Adderall, a prescription stimulant used to help treat the symptoms associated with attention-deficit hyperactivity disorder (ADHD), is the brand name for a combination of four amphetamine salts that target chemicals and nerves in the brain relating to impulse control and hyperactivity.

When Adderall is taken as directed by people with ADHD, it can be extremely useful. However, if it is not taken within its strict dosage limits or when it is ingested by someone who does not have ADHD, it can quickly become addictive and lead to serious, potentially permanent health problems.

When people think about Adderall misuse and abuse, many envision high school and college students taking it in large doses or unprescribed as a kind of “study drug” to improve academic performance, to keep them awake and alert longer to stay ahead of due dates and deadlines.

And while this is perhaps the most publicized form of Adderall abuse, this same age group also frequently misuses Adderall in a different, possibly even more dangerous way: taking Adderall with alcohol. In a 2013 study on prescription stimulant misuse, more than 46 percent of the surveyed college students who reported using Adderall non-medically had also been taking it with alcohol.

While regular alcohol use has been normalized in the United States and Adderall is a medication that comes from a doctor and is, therefore, perceived as safe, the side effects of mixing these substances are anything but safe and can easily prove deadly. But what are the effects of mixing alcohol and Adderall? Is drinking on Adderall life-threatening?

How Does Adderall Work?

There are many different chemicals in your brain and central nervous system, which are called neurotransmitters, that perform a variety of important functions. The main two that are most affected by Adderall are norepinephrine, which helps speed up brain activity to keep you focused and alert, and dopamine, which provides mild feelings of pleasure and euphoria as a reward to motivate the brain to remain on task and complete the desired task to get more dopamine.

People with ADHD are generally thought to have either lower levels of these specific chemicals or faulty receptors that don’t produce them properly. This is where Adderall comes in, boosting the levels of these neurotransmitters and making the receptors more efficient.

Like many other stimulants, Adderall does this in two main ways: first, it enters the brain and binds to the norepinephrine and dopamine receptors, activating them over and over to produce an excess of both chemicals.

The second way in which Adderall works is by blocking a process called reuptake. Reuptake is what happens after the brain releases a certain amount of neurotransmitters and, once they have fulfilled their purpose and are no longer needed, reabsorbs to be used again later.

Adderall inhibits this process, stopping the dopamine and norepinephrine from being absorbed, which means that their effects last longer and allows the levels of both chemicals to build up in the brain synapses, along with all the extra dopamine and norepinephrine Adderall also produced.

How Does Alcohol Work?

Alcohol is a general term in chemistry that refers to any organic compound with a particular chemical structure. There are several chemicals in the alcohol family, but there’s only one that’s safe for human beings to consume in moderation. Drinking alcohol, called ethanol or ethyl alcohol, is an organic chemical that’s produced naturally when yeast causes the fermentation of sugar. It’s thought that humans developed the ability to drink alcohol so they could eat fruit that had fallen to the ground and started to ferment. 

Still, alcohol has a profound effect on your body, despite your ability to consume it. Many medications come with the warning that they shouldn’t be taken with alcohol. But how does alcohol work in your body? When alcohol is consumed, it’s absorbed into your bloodstream through digestion. Your liver will go to work removing as much as it can from your blood, but drinking more than one drink in an hour can cause some alcohol to get past that filter. 

Once alcohol is in your bloodstream, it’s distributed throughout your body, including your brain. It can affect several other organs as well. In the brain, alcohol works as a central nervous system depressant, which means it slows down activity in your nervous system. It does that by interacting with a chemical messenger in your brain called gamma-aminobutyric acid (GABA). 

GABA is a neurotransmitter that’s involved in rest, relaxation, anti-anxiety, and sleep. It works by binding to GABA receptors and slowing down activity in your nervous system. Alcohol, like other depressants, increases the effectiveness of GABA in your brain. It makes GABA temporarily more effective when it comes to causing sedation, drowsiness, and anxiety release.

However, many people that drink alcohol may also report feeling excited, energized, and social, which seems like the opposite of what a depressant would do. Alcohol has several complicated effects on the brain. One of its effects that may cause these invigorating feelings is its effects on dopamine. Like Adderall, alcohol can increase dopamine activity in the brain, which accounts for the rewarding energizing feeling alcohol causes. 

Alcohol is complicated, and its effects on the brain aren’t fully understood. But its various effects and the way it can put a strain on your liver are why many medications may clash with alcohol.

Why Do People Take Adderall With Alcohol?

The combined use of multiple addictive substances for recreational or nonmedical purposes is known as polysubstance abuse. In many cases, people who take Adderall with alcohol are not necessarily purposefully meaning to engage in polysubstance abuse.

Despite its increasing notoriety within the past two decades, many people still underestimate the possible dangers associated with Adderall. This is especially true of teens and young adults, the most common demographic for both Adderall use as well as abuse.

Because it is a prescription medication, rather an illicit stimulant like cocaine, people are much more likely to ignore possible health risks and use warnings. Someone with an Adderall prescription may have a couple of drinks at a party, not realizing the potential consequences of doing so.

But this is not always the case, as a recent survey found that 19 percent of people who had been prescribed Adderall for their ADHD had intentionally misused it while taking alcohol.

The most common reasons for someone to engage in polysubstance abuse is usually to either strengthen the desired effect shared by these substances or use one drug to counteract the effects of the other.

In the case of Adderall and alcohol, it’s the latter. Alcohol is nearly the exact opposite of Adderall. It is a central nervous system (CNS) depressant that creates feelings of sedation and intoxication in users by slowing down activity in the central nervous system. While Adderall speeds up mental functions and certain bodily functions like heart rate, alcohol, conversely, slows them down.

Stimulants, however, tend to be stronger than depressants, which means that when taken in a large enough dose, Adderall can mask the depressant effects of alcohol. In short, many people mix Adderall and alcohol because the energizing stimulant effects of Adderall keeps them from feeling drunk, which means that they can keep drinking more for longer.

Of course, this does not mean that someone taking both substances is not actually getting drunk, they’re just not feeling the effects, which can have extremely serious consequences.

What Are the Side Effects of Taking Adderall With Alcohol?

As previously mentioned, Adderall dulls the sedative effects of alcohol that keeps you from being able to drink to the point of an overdose, greatly increasing the risk of alcohol poisoning. Even though alcohol and Adderall have the opposite effect on your body, they both require the same liver enzymes to be broken down, overwhelming the liver to the point of poisonous toxicity and potential liver failure. But can Adderall kill you when combined with alcohol?

Because someone will most likely not be able to feel the early signs of an alcohol overdose, they may not realize they are in danger until more extreme signs associated with a fatal overdose manifest, including:

  • Loss of consciousness
  • Uncontrolled vomiting, even while unconscious
  • Respiratory failure
  • Organ failure
  • Coma
  • Death

Apart from a possibly lethal alcohol overdose, perhaps the most dangerous side effect caused by taking Adderall with alcohol is what it can do to your heart. The two substances are each exerting opposite influences on heart rate, with Adderall trying to speed it up while alcohol slows it down. This push-and-pull places a significant amount of strain on the heart, which can lead to:

  • Dangerously high blood pressure
  • Heart palpitations
  • Arrhythmia
  • Heart attack
  • Stroke
  • Heart failure
  • Seizures

These effects generally come on very suddenly, which again makes them much more likely to result in death before the person experiencing these symptoms can receive emergency medical attention.

The side effects of taking Adderall with alcohol, quite simply, can kill you. Even the side effect that people who mix the two are trying to achieve, masking the symptoms of excessive alcohol use, comes with an extremely high risk of death from alcohol poisoning.

Addressing Substance Use Disorders

Polydrug use, like taking Adderall and alcohol at the same time for recreational purposes, can be a sign of a substance use disorder. Many people that develop addictions need to be treated for more than one substance. Sometimes, people with alcohol use disorders may start taking Adderall to help treat anxiety, not knowing that mixing the two can be dangerous. Common mental health issues are also common alongside substance use problems, and both problems need to be addressed for treatment to be effective.

If you feel like you might have a substance use problem, you can start to address it by speaking to a doctor or an addiction treatment professional. The first step is to assess your needs and to find the best first step in treatment for you. For many, medically managed detox is an important first step, especially among people that become dependent on alcohol. Because alcohol can be dangerous during withdrawal, it’s often necessary to go through withdrawal with medical help. Adderall may also cause some uncomfortable symptoms. 

You may progress through inpatient and outpatient treatment programs with a variety of therapy options that can help you learn to deal with substance use problems and any underlying issues like anxiety.

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