Xanax and Adderall
Xanax and Adderall are two of the most widely prescribed (and popularly misused) psychiatric medications in America. Xanax has reached a point of such cultural dominance that The New York Times wrote of “the United States of Xanax,” while the ubiquity of Adderall prompted another in-depth piece on “Generation Adderall.”These two medications help manage certain conditions that millions of people struggle with, but as a result of their mechanisms of action, they also carry the risks of abuse and addiction. Additionally, intentionally mixing these medications for the sake of a combined high can be a dangerous mix—one that can pose risks to both their mental and physical health as well as their overall well-being.
How Xanax Works
- Xanax is a commonly prescribed benzodiazepine, a type of drug that works by boosting the activity of a particular neurotransmitter in the brain. The neurotransmitter in question is gamma-aminobutyric acid, or GABA, for short.
- People with excessive excitatory signaling or brain activity may experience anxiety, sleep disturbances, and other conditions associated with excessive excitement in the brain. GABA works to inhibit such brain activity and can elicit a sense of calm and drowsiness.2 This makes Xanax an effective tool in managing issues such as generalized anxiety disorder (a condition marked by excessive apprehension and worry about everyday events) and panic disorder (recurrent and unexpected panic attacks).
- The influence that Xanax exerts on GABA neurotransmission makes the drug effective for those who need it; however, the same boost in GABA that proves to be so therapeutic for people with conditions such as panic disorder and generalized anxiety disorder is also associated with a neurochemical process that can support the development of addiction, especially when the drug is misused and/or taken recreationally.1,3
- Benzodiazepine use can cause surges of dopamine, the neurotransmitter in the brain that is associated with reward and commonly linked to addiction, because the release of GABA inhibits the interneurons that normally stop excessive dopamine release. This causes a dopamine spike, and while other drugs of abuse cause dopamine surges via different mechanisms, the impact of the brain’s reward center is the same.Taking too much Xanax can also result in a number of adverse health effects.
Xanax is considered relatively safe when used as prescribed; however, misuse of the drug can be incredibly risky and result in serious health consequences. Xanax abuse occurs in a number of ways. People may:4
- Take another person’s medication.
- Take more Xanax than prescribed or in ways other than directed.
- Use Xanax to get high.
When someone begins abusing Xanax, they will often feel sleepy and clumsy, for example they may stumble or fall when trying to walk.2
- Taken in high doses, Xanax can cause a euphoric high but may also lead to hostility, extreme drowsiness, depression, confusion, and impaired reflexes.
- As a central nervous system depressant, abuse of Xanax may cause respiratory depression and severe sedation, especially when mixed with alcohol, opioids, and other CNS depressants (e.g., barbiturates, prescription sleep aids, other benzos).4
- The combination of these substances can slow a person’s heart rate and breathing patterns to dangerous levels, resulting in overdose, respiratory arrest, coma, and death.4 Overdose from benzodiazepines is increasingly common—almost 9,000 people died from this class of drug in 2015 alone.4
- Abuse may also quickly increase tolerance (or the need to increase the dose to feel the desired effects). It may also cause a rapid development of physical dependence (the body’s reliance on the substance to feel normal) which, once established, could result in the onset of potentially severe withdrawal symptoms when the dose is reduced or the drug is discontinued completely.3
Tolerance and physical dependence will develop to some degree even with normal prescription use, which is why medications like Xanax are intended for short courses of use that should be monitored closely by the prescribing physician.
In this manner, doctors are able to help to make careful and safe dose adjustments to account for tolerance and can help to ensure a safe withdrawal for their dependent patients who wish to get off Xanax. Those who misuse Xanax may increase their doses continually on their own in order to combat tolerance, subjecting themselves to ever-growing risks and severe physiological dependence. They may also be unaware of just how dangerous withdrawal can be and attempt to go cold-turkey on their own, a move that can threaten their lives.
Withdrawal symptoms can be quite serious and may include:1
- Dysphoria and other mood changes.
Xanax alone has numerous risks and side effects, especially when misused. People may compound these risks when they combine their use of Xanax with other substances, such as Adderall. This all-too-common practice of mixing “uppers” with “downers” can result in a number of additional risks to an individual’s health.
How Adderall Works
On the other end of the drug effects spectrum is Adderall, a brand name for a prescription stimulant medication that combines amphetamine and dextroamphetamine. While benzodiazepines like Xanax work by calming activity in the central nervous system (CNS), Adderall is prescribed because it stimulates certain physiological processes, making people feel energetic, alert, and productive.
