak with an addiction treatment specialist.

If you need help with your substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We provide treatment services for adults with alcohol, opioid, and other substance use disorders. We are currently located in LouisianaMassachusettsNew JerseyNorth CarolinaOhio, and Washington.

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