Hydrocodone and Alcohol

A Dangerous Combination

Table of Contents


Hydrocodone is a semisynthetic, moderately potent, orally available opioid. It is typically used therapeutically in combination with non-narcotic compounds. As a Schedule II drug, hydrocodone is considered to have a high risk of addiction and may lead to severe psychological or physical dependence if abused. However, hydrocodone is also considered to have currently accepted medical uses. As such, hydrocodone (sometimes containing acetaminophen or ibuprofen) is used as a medication or supplement to manage acute pain (severe enough that alternative, non-opioid treatment options are inadequate), as well as to treat symptoms of the common cold and hay fever in combination with decongestants, antihistamines, and expectorants (cough suppressants). Hydrocodone is available in tablet, capsule, and syrup formulations and typically does not result in a high. If abused, hydrocodone induces side effects similar to those of opium, or heroin:

Hydrocodone vs Oxycodone

Hydrocodone and oxycodone are both classed as Schedule II semi-synthetic narcotics (opioids) because they are each synthesized from a naturally occurring compound derived from the resin of poppy seeds. Narcotic by definition refers to opium, opium derivatives, and their semi-synthetic substitutes. Hydrocodone–marketed under trade names such as Hysingla (hydrocodone alone) and Vicodin (hydrocodone and acetaminophen)–is synthesized from codeine. Oxycodone–marketed under trade names such as OxyContin (oxycodone alone) and Percocet (oxycodone combined with acetaminophen)–is synthesized from thebaine. Regarding effects, both create feelings of relaxation, as well as physiological effects including pain relief, sedation, respiratory depression, papillary constriction, and cough suppression.


Taking hydrocodone combination medications on one’s own rather than with medical advice from a practitioner licensed to administer such medications is considered abuse; as does crushing, chewing, snorting, or injecting dissolved hydrocodone tablets–which results in the uncontrolled delivery of the hydrocodone and can result in overdose and death! While withdrawal and tolerance are the hallmarks of dependence, their presence doesn’t necessarily indicate abuse. In fact, the American Society of Addiction Medicine defines addiction, as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences, which drives the use of substances or behaviors that become compulsive and [may] continue despite harmful consequences.

How Opiates Affect the Brain

Many drugs that interfere with the function of neurotransmitters (chemical messengers) in the brain have some impact on the brain’s reward processing center and pathway and are thus inherently addictive. For instance, opiates are incredibly addictive because they directly interact with the body’s opioid system, which controls pain, reward, and addictive behaviors, via three opioid receptors: mu, delta, and kappa. Prescription opioid pain relievers like oxycodone and hydrocodone have the same molecule fragment as the endorphins that bind to mu-receptors. As such, these drugs compete with natural endorphins for mu-receptors, disrupting the further production of endorphins in short term use and additionally disrupting the production of mu-opioid receptors in long term use. Endorphins normally activate mu-receptors to slow central nervous system (CNS) functions (i.e. breathing rate), impact mood, and produce a painkilling effect. In the short term, the use of hydrocodone produces a spike in dopamine levels. Over time, the body becomes increasingly tolerant and less affected by the opiate, which may lead to taking more and other drug-seeking behavior.

Identifying Hydrocodone Dependence

Even when used responsibly and as prescribed (i.e. in the smallest effective dose and as infrequently as possible), hydrocodone is highly addictive because of interference with the balance of chemicals in the brain. Dependence upon hydrocodone looks like psychological addiction, including anxiety and insomnia, and physical addiction, including dizziness, vomiting, blurred vision, nausea, nasal congestion, and tightness in the chest.


Hydrocodone is dangerous and an overdose can be fatal even if it is not used with other substances. That said, hydrocodone may strengthen the effects of other opiate agonists, and other medications, including:
Product labels for hydrocodone combination drugs often warn that hydrocodone may impair the mental and/or physical abilities required for the performance of some tasks (i.e. driving a car, operating machinery). Alcohol and other CNS depressants may also produce an additive CNS depression when taken in combination with hydrocodone. When hydrocodone is taken as an extended-release product, there is a higher risk for overdose and death due to the larger amount of hydrocodone present. If hydrocodone and alcohol are consumed simultaneously, severe drowsiness, respiratory depression, coma, and even death may occur. Perhaps less seriously, this combination may cause severe drowsiness, breathing problems, and decreased awareness–essentially, resulting in a condition where there is an increased risk to themselves or others and unable to ask for help. Additionally, all substances, including hydrocodone and alcohol, are metabolized by the liver. Like drinking a lot of alcohol, long term use of hydrocodone containing acetaminophen may cause severe liver damage. Clearly, the combined consumption of these substances is not in the liver’s best interest!


If you have taken hydrocodone for a long time or at high doses, you should be weaned off hydrocodone slowly to prevent serious side effects of physical withdrawal. Opioid replacement therapy, or medical detox, can help with the physical reactions of opiate withdrawal. Hydrocodone and alcohol are both addictive drugs that when abused produce many negative and potentially life-threatening side effects. A history of excessive alcohol and hydrocodone use may be a co-occurring disorder and should be treated by professional help, particularly from a recovery center that specializes in dual diagnosis for addiction to alcohol and hydrocodone. Programs specializing in these disorders provide holistic therapies instead of treating one at a time. Detox is typically not a sufficient treatment for addiction, so comprehensive substance abuse programs are necessary to prevent relapse and support long-term recovery from hydrocodone addiction and alcoholism.


  1. https://www.dea.gov/sites/default/files/2020-04/Drugs%20of%20Abuse%202020-Web%20Version-508%20compliant-4-24-20_0.pdf
  2. https://www.dea.gov/sites/default/files/pr/multimedia-library/publications/drug_of_abuse.pdf
  3. https://pubchem.ncbi.nlm.nih.gov/compound/Hydrocodone#section=Drug-and-Medication-Information
  4. https://www.ncbi.nlm.nih.gov/books/NBK548700/
  5. https://www.asam.org/Quality-Science/definition-of-addiction
  6. https://www.sciencedaily.com/releases/2007/10/071014163647.htm
  7. https://www.jneurosci.org/content/35/41/13879

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