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Concurrent Alcohol and Hydrocodone Abuse

The Problem of Alcohol and Hydrocodone Abuse

Both alcohol and hydrocodone are relatively safe when used appropriately and in moderation. When used excessively or when combined, these substances can create volatile and unpredictable outcomes.


Alcohol is a widely used and abused substance. In fact, according to a large study published in JAMA Psychiatry, approximately one-third of adults in the US have met the criteria for an alcohol use disorder at some point.

The concept of alcohol abuse can apply to situations wherein people:

  • Use the substance illegally—e.g. prior to drinking age.
  • Drink to intoxication.
  • Drink to self-medicate.
  • Drink despite the risk of harmful results.


Hydrocodone is the most commonly prescribed opiate pain reliever in the US and is found in many brand name formulations, like:

  • Hycodan.
  • Lortab.
  • Lorcet-HD.
  • Norco.
  • Vicodin.
  • Vicoprofen.

This substance is only available with a prescription and can aid in the management of moderate to severe pain. Like alcohol, hydrocodone can produce feelings of euphoria that may lead to the development of physical dependency and, eventually, substance addiction.

Abuse of hydrocodone occurs when people:

  • Take the medication without a prescription.
  • Take the medication more frequently or in higher doses than prescribed.
  • Take the medication for reasons other than prescribed.
  • Take the medication in combination with other substances to amplify its intoxicating effects.

Learn more about the effects of hydrocodone and alcohol misuse.

Signs and Symptoms of Alcohol With Hydrocodone


To understand the dangers of concurrent alcohol and hydrocodone abuse, it is helpful to understand the consequences of each. When alcohol use becomes heavy, it can lead to many unwanted results, such as:

  • Reduced coordination and muscle control.
  • Decreased inhibitions, which could result in verbal or physical confrontations.
  • Impaired judgment, potentially placing the user and those around them in dangerous situations.
  • Nausea and vomiting.
  • Mood changes.
  • Poor memory.

Over an extended period, alcohol use can lead to increased incidences of liver problems and even some forms of cancer.


Hydrocodone can lead to signs and symptoms that are similar to other opiates like morphine, heroin, and oxycodone. They include:

  • Changed perceptions of pain.
  • Slowed heart rate.
  • Slowed breathing.
  • Slowed gastrointestinal motility.
  • Lower motivation and energy.
  • Mood changes.
  • Depression.

Combined Effects of Hydrocodone and Alcohol

Alcohol and hydrocodone work differently in the body, but they both serve to slow down the body and diminish response time. Substances that work in this way are referred to as depressants.

When two or more depressants are used concurrently, they may increase the unwanted repercussions dramatically—leading to increased health risks.

depressed man drinking alcohol with pillsPeople that use alcohol and hydrocodone in combination may put themselves at risk for:

  • Alcohol poisoning or overdose.
  • Loss of consciousness.
  • Vomiting.
  • Dangerously slowed breathing.
  • Dangerously weak heart rate.
  • Seizure.
  • Coma.
  • Death.

An additional risk of this concurrent use is the impact on the liver. As mentioned, alcohol will damage the liver over time. In the case of some combination pharmaceutical formulations—including Lortab, Norco and Vicodinhydrocodone is mixed with acetaminophen, the latter being related to severe liver complications if used in excess. Concurrent use of alcohol additionally lowers the threshold for acetaminophen’s liver toxicity.

When Abuse Becomes Addiction

When alcohol and hydrocodone are used together, the short- and long-term effects have the potential to become compounded and increasingly harmful. Among the most unwanted effects of concurrent use is the heightened risk of developing both tolerance and physical dependence—both ultimately paving the way towards a poly-substance addiction.

Individuals may double up on various substances as a way to augment the experience of each. At least initially, the separate highs or euphoric effects of both substances serve to supplement the other, resulting in a synergized reward that the brain quickly takes note of. This rewarding experience serves as a foundation from which the brain will continue to internally promote the use and re-use of these substances to achieve a pleasant high—even when it begins to consistently lead to unwanted life consequences.

Just as in the case of using individual substances in isolation, as use continues, the brain and body will become more familiar with the substance combination and will eventually adapt to the presence of the drugs. This adaptation results in what is known as tolerance—where the user will be required to increase the amount of drugs used or begin to use them more frequently to approximate the initial high.

As the body acclimates to these consistently elevated levels of substance use, physiological dependence can develop. Dependence results when the body is so accustomed to substances being available that it may begin to essentially malfunction without them. Should this occur, without alcohol and hydrocodone in the body, the user may experience high levels of discomfort and sometimes dangerous withdrawal symptoms.

Alcohol and Hydrocodone Addiction Treatment

The Need for Supervised Detox

Withdrawing from alcohol or hydrocodone alone can be a very uncomfortable experience. When the two are combined, withdrawal can be dangerous and deadly due to the severe withdrawal syndrome associated with alcohol. Withdrawing from combined use can lead to:

  • Body pain.
  • Nausea and vomiting.
  • Restlessness.
  • Agitation.
  • Hallucinations.
  • Goose bumps.
  • Increased anxiety.
  • Insomnia.
  • Confusion.
  • Sweating.
  • Seizures.

Because of the possible consequences, many will need to detox under supervision. Undergoing a period of detoxification with medical supervision will assist with comfort and safety while yielding better long-term outcomes, since cravings—and the subsequent risk of relapse—will be high during this period.

Addiction Treatment

Once detox has completed, the focus on recovery can begin, with several levels of available addiction treatment, including:

  • Inpatient hospitalization—This is a short-term program to stabilize physical health and mental health issues.
  • Residential rehab—Residential programs usually last for between 1 and 3 months with steady supervision. Daily treatments will include group counseling and individual therapy, possible medication management, and encouragement to engage in a healthy lifestyle.
  • Outpatient therapy—This includes a wide range of outpatient modalities ranging from 1 hour weekly to 6 hours daily of treatment time. Therapy will address triggers of use and methods to prevent relapse. This is a good option for those with a strong support system in place at home and is often used in conjunction with residential treatment as a continuation of care.

Many people in recovery engage in informal support groups like 12-Step meetings to gain information and support from people with similar substance-related issues.

Alcohol and Hydrocodone Use Statistics

The Drug Enforcement Administration reports:

  • More than 135 million prescriptions were filled for hydrocodone in 2013.
  • Nearly 25 million people have abused hydrocodone in their lifetime.
  • Emergency room visits related to hydrocodone increased 107% from 2004 to 2011.

Regarding alcohol use, the National Institute on Alcohol Abuse and Alcoholism reports:

  • 25% of people aged 18 and over reported binge drinking during the last month.
  • Almost 90,000 people die from alcohol-related issues each year.
  • Alcohol is linked to nearly half of all deaths from liver disease.

Teen Drinking and Hydrocodone Abuse

While both the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration report that the rates of teen drug use are stable or decreasing slightly, the ease of access to these substances and the perception that prescription drugs are safer than illegal drugs is a huge factor in the abuse of these substances. Teens unwittingly place themselves at high risk due to the amplified potency that results from mixing the drugs.

Increased preventative measures like education and family communication can lead to lower levels of substance abuse in teens, including those of prescription opioids and alcohol. Learn more about teen drug and alcohol misuse.

Resources, Articles and More Information

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