What symptoms can occur when alcohol is used during withdrawal from Adderall (amphetamine‑dextroamphetamine)?

Alcohol Use During Adderall Withdrawal: Symptom Profile

Combining alcohol with Adderall (amphetamine-dextroamphetamine) withdrawal creates a complex clinical picture dominated by overlapping central nervous system effects, though neither alcohol withdrawal nor amphetamine withdrawal has a clearly defined abstinence syndrome with specific pharmacologic treatment.

Understanding Amphetamine Withdrawal

• Amphetamine withdrawal does not produce a clearly defined abstinence syndrome with specific physical withdrawal symptoms like those seen in alcohol, opioid, or benzodiazepine withdrawal. 1

• The most common symptoms during amphetamine/stimulant withdrawal include agitation, sleep disturbance, and mood changes that improve gradually over time in a supportive environment. 1

• Depression or psychosis can occur less commonly during stimulant withdrawal, requiring close monitoring and specialist consultation when present. 1

• Research in adolescent populations shows that central stimulant withdrawal symptoms are prevalent, though the exact symptom profile can be complicated by polysubstance use. 2

Alcohol's Impact on Withdrawal Symptoms

• Heavy alcohol use has been shown to exacerbate withdrawal symptoms from other drugs, including stimulants, creating a more severe and prolonged symptom burden. 2

• When alcohol is consumed during Adderall withdrawal, patients may experience overlapping symptoms from both substances: anxiety, irritability, agitation, tremors, sleep disturbance, and mood dysregulation. 3

• Alcohol withdrawal itself produces autonomic hyperactivity (tachycardia, hypertension, sweating, tremors), nausea, vomiting, anxiety, irritability, and in severe cases hallucinations or seizures—symptoms that typically begin 6-24 hours after the last drink and peak at 3-5 days. 3

Cardiovascular Risks of Combined Use

• The concurrent use of Adderall and alcohol creates a potentially dangerous situation with serious cardiovascular adverse effects, including documented cases of acute myocardial infarction in adolescents and young adults without cardiovascular risk factors. 4, 5

• Adderall causes α-adrenergic stimulation leading to vasoconstriction and increased peripheral resistance, plus β-adrenergic stimulation increasing heart rate and stroke volume—effects that can be unpredictably potentiated by alcohol. 6

• Clinical cardiovascular manifestations include tachycardia, hypertension, chest pain, and in severe cases myocardial ischemia or infarction. 4, 5, 6

Central Nervous System Effects

• The combination produces hyperactivity, tremors, agitation, anxiety, and sleep disturbance from both the stimulant withdrawal and alcohol's effects. 3, 2, 6

• Hyperthermia, mydriasis (dilated pupils), and seizures can occur with Adderall toxicity, which may be present if the patient recently used the medication. 6

• Mood disturbances including depression, irritability, and dysphoria are common during stimulant withdrawal and can be worsened by concurrent alcohol use. 1, 2

Management Approach

• No specific medication is recommended for amphetamine withdrawal treatment; management focuses on symptomatic relief in a supportive environment. 1

• Benzodiazepines are the gold standard for alcohol withdrawal and can address overlapping symptoms of agitation and sleep disturbance from both substances. 3

• If alcohol withdrawal is present (tremor, autonomic instability, anxiety), initiate benzodiazepines using long-acting agents like diazepam 10 mg orally 3-4 times daily or chlordiazepoxide 50-100 mg loading dose. 7, 3

• Thiamine 100-300 mg/day must be administered to all patients with alcohol use to prevent Wernicke encephalopathy, given before any glucose-containing fluids. 7, 3

Critical Pitfalls

• Do not assume symptoms are solely from one substance—polysubstance use creates overlapping and potentially synergistic effects that complicate the clinical picture. 2

• Maintain high suspicion for cardiovascular complications (chest pain, abnormal ECG) in patients who have recently combined Adderall and alcohol, even in young patients without risk factors. 4, 5

• Psychiatric consultation is mandatory after stabilization for evaluation of substance use disorders, mood disorders, and long-term treatment planning. 7, 3

• Monitor closely for depression or psychosis during stimulant withdrawal, as these less common complications require specialist input. 1