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Combining MDMA and Alcohol May Be More Dangerous Than You Think

Oct 04, 2022

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MDMA (3, 4-Methylenedioxymethamphetamine) is a potent central nervous system (CNS) stimulant that people take recreationally to alter their mood. Many people mix the drug with the psychoactive substance alcohol, which has the opposite effect on the CNS, being a depressant. However, the combination of these two substances can be dangerous and result in an overdose, plus their long-term use poses a risk of developing a substance use disorder.

MDMA and Its Side Effects

MDMA is a synthetic drug made from safrole oil and comes in tablet, liquid, or powdered form. When taken orally, MDMA takes around thirty to forty-five minute to take effect and lasts around three to six hours. The drug is illegal in the UK, being scheduled as a Class A substance. Other common names for the substance include:

  • Ecstasy

  • E

  • Molly

  • Mandy

  • XTC


The substance works by altering the activity of mood-regulating neurotransmitters (chemical messengers) in the brain, which brings about stimulatory and hallucinogenic effects. This change in chemical balance gives MDMA its empathogen properties, where users experience increased energy, empathy, emotional closeness to those around them, and pleasure.

The drug causes the increased release of:

  • Serotonin: This is the neurotransmitter that regulates mood, sleep, appetite, and sexual arousal amongst other bodily functions. Increased levels of serotonin result in elevated emotional closeness, empathy, and mood.

  • Dopamine: This chemical increases energy and reinforces behaviour.

  • Norepinephrine: Higher levels of this norepinephrine increases heart rate and blood pressure.


MDMA in tablet or powdered form comes commonly mixed with a range of other substances, resulting in unexpected reactions for users. It also comes with the risk of multiple negative side effects of MDMA itself including:

  • Sweating

  • Nausea

  • Blurred vision

  • Jaw clenching

  • Irritability

  • Impulsiveness and aggression

  • Chills

  • Muscle cramping or stiffness

  • Anxiety

  • Depression

  • Memory and attention problems


Alcohol and its Side Effects

Alcohol is a substance found in multiple drinks such as beer, wine, and liquor, made by a fermentation process using sugars and yeast. The psychoactive substance depresses the activity of the CNS, resulting in relaxation and circumstantially boosts mood.

However, some other more negative side effects include:

  • Dehydration

  • Nausea or vomiting

  • Slower or slurred speech

  • Impaired vision

  • Loss of coordination

  • Impaired judgement

  • Decreased inhibition

  • Slower reaction times and reflexes

  • High blood pressure

  • Fainting

  • Memory loss

  • Depression


Alcohol consumption increases the risk of a number of illnesses, including multiple kinds of cancer, liver disease, and cardiovascular disease. The drug has a high potential for abuse, injury, and death worldwide, with 5.3% of all deaths globally being caused by the harmful use of alcohol. In 2020, the UK alone saw 8,974 alcohol-related deaths which equates to 14 per 100,000 people.

Combining MDMA and Alcohol

According to a study published in the Journal of Addiction Research & Therapy, more than 95% of MDMA users also combine the drug with alcohol. This common combination is taken for multiple reasons such as wanting to prolong the MDMA high, wanting to counteract the adverse side effects of one to the other, or being in an environment where both substances are easily accessible.

How long these drugs stay in a person’s system depends on their age, weight, the amount taken and other health conditions they may have. The drug can still be detected by drug test up to four days from being taken, with alcohol able to be detected from twenty-four hours to ninety days depending on the type of test used.

When the two drugs are combined, they pose a significantly higher risk to the health of the user than if they were taken separately. Some of these risks include:

  • Serotonin syndrome: Both MDMA and alcohol change the levels of neurotransmitters, increasing the amount of serotonin and dopamine. Too much serotonin in the brain can result in serotonin syndrome, causing a range of symptoms including high body temperature, agitation, tremors, sweating, and in severe cases, death.



  • Dehydration: Both substances cause severe dehydration, encouraging the further intake of dehydrating alcohol. It is important for users to stay hydrated with electrolytes when consuming these drugs, though not drinking too much as this could lead to hyponatremia (water intoxication). It is also important to take regular breaks to cool down their body temperature if in a crowded place or if they are partaking in energetic activities.



  • Low mood or depression: The abnormal surge of serotonin usually results in the depletion of chemicals after the high wears off. This leads to low mood and depression, or a ‘come down’ as it is commonly referred to. For this reason, long-term use of the drug can result in the development of mental health issues such as insomnia, severe anxiety, paranoia, depression, and suicidal thoughts.



  • Organ failure and damage: A research paper found that combining alcohol and MDMA could increase the risk of damage to the brain, heart, liver, and kidneys.



  • More intense adverse reactions: The liver metabolises both of these drugs to remove them from the bloodstream. As the liver is working to remove both substances at once, they end up staying in the bloodstream for longer than if taken alone, possibly leading to stronger adverse reactions to MDMA.



  • Increased risk of an overdose: Intaking both MDMA and alcohol simultaneously can result in an overdose, particularly from alcohol. The dopamine reward pathways that are triggered from these substances encourage the drinking of more alcohol. Signs of an overdose include pale skin, difficulty breathing, seizures, unconsciousness, or unresponsiveness.


Overdosing on alcohol and MDMA can bring about a number of symptoms of different severities, with some cases needing to go to hospital. If you suspect you or someone you are with is having an overdose, contact the emergency services immediately. Treatment for an MDMA and alcohol overdose can include stomach pumping, treatment for anxiety, intubation to assist with breathing, and intravenous fluids to restore balance to water, blood sugar, and vitamin levels.

Both of these substances have high potential for addiction, though if someone does develop a substance use disorder, there are thankfully a number of research-backed therapy programs that can successfully lead to long-term recovery. A supervised medical detox in a residential treatment centre or as part of a private home detox is usually the first stage, where withdrawal symptoms from the drugs are managed to make the process as comfortable and safe as possible. A long-term treatment program is then put in place to follow, which helps manage drug cravings and prevent relapse.