At Crescent City Psychiatric, we often see how alcohol, cannabis, nicotine, and prescription pain pills overlap in daily life. Having a few drinks while smoking, or using cannabis while also taking pain medication, may seem harmless on the surface. But when substances are combined, known as polysubstance use, they can have powerful effects on brain chemistry and mental health. Instead of just adding up, the effects of different substances compound, making individuals more vulnerable to mental health disorders.This overlap of multiple substances can push the brain into imbalance, often triggering conditions like mood swings, depression, and heightened anxiety.
How Substances Affect Brain Chemistry
The brain communicates through chemical messengers called neurotransmitters. These control mood, focus, energy, and stress. Some of the most important are:
- Dopamine: the “reward” chemical tied to motivation and pleasure.
- Serotonin: regulates mood, sleep, and emotional balance.
- Norepinephrine: boosts alertness, focus, and energy.
- GABA: the brain’s natural calming system that reduces stress.
When substances repeatedly alter these systems, the brain struggles to find balance, which can lead to long-term changes in mood and mental health.
When Brain Chemistry Goes Off Balance
Because these neurotransmitters play such a big role in regulating how we think and feel, disruptions can have serious consequences. When dopamine, serotonin, norepinephrine, or GABA are thrown off by repeated substance use, the brain may shift into a constant state of imbalance. This can show up as ongoing anxiety, depression, or mood swings. Sleep problems are also common, with many people struggling with insomnia. In some cases, these chemical changes can even look like symptoms of ADHD—such as trouble focusing, restlessness, or impulsivity. Over time, these struggles may worsen, making it harder to function day-to-day without treatment. Each substance influences these systems in different ways, which is why combining them creates such unpredictable and often harmful effects.
Cannabis
Cannabis interacts with the brain’s endocannabinoid system but also influences dopamine and GABA. Some people feel calm when using it, but long-term use can reduce motivation, impair memory, and increase anxiety. In vulnerable people, it can even trigger psychotic symptoms. When used with alcohol or nicotine, its effects on dopamine and cravings become stronger.
Alcohol
Alcohol increases GABA, creating relaxation, and briefly raises dopamine. But over time, heavy drinking lowers serotonin and dopamine, which can bring depression, irritability, and poor sleep. Mixing alcohol with pain pills is especially dangerous because both slow down the brain and breathing, raising overdose risk.
Nicotine
Nicotine, found in cigarettes, vapes, and pouches, powerfully boosts dopamine and increases norepinephrine, creating focus and energy for a short time. But the brain adapts quickly, leaving people anxious, restless, or irritable when they don’t use it. Nicotine is often paired with alcohol or cannabis and can strengthen cravings for other substances.
Pain Pills (Opioids)
Prescription opioids like oxycodone and hydrocodone relieve pain and create euphoria by activating the brain’s opioid system. They indirectly boost dopamine while calming stress pathways. Misuse leads to tolerance, withdrawal, and mood problems such as depression and anxiety. Combining opioids with alcohol or other sedatives is especially dangerous because it can severely slow breathing.
Why Combining Substances Raises Risks
Each substance disrupts the brain in its own way. Together, they stack their effects and make recovery harder. For example:
- Alcohol and opioids both calm the brain, sharply increasing overdose risk.
- Nicotine strengthens cravings for alcohol or cannabis.
- Cannabis and alcohol impair memory, decision-making, and emotional control.
Over time, this can show up as:
- Persistent depression or lack of motivation
- Anxiety or panic attacks
- Mood swings and irritability
- Poor focus, memory loss, or slowed thinking
- Sleep disturbances
- In some cases, psychotic symptoms
These issues often mimic or worsen mental health conditions such as depression or anxiety disorders, complicating treatment.
Path to Recovery
The good news is recovery is possible. Treatment often combines medical care, counseling, and healthy lifestyle changes. Doctors may use medications to help reset brain chemistry, while therapy provides tools for managing stress and cravings. Sleep, nutrition, and exercise also support healing.
Recognizing polysubstance use is the first step. Even if each substance seems “manageable” on its own, the combined effects can take a toll on the brain and overall well-being. With the right care, people can restore balance and improve both brain health and quality of life.If you or someone you love is struggling with substances or mental health, Crescent City Psychiatric is here to help. Our team provides compassionate, evidence-based treatment that focuses on both brain chemistry and mental health, helping you restore balance and move toward lasting recovery. With new patient appointments in Metairie and Mandeville, contact us today to learn how we can support your journey.
