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Mixing Stimulants and Alcohol

What are Stimulants?

Stimulants are a broad class of drugs that include prescription medications and illicit drugs that increase the activity of the central nervous system that affect brain activity in a way that can make a person feel more energized, alert, and focused.

Prescription stimulants, such as Adderall (amphetamine and dextroamphetamine), Concerta and Ritalin (methylphenidate), Focalin (dexmethylphenidate), and Vyvanse (lisdexamfetamine), are prescribed to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.2 These medications are commonly misused, often by young adults who use them in efforts to improve their ability to focus and improve academic performance, hence why they are also known as “study drugs”.  Stimulant medications are also misused by shift workers to help them work through the night. Stimulants are not only known to increase alertness, but they also can speed up metabolism, and as a result can be misused by individuals who are trying to lose weight. Illicit stimulants include cocaine, amphetamine, methamphetamine (crystal meth, glass, or ice), and MDMA (also known as ecstasy or Molly).

Side effects of stimulants include the following:

  • Sleep problems
  • Deceased appetite
  • Weight loss
  • Increased heart rate
  • Increase blood pressure
  • Moodiness
  • Irritability
  • Increased aggression
  • Increased energy
  • Increased body temperature
  • Muscle tremors

Stimulants are frequently taken together with alcohol to potentiate (strengthen) euphoria and pleasure. Many individuals assume that mixing alcohol with stimulants will give them a longer high or some individuals will drink alcohol falsely assuming that alcohol will cancel out the unwanted side effects of their prescribed ADHD medications. Others believe that if they ingest stimulants and drink alcohol at the same time, they can potentially ingest more alcohol without feeling as intoxicated. All of these are false and very dangerous assumptions.4

How Does Alcohol Act in the Body?

Alcohol is a central nervous system (CNS) depressant drug that affects many neurotransmitters, including GABA (gamma-aminobutyric acid), the main inhibitory neurotransmitter of the CNS.5 Alcohol is known to slow down reaction times, cause slurred speech, poor coordination, impair concentration and memory and alter your mood and emotions. Some people often mistake that alcohol has stimulant effects on the body because it decreases inhibitions, often causing individuals to make poor impulsive decisions such as fighting, driving under the influence, and unsafe sexual practices. Alcohol also can be a “social lubricant”, meaning that is opens people up more to talk and mingle in social situations. 1

People sometimes mistakenly think that mixing stimulants with alcohol (a depressant) will cancel out the side effects of each substance.4 In reality, however, this combination only masks the effects of each substance and can lead to potentially dangerous consequences, including the risk of stimulant overdose and/or alcohol poisoning.7

Mixing Alcohol and Stimulants

One of the most dangerous consequences of combining alcohol and stimulants is an increased risk of cardiovascular toxicity, which can cause harmful consequences to your heart and circulatory system which can include the following:

  • Increased blood pressure
  • Increased heart rate
  • Increase stress on the heart
  • Risk of cardiac arrhythmias
  • Risk of heart attack.4

In addition, mixing alcohol and stimulants can lead to additional physical, psychological, and behavioral health consequences, such as:1,3,7,10

  • Serious damage to the brain and cognitive function, such as disrupting learning and memory processes.
  • Inadequate blood flow to the brain,
  • Increased drug-seeking behavior and substance use.
  • Increased strain on the kidneys, dehydration, and intensified hangover symptoms.
  • Poor academic performance and lower GPAs.
  • An increased risk of severe legal and safety problems such as DUI/DWI, vehicle crashes, dangerous risk-taking behaviors, or physical altercations.
  • An increased risk of overdose.
  • An increased risk of sudden death.

There are also specific consequences associated with combining alcohol with certain stimulant substances, such as:4,9,10

  • Combining alcohol and cocaine can lead to the production of a toxic metabolic byproduct, known as cocaethylene, which can cause further stress to your heart and increase the risk of adverse cardiovascular effects, such as a sudden heart attack even in a young healthy individual.
  • Combining methamphetamine and alcohol may be related to an increased risk of developing alcohol use disorder (AUD), the clinical term for alcohol addiction. One study showed that 77% of people who are dependent on amphetamines also have an AUD. Additional consequence of this combination can include decreased meth metabolism, leading to a higher concentration of meth in your system, which can increase the stimulating effects. Meth use is known to cause rotting teeth, paranoia, extreme weight loss, acne or sores, and meth withdrawal. Combining alcohol with meth has the potential to worsen these side effects in addition to experiencing the side effects of alcohol abuse.
  • Methylphenidate (aka Ritalin, Concerta). Combing this medication with alcohol can increase the risk of neuropsychiatric and cardiac emergencies. One study found an increased risk for suicide, death, convulsions, and cardiovascular events in students who had combined these substances.

Treating Alcohol and Stimulants Abuse

If you or someone you care about is struggling with polysubstance abuse, it’s recommended to seek proper treatment to prevent the negative effects of addiction as well as the potentially damaging consequences of combining alcohol with stimulants.

The right treatment setting for you will depend on your needs, but can include one or more of the following options:12,13

  • Medical detox. This is often the first step in the recovery process. Detox is an intervention that helps you clear your body of the misused substance and safely undergo withdrawal. The goal is to minimize side effects of withdrawal which can be done by administering medications and fluids while being in a calm, supervised setting It takes place in a supervised environment that involves medical care from physicians and other medical professionals. Medical detox can take place in an inpatient setting, where you receive 24/7 medical care and attention, or an outpatient setting, where you live at home and travel to a detox center on a regular schedule. The Substance Abuse and Mental Health Services Administration (SAMHSA) advises hospitalization or some form of 24-hour supervised medical care for people undergoing detox from alcohol as well as stimulants, due to the risk of suicidality and depression that can occur during withdrawal.
  • Inpatient rehab. This can occur on a variety of levels of intensity and durations. Inpatient care means you live onsite for the length of treatment. You participate in a variety of therapies and receive around-the-clock monitoring and care. Inpatient care can be helpful for many people, including those without supportive home environments, those who are deemed to require a high level of support, or those who have serious co-occurring mental health or medical conditions.
  • Outpatient treatment. This means you live at home and travel to rehab anywhere from one to several times per week. Depending on your needs, outpatient care can be intense and require that you attend treatment most days per week for several hours a day, or less intense and require participation for an hour or two for just 1-2 days per week. People often step down to outpatient treatment as a way of continuing their care once they have completed an inpatient stay, or they may enter it directly if it’s determined to be an appropriate placement for their needs. Since they don’t stay overnight, people who engage in outpatient care should have a strong support system and a stable living environment.

During treatment, you may participate in a variety of treatments that will be guided by your unique needs and situation. Some of the therapies and interventions you may engage in can include:14,15,16

  • Medication-assisted treatment (MAT). MAT involves a combination of medication and behavioral therapy. This provides a comprehensive, whole-person approach to treatment, according to SAMHSA.
  • Behavioral therapies. You may participate in a variety of behavioral therapies, such as cognitive-behavioral therapy (CBT), contingency management (CM), or motivational enhancement therapy (MET), which aim to address unhelpful thoughts and behaviors that contributed to your patterns of substance use.
  • Mutual support groups. This can include 12-step groups like Alcoholics Anonymous (AA) or Cocaine Anonymous, or non-12-Step groups with a secular approach, such as SMART Recovery. Many people also continue to participate in support groups after treatment has ended as a way of obtaining ongoing recovery support.

With the help of treatment, those struggling with alcohol and drugs can identify root causes of addiction and gain the tools needed to support their sobriety.

References

  1. Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., & Sutfin, E. L. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and alcohol dependence, 131(1-2), 71–77.
  2. National Institute on Alcohol Abuse and Alcoholism. (2020, November). Harmful Interactions: mixing alcohol with medicines.
  3. Turner, M. (2019). The treatment of narcolepsy with amphetamine-based stimulant medications: a call for better understanding. Journal of clinical sleep medicine, 15(5), 803–805.
  4. UC Santa Cruz Student Health Outreach & Promotion. (2016, December 29). Common alcohol & drug combinations.
  5. Costardi, J. V., Nampo, R. A., Silva, G. L., Ribeiro, M. A., Stella, H. J., Stella, M. B., & Malheiros, S. V. (2015). A review on alcohol: from the central action mechanism to chemical dependency. Revista da Associacao Medica Brasileira, 61(4), 381–387.
  6. Abrahao, K. P., Salinas, A. G., & Lovinger, D. M. (2017). Alcohol and the brain: neuronal molecular targets, synapses, and circuits. Neuron, 96(6), 1223–1238.
  7. Lakhan, S. E., & Kirchgessner, A. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain and behavior, 2(5), 661–677.
  8. Centers for Disease Control and Prevention. (2021, July 19). Polysubstance use facts
  9. Singh, A. K. (2019). Alcohol interaction with cocaine, methamphetamine, opioids, nicotine, cannabis, and γ-hydroxybutyric acid. Biomedicines, 7(1), 16.
  10. Van Zyl, P. M., Joubert, G., Fechter, L., Griesel, J., Nel, M., Honiball, A., … & Diedericks, M. (2017). Methylphenidate use among students living in junior on-campus residences of the University of the Free State. South African Family Practice, 59(4), 123-127.
  11. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (third edition): Principles of effective treatment.
  12. Substance Abuse and Mental Health Services Administration. (2019, October). Treatment options: Types of treatment.
  13. Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  14. Substance Abuse and Mental Health Services Administration. (2022, January 10). Medication-assisted treatment (MAT).
  15. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide (third edition): Behavioral therapies.
  16. Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation, 7, 143–154.