Use of Stimulants in the Treatment of ADHD and the Risks of Alcohol Consumption

Stimulants include both prescribed medications and illicit drugs. They act on the central nervous system (CNS), increasing its activity by interacting with neurotransmitters such as dopamine and norepinephrine. These effects promote greater alertness, energy, and focus (1).

Prescribed stimulants, such as dextroamphetamine, methylphenidate, and lisdexamfetamine, may be indicated for the treatment of ADHD (attention-deficit/hyperactivity disorder) and narcolepsy. Although effective, they can cause various adverse effects. Among the most common are sleep problems, reduced appetite, weight loss, increased heart rate and blood pressure, irritability, mood swings, and, in more severe cases, aggression or muscle tremors (1).

Many individuals mix these substances with alcohol in an attempt to enhance euphoria or reduce the unwanted side effects of alcohol (2). However, the interaction between stimulants and alcohol can mask alcohol intoxication, leading to excessive alcohol consumption. Additionally, it amplifies cardiovascular effects, such as elevated blood pressure, increased heart rate, and a higher risk of arrhythmias and heart attacks (3).

For individuals with ADHD, studies suggest that proper treatment with prescribed stimulants can reduce the risk of alcohol and substance abuse disorders (4). This protective effect occurs because individuals with ADHD often exhibit greater impulsivity and a dysregulated reward system, characteristics that increase the likelihood of seeking immediate relief through risky behaviors, such as alcohol and drug use (5).

Although the risks associated with mixing alcohol and stimulants for ADHD treatment are already known, there is still a need for further studies to fully understand the interaction mechanisms between these substances and their long-term consequences. Future research may help clarify these effects and contribute to more effective strategies for the prevention and management of patients using these medications.

References:

1. Farzam K, Faizy RM, Saadabadi A. Stimulants. [Updated 2023 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539896/
2. Barrett, S. P., & Pihl, R. O. (2002). Oral methylphenidate-alcohol co-abuse. Journal of clinical psychopharmacology, 22(6), 633–634. https://doi.org/10.1097/00004714-200212000-00020
3. Barkla, X. M., McArdle, P. A., & Newbury-Birch, D. (2015). Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature. BMC psychiatry, 15, 270. https://doi.org/10.1186/s12888-015-0657-9
4. Hammerness, P., Petty, C., Faraone, S. V., & Biederman, J. (2017). Do Stimulants Reduce the Risk for Alcohol and Substance Use in Youth With ADHD? A Secondary Analysis of a Prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate. Journal of attention disorders, 21(1), 71–77. 
5. Luderer, M., Ramos Quiroga, J. A., Faraone, S. V., Zhang James, Y., & Reif, A. (2021). Alcohol use disorders and ADHD. Neuroscience and biobehavioral reviews, 128, 648–660. https://doi.org/10.1016/j.neubiorev.2021.07.010