Drought–flood abrupt alternations (DFAAs) have a greater impact on ecosystems and socioeconomic environments than lone droughts or floods. Despite the significant impact of DFAAs, research has paid little attention to their evolutionary characteristics, particularly in relation to vegetation growth in the Heilongjiang River Basin. Therefore, this study focuses on the Heilongjiang River Basin and employs the DFAA Index to identify and analyze abrupt alternation events from 1970 to 2019. It also examines the annual and interannual distributions of vegetation growth changes from 2000 to 2019, based on the Normalized Difference Vegetation Index. Lastly, it utilizes correlation analysis to investigate the responsive relationship between vegetation growth and DFAA events. The results indicate the following: (1) Within the Heilongjiang River Basin, the number of drought-to-flood events increased over time, whereas the number of flood-to-drought events decreased over time. The frequency of mutation was relatively high in the northern region, low in the eastern region, elevated in spring and summer, and reduced in winter. (2) The Normalized Difference Vegetation Index was lowest in January, highest in July, and approximately 0 during the winter. The vegetation coverage reached its peak during the summer. (3) Vegetation changes in response to DFAAs exhibited a significant time lag. Vegetation changes in spring–summer lagged behind DFAA events by 3–4 months, while in summer–autumn, the lag was approximately 3 months. These results are of great significance for the early warning and prevention of DFAAs in the Heilongjiang River Basin.