Mixing Alcohol and Stimulants: Risks, Effects, and Dangers

What are Stimulants?

Stimulants are a broad class of drug that include prescription medications as well as illicit drugs—all of which increase certain types of central nervous system (CNS) activity by interacting with various neurotransmitters, including dopamine and norepinephrine. This can make individuals feel more alert, energized, and focused.³

However, misuse of certain stimulants—which in their various forms may be encountered as pills, powders, rocks, or dissolved into solution for injecting—can have a range of adverse effects, including confusion, paranoia, restlessness, seizures, rapid breathing and heart rate, elevated blood pressure, and increased risk of stroke and heart attack.^3,4

While prescription stimulants are widely regarded as safe and an effective treatment for individuals with conditions such as attention-deficit/hyperactivity disorder (ADHD) or narcolepsy, they are classified as Schedule II substances under the Controlled Substances Act due to their high potential for misuse.^3,5

Commonly prescribed stimulants include:³

• Dextroamphetamine (Dexedrine).
• Dextroamphetamine/amphetamine combination medications (Adderall)
• Methylphenidate (Ritalin and Concerta).

Additionally, while there are some limited medical uses for other stimulants like cocaine and methamphetamine, a lot of what’s encountered on the illicit market is illegally manufactured, non-pharmaceutical forms of methamphetamine, amphetamines, cocaine, and MDMA (ecstasy).^6,7

Individuals may misuse stimulants for different reasons, including to produce a sense of exhilaration, enhance self-esteem, improve memory and mental or physical performance, reduce appetite, prolong wakefulness for an extended period, or to get the “rush” of euphoria often reported by individuals who use prescription and illicit stimulants.^3,7

While the effects of stimulants vary, depending on substance, dose, and route of administration, the acute effects may include:⁴

• Euphoria.
• Alertness.
• Insomnia.
• Reduced appetite.
• Increased heart and respiratory rates.
• Elevated blood pressure and body temperature.

At higher doses, stimulants may cause additional adverse effects. Again, effects are dependent on the substance, the dose, and the route of administration but may include:⁴

• Confusion.
• Paranoia.
• Aggression.
• Overactive reflexes.
• Muscle pain and weakness.
• Restlessness.
• High fever.
• Sweating.
• Tremors.
• Stroke.

When prescription stimulants—such as Adderall, Concerta, and Dexedrine—are used concurrently with alcohol, the mixture of substances may cause dizziness, drowsiness, impaired concentration, and increase the risk of heart problems.⁸

Illicit stimulants aren’t always used alone. It is common for individuals, who use cocaine or amphetamines, for instance, to also drink alcohol.^7,8 In fact, one study found that 74% of individuals who used cocaine had a history of also using another substance, and 80% of individuals who used amphetamines also used another substance.⁹

While alcohol and stimulants may be used simultaneously for recreational purposes, combining stimulants and alcohol can be dangerous and cause life-threatening consequences.⁴

Is Alcohol a Stimulant or a Depressant?

At the start of a drinking session, when blood alcohol levels begin to rise, some of alcohol’s intoxicating effects may appear subjectively stimulatory; however, alcohol is, in fact, a CNS depressant. Through its various interactions with different neurotransmitter systems, alcohol can have pronounced sedating effects as blood alcohol levels continue to rise.^10,11

Individuals sometimes mistakenly think that mixing stimulants and alcohol may somewhat balance out the effects of each substance.¹ What is more likely to happen when individuals combine stimulant substances and alcohol is that the onset of sedative effects that might otherwise lead someone to slow or stop drinking become somewhat delayed.¹¹ Masking the effects of one or both drugs in such a manner could lead an individual to take more of one or both substances, which puts them at a greater risk of injury and health consequences, including overdose.¹

Dangers of Mixing Stimulants and Alcohol

As previously mentioned, mixing stimulant drugs with alcohol can have unpredictable, even-life-threatening effects. One of the most serious health consequences associated with combining stimulants and alcohol is the increased risk of cardiotoxicity, which can cause harmful effects to the heart and circulatory system.^2,8

Cardiovascular Consequences

The use and misuse of stimulants alone can impact cardiac functioning.¹² The mixture of stimulants and alcohol can increase some of these risks and may be more likely to lead to potentially catastrophic cardiovascular issues. These effects may include:^2,13,14

• High blood pressure.
• Elevated heart rate.
• Irregular heart rhythm.
• Increased myocardial oxygen demand.
• Heart attack.
• Stroke.

Other Physical, Psychological, and Behavioral Consequences

The mixture of stimulants and alcohol can have other dangerous consequences, including:^1,2,11,15

• Sleep problems.
• Cognitive functioning issues, including problems with memory and verbal learning.
• Increased drug-seeking behavior and substance use.
• A greater risk of severe safety problems, such as driving under the influence, crashing a vehicle, participating in risk-taking behaviors, and getting into physical altercations.
• Sudden death.
• Overdose.

Consequences Associated with Mixing Alcohol and Specific Stimulants

Certain stimulant types are associated with more specific substance-related health issues when mixed with alcohol.¹⁵ These include:

Cocaine. Using cocaine and alcohol together can produce a toxic metabolite byproduct called cocaethylene, which can increase blood pressure and heart rate more than cocaine alone.¹⁶ In fact, cocaethylene increases the risk of serious health effects, including sudden death from lethal heart attack and stroke as well as serious liver problems.⁴

Methamphetamine. Research indicates that methamphetamine and alcohol are often used together. Data shows that approximately 77% of individuals diagnosed with amphetamine dependence also have an alcohol use disorder.¹⁵ Studies also suggest that alcohol inhibits meth metabolism, which means a higher concentration of meth remains in the blood, which can increase the stimulating effects on the brain and heart.^2,15

Methylphenidate (Ritalin and Concerta). One study indicates that individuals taking methylphenidate—a commonly prescribed medication for the treatment of ADHD—in conjunction with alcohol, consumed significantly more alcohol than when they used alcohol alone.¹⁷

Treatment for Stimulant and Alcohol Addiction

Compulsive polysubstance use is a prevalent issue, however treatment is available. Effective treatment must address the simultaneous intoxication and withdrawal from multiple substances as well as additional co-occurring mental health conditions and other physical health issues.¹⁴

If you or someone you love struggle with polysubstance misuse, it’s recommended to seek treatment to prevent the negative effects of addiction as well as the potentially damaging consequences associated with combining stimulants with alcohol.

The right treatment plan depends on your specific needs, which can be thoroughly assessed by your primary care physician, a mental healthcare professional, or an addiction treatment specialist, and may include one or more of the following:¹⁸

• Detox. Medical detox is often the first step in a more comprehensive treatment plan. Detox helps you clear your body of the substances while you safely undergo withdrawal under the supervision of healthcare professionals, who can keep you as comfortable as possible.
• Inpatient rehab. Inpatient care, sometimes referred to as residential treatment, requires you to live onsite for the duration of treatment so you can receive around-the-clock monitoring and care. Treatment typically involves a combination of interventions, including psychoeducation, individual and group counseling, and behavioral therapies.
• Outpatient treatment. While providing access to a range of treatment approaches similar to that of inpatient programs, outpatient treatment allows you to live at home or in a sober living environment while you receive treatment. Outpatient programs vary in terms of intensity and length. Depending on your needs, you may attend treatment several hours each day, most days of the week, or you may go to the facility for a couple of hours, a few days each week. Sometimes individuals, who had been in an inpatient or residential program, step down to an outpatient program as part of their comprehensive treatment plan.

Regardless of the setting, some of the interventions utilized during treatment for polysubstance misuse may include:^18-21

Medications. Medications for addiction treatment, used alongside behavioral therapies is considered best practice and the most effective treatment for certain substance use disorders. There are not currently any medications that have been approved in the treatment of stimulant use disorder. However, there are several medications that have proven effective in treating alcohol use disorder, which may be effective in treating polysubstance use involving stimulants and alcohol.

Behavioral therapies. You may participate in a variety of behavioral therapies that will help you identify the unhelpful thoughts and behaviors that contributed to your substance use and teach you coping skills to change those behaviors and thoughts, manage stressors, and avoid relapse. Some of the commonly used behavioral therapies used in the treatment of alcohol and stimulant use disorders include cognitive-behavioral therapy (CBT), contingency management, motivational interviewing (MI), and family therapy.

Mutual-help groups. 12-step groups, such as Alcoholics Anonymous (AA) or Cocaine Anonymous, or other secular groups like SMART Recovery can be helpful in the treatment of polysubstance use. These nonclinical, nonprofessional exchanges of support among peers working toward recovery from drugs and alcohol can aid in a person’s long-term recovery.

If you’re ready to get help, call American Addiction Centers (AAC) at . You can speak to one of our knowledgeable admissions navigators, who can listen to your story, answer your questions, explain your treatment options, and help you begin your journey to recovery.