While Xanax targets GABA, Adderall primarily influences the activity of two neurotransmitters—dopamine and norepinephrine. An increase in dopamine activity accompanies a person doing something pleasurable or rewarding. By doing so, it reinforces that action and often leads to a sense of anticipation to do that activity again. Norepinephrine also plays a role in the stimulating effects on the body and leads to:8
- A sense of increased energy.
- Less need for sleep.
- Lower appetite.
Like Xanax, Adderall has legitimate medical uses. It is prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) as well as the sleep disorder narcolepsy.7 When used as directed in people with ADHD, users may feel more focused and able to concentrate than they normally would while experiencing a relief from hyperactivity and restlessness.
Much like Xanax, Adderall is an effective medication when used as intended but can be abused. People may misuse the drug by:8
- Taking more of the drug than directed.
- Taking the drug in ways other than intended, such a crushing the tablets and snorting them.
- Taking someone else’s prescription.
Adderall has become a widely misused drug on college campuses and in the high-stakes corporate world, where students and executives have to perform mentally taxing activities with little sleep.2
- Adderall is so prevalently misused on college campuses that it has become known as a “study drug,” with fulltime college students being more likely to take Adderall to help them with their academics than people of the same age who are not in college. In a 2016 study, 9.9% of college students versus 6.2% of noncollege peers abused Adderall in the prior year.
- Because Adderall is legal to use with a prescription, it has replaced cocaine as the go-to substance for people on the Wall Street circuit and in law firms, who have to work through weekends and retain a mercilessly competitive edge over their coworkers and competitors. Adderall use is also increasing with professional athletes and even older people looking to sharpen their cognitive skills and otherwise misuse the drug for its positive effects.2
- Unfortunately, many users who become hooked on Adderall will continue to take the drug, convinced that the euphoric effects they remember from their first dose will help them feel better again. Instead, as they increase their doses to offset a growing tolerance, they expose themselves to even greater risks.
People who abuse Adderall may be subject to:8
- Hypertension (high blood pressure).
- Tachycardia (increased heart rate).
- Arrhythmia (irregular heart rhythm).
- Hyperthermia (high body temperature).
- Inability to sleep.
- Poor nutritional status from chronic lack of appetite.
- Anger, violence, and paranoia.
- Increased risk of stroke.
Medical issues associated with Adderall abuse—such as dangerously high body temperature, dehydration, cardiac abnormalities, and seizures—may all contribute to severely compromised health and, in some cases, death.8
People abusing Adderall might do so on long binges where they consume high doses for long periods of time. Frequently, once the binge ends, a crash follows, during which the user might suffer from:8
- Intense Adderall cravings.
- Erratic sleep schedule.
- Anxiety and irritability.
- Inability to experience happiness (anhedonia).
- Suicidal thoughts or actions.
Due to its potential for abuse (and the risks associated with such abuse), Adderall is a Schedule II controlled substance.7 As a Schedule II controlled substance, the DEA recognizes the legitimate medical uses of Adderall, but puts restrictions on its production, distribution, and use and warns that there is a high potential for abuse and dependence.
Mixing Adderall and Xanax
- There are people who take Xanax and Adderall at the same time in an attempt to enhance or modify the effects of either drug alone. In fact, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), stimulant use disorders commonly co-occur with sedative use disorders.
- So, people regularly take Adderall and Xanax together, but why? What are people trying to achieve by mixing these prescription drugs that induce very different effects?
- Different people will have different motivations for combining drugs. Some people believe that Xanax and Adderall together will “level out” the effects of each individual medication. For example, if someone has been using Adderall all day to study for an exam, but now needs to relax enough to fall asleep, they may take Xanax for its sedative effects.11 Similarly, someone abusing Xanax to relax might take an Adderall before going to work or school to increase their ability to pay attention and focus. Others may simply take both to see if it will give them a more intense high.
- The idea of combining uppers (stimulants) and downers (sedatives) in the form of medications mirrors the practice of “speedballing,” taking heroin and cocaine at once. Adderall and Xanax may not be illegal drugs, but the dangers of combining them are similar. The body may struggle to contend with the physiological extremes that such a combination elicits.
- Mixing Adderall and Xanax is very risky for a number of reasons. Using stimulants and sedatives simultaneously could increase the risk of an overdose because users may find themselves less able to pace their consumption, often overcompensating for whichever effect is stronger at the time. As one drug masks the effects of the other, higher levels of intoxication are likely.12
- A person taking large amounts of Adderall and Xanax might not be able to perceive the effects the drugs are having on their heart, their respiration, or their coordination and may be more prone to the harmful effects as well as accidents and injuries because they don’t realize just how intoxicated they have become.2,12
- Withdrawal may be severe as well. Any person who is physically dependent on sedatives and stimulants should receive a thorough evaluation from a substance use disorder specialist to assess the need for detox. Detoxification from Xanax is sