Mixing ADHD Medication With Alcohol

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You go out for happy hour with your work friend and indulge in a nice espresso martini. Your phone alarm dings, and you realize it’s time to take your daily attention-deficit/hyperactivity disorder (ADHD) medication. But, while looking at the pill in one hand and the drink in the other, you pause to wonder: Should I be taking these both at the same time?

Millions of adults have ADHD in the United States. Half of those diagnosed report being prescribed ADHD medication. And I likely don’t have to tell you how many Americans drink—you know the popularity of bars, bourbon, and beer.

So, just how worried should people be about combining their daily ADHD medication with a drink or two?

When you combine any two drugs, whether it be alcohol with an aspirin or your morning coffee with a birth control pill, these drugs will interact with each other. Sometimes this ends up being harmless, and sometimes it can end up helping, like when your doctor recommends a new medication that could make your antidepressant more effective. But sometimes it can be problematic.

We know that drinking too much can lead to blackouts, comas, and even death. On average, six people die in the United States every day from alcohol poisoning alone, and that doesn’t take into account the chronic disease, drunk driving, and alcohol-related accidents that occur.

Masking How Drunk You Feel

Humans are notoriously bad at recognizing how much they should be drinking. And other drugs, like ADHD medication, can make this even more difficult to figure out. Stimulants like ADHD medication (but also the espresso in your martini!) can mask just how drunk you feel, even though they’re not actually changing how drunk you actually are.

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They do this not by actually changing how alcohol works but by tricking you. The energizing, focused feeling from medications like Adderall and Ritalin makes people feel more awake. Drowsiness is one of the most common signs that people look for to tell them when to stop drinking, so the lack of feeling tired is tricking them into thinking they haven’t had as much as they have. So people continue to refill their drinks, not recognizing just how close to overdose they are.

Drug Interactions

And that’s just what ADHD medication is doing to your drink. Alcohol can also be changing the medication in return. Alcohol increases the concentration of methylphenidate (Ritalin) along with other drugs like cannabis. This leads to more of the drug being free to cause an effect.

So, combining a drink with your daily medication could change how effective those medications actually are for your symptoms.

And this interaction could be hazardous for other parts of your brain. Adolescents who use alcohol in combination with Adderall may be more at risk for heart problems, increasing rare but life-threatening events like heart attacks.

In fact, a new drug metabolite named ethylphenidate is created when alcohol and Ritalin are combined. Little is known about this metabolite, but it is suggested to be formed when people use high doses of Ritalin. People worry about this metabolite as the combination of cocaine and alcohol does something similar, one with much worse effects, so scientists have been paying particularly close attention to it. But don’t let this cause you anxiety—this effect seems to only exist at higher doses of Ritalin, not if you’re taking a low or moderate dose of medication and periodically have a beer with dinner.

Prevalent Misinformation

While the early evidence suggests that there might be interactions between ADHD medication and alcohol, misinformation seems to be percolating faster than actual evidence.

Social media can rapidly spread both factual and patently incorrect information about drug interactions, some of which can be dangerous. Rumors include the idea that if you use alcohol while taking Adderall, you’re more likely to black out or become more dangerous.

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And while alcohol is paired with aggression, with half of all violent crimes and sexual assaults being influenced by alcohol, it doesn’t seem like ADHD medication increases that. Alcohol does enough on its own.

We see the embers of interactions between alcohol and ADHD medication, suggesting that we drug researchers need to pay more attention to it. But that’s all we know in terms of how these incredibly popular drugs mesh with each other.

Right now, the science lags behind the practice. So, should you worry, based on what we know right now? Probably not. But does what we know suggest that we should do more research? Definitely.