Drugs that are classified as central nervous system stimulants accelerate the firing rates of the neurons in the brain and spinal cord. These drugs have very useful medicinal purposes, such as to treat sleep disorders; to address attention deficit hyperactivity disorder (ADHD); to treat lethargy that can be associated with traumatic brain injury, stroke, hormonal imbalances, or other metabolic conditions; as aids to help individuals lose weight; and to increase wakefulness or concentration. Some of these medications include:
- Amphetamines that are used in diet medications or for the treatment of ADHD
- Drugs like Ritalin (methylphenidate)
- Many antihistamines
- Methamphetamine (meth or crystal meth)
- MDMA (ecstasy)
Some of these drugs are controlled substances, such as cocaine, whereas others can be bought over the counter, such as antihistamines and even some mild stimulants that are used in over-the-counter diet pills. The majority of stimulant drugs have at least some effect on the neurotransmitters dopamine and norepinephrine, although other neurotransmitters may certainly be involved. Stimulants typically increase the effects of these excitatory neurotransmitters.
By contrast, alcohol is a central nervous system depressant drug that is believed to have its primary effects on the inhibitory neurotransmitter GABA (gamma aminobutyric acid) and the excitatory neurotransmitter NMDA. Alcohol use increases the availability of GABA and decreases the functioning of NMDA. Alcohol use also activates the neurotransmitter dopamine, as do most drugs that have abuse potential.
Alcohol is the second most commonly abused drug in the United States behind nicotine products. It is also the most common drug that is mixed with other drugs when individuals abuse illicit substances, even when individuals use or abuse drugs specifically designed for medicinal purposes.
Mixing Alcohol and Stimulants
Research data looking at the effects of mixing drugs suggests that it is not rare for individuals who abuse alcohol to also take stimulant medications. Most often, the use of alcohol in conjunction with a stimulant medication is undertaken to reduce the effects of the stimulant medication (take off the edge or the shakiness associated with stimulants while at the same time maintaining high levels of energy and euphoria). Some individuals may use stimulants to deal with the lethargy associated with heavy alcohol use, but this is less common.
College students who abuse stimulant medications that are normally used to treat ADHD are also notorious for drinking alcohol in conjunction with abusing these stimulants (by snorting them). The labels of prescription stimulant medications and even over-the-counter medications strongly urge users not to consume these medications with alcohol.
There are numerous potential interactions that can occur when one uses central nervous system stimulant drugs and alcohol in conjunction with each another.
- Alcohol negates the medicinal effects of a stimulant drug. When an individual uses a stimulant with alcohol, more of the stimulant is required to experience its medicinal effects.
- Individuals who abuse stimulant medications like cocaine, methamphetamine, or Ritalin with alcohol also experience a dampening of the effects of the stimulant that can lead to them taking more, even to the point of overdosing.
- Likewise, the stimulant medication reduces the effects that are commonly associated with drinking alcohol. This means that individuals may not feel intoxicated and may continue drinking to the point of developing serious issues, such as alcohol poisoning or an overdose. The research reported by SAMHSA indicates that people who drink alcohol in conjunction with stimulants often drink far more alcohol than they can tolerate. Typically, individuals suffer from the effects of excessive alcohol use when using both drugs as opposed to the excessive effects of stimulant abuse.
- The combination of alcohol and stimulant medications severely reduces an individual’s cognitive capacities far more than the use of either drug alone. Individuals will experience a more rapid decline of their ability to control their behavior, inhibit emotions or urges, make decisions, solve problems, and even pay attention to issues. Often, these individuals have very poor emotional control and become irritable and aggressive.
- The physical effects of combining these drugs can inhibit an individual’s ability to walk, perform routine functions, and operate machinery, such as driving a car. Combined with a lack of judgment or insight as a result of using these drugs, this makes performing a normal activity like driving, operating a stove, a power tool, etc., potentially dangerous.
- Combining stimulant medications and alcohol leads to an increased risk to develop seizures, stroke, high blood pressure, and/or heart attack.
- The combination also leads to increased burden on the kidneys, liver, and gastrointestinal system. This can lead to issues with ulcers, kidney disease, and liver disease (fatty liver, alcoholic hepatitis, and cirrhosis).
- Long-term use of alcohol and stimulant medications reduces the effectiveness of the immune system and can increase the person’s likelihood of contracting infectious diseases.
- The risk of contracting numerous forms of cancer is increased by combining these drugs over the long-term.
- Long-term neurological conditions can result, such as issues with movement, attention, and memory.
- Chronic abuse of any type of drug is associated with an increased potential to develop some other form of mental illness. Chronic abuse of different types of drugs in combination increases this risk. This includes chronic use and abuse of alcohol and stimulant drugs. The risk for psychotic experiences is also increased.
- Tolerance rapidly develops to both alcohol and stimulant medications. This means that individuals will begin to consume more and more of both of these drugs in order to experience the effects they once achieved at lower doses. This can be a particularly dangerous situation, and it can lead to overdose and an accelerated path to physical dependence.
- The withdrawal syndrome that commonly occurs as a result of stimulant abuse is more psychologically based with individuals experiencing issues with depression, apathy, motivation, and cravings. Going through withdrawal from alcohol in addition to the emotional crash associated with discontinuing stimulants can be particularly dangerous for people who are emotionally unstable. They may engage in potential self-harm and suicide attempts, or be more prone to accidents.
- The withdrawal syndrome associated with alcohol can be potentially fatal as a result of seizures. Using stimulant medications in conjunction with alcohol in large amounts also increases the potential for seizures, which can be potentially fatal.
- Chronic use of both of these drugs in conjunction can lead to a faster path to the development of a substance use disorder that can be particularly complicated (having a combined alcohol use disorder and stimulant use disorder).
Special mention should be made regarding combining cocaine and alcohol. When individuals combine cocaine with alcohol, the liver produces a substance called cocaethylene. The substance is produced as a result of the interaction between cocaine and alcohol in the system, as the liver attempts to metabolize alcohol first and then cocaine later. Cocaethylene is an extremely toxic substance that is not eliminated at the same rate as other drugs. It is associated with numerous physical and mental effects, including increased susceptibility to heart disease, liver damage, and neurological disease and disorders.
Individuals who develop substance use disorders are suffering severe distress, functional impairment, and problems controlling use of their drugs of choice. These individuals often have numerous ramifications of their drug abuse, including problems in their personal relationships, at work, at school, with the law, etc. The nature of substance use disorders is often paradoxical, such that individuals with severe substance use disorders rationalize their substance use even though their entire world is falling apart. They often view their substance use as beneficial or normal for them, whereas everyone else readily observes the devastation that using drugs and/or alcohol causes them. This is why individuals need professional assistance to help them deal with these issues.
One of the most common excuses for continued substance abuse is that individuals believe they can stop at any time and that the results of drug abuse, even combining potentially dangerous drugs like alcohol and stimulants, do not occur until someone has abused them for years. This is not true. For example, a case study presented in the Journal of the American Board of Family Medicine documented the situation of it 20-year-old male college student who had been using the prescription stimulant medication Adderall for the treatment of ADHD. This person was healthy, young, and active, but they combined alcohol with their Adderall and suffered a heart attack. These types of interactions are not as rare as many individuals believe.
Treatment for substance use disorders follows an organized approach that has been developed because of empirical evidence to suggest its effectiveness. Individuals who abuse more than one substance on a regular basis need an even more targeted approach. In addition, individuals who abuse more than one substance on a regular basis often have other co-occurring disorders (other types of psychiatric/psychological disorders) that also need treatment at the same time.
The protocol for individuals who chronically abuse stimulants and alcohol consists of an in-depth evaluation of the person’s functioning at all levels (physical, psychological, and social). This would identify all issues that need to be addressed in the overall treatment plan and help clinicians develop a comprehensive treatment plan for the individual. The protocol would include:
- Detox: It would likely begin with some form of physician-assisted withdrawal management. This process typically involves an addiction medicine physician monitoring the recovery of the individual as they abstain from drugs and controlling withdrawal symptoms with medications on a tapering schedule (most likely a benzodiazepine).
- Medication: As the individual goes through the withdrawal management process, they are given smaller doses of the medication at specified intervals to wean them off it. This helps them discontinue their drugs of choice without experiencing significant or dangerous withdrawal symptoms.
- Therapy: While the withdrawal management protocol is being implemented, individuals often become involved in some form of behavioral intervention, such as therapy or support group participation.
- Aftercare: Once the withdrawal management and intensive treatment program is completed, the individual needs to become involved in an intensive aftercare program. Aftercare programs typically consist of one or more of the following:
- Substance use disorder therapy (the cornerstone of the recovery program)
- Participation in peer support groups, such as Alcoholics Anonymous
- Family therapy
- Alternative therapies like music therapy
- Continued medical management of issues as needed
- Continued treatment of any co-occurring disorders
- Drug screenings: Successful aftercare programs should have some way of objectively monitoring the individual’s abstinence via random drug and alcohol screenings.
Individuals in recovery are always at an increased risk for relapse, no matter what stage of recovery they are in. This even applies to the individuals who have been abstinent for a decade or longer, though the risk of relapse declines sharply after an individual has been abstinent for seven years.
For the vast majority of individuals who are successful in long-term recovery programs, their recovery becomes part of their lifestyle. They maintain participation in treatment-related activities, such as community or peer support groups, and this participation continues throughout their lives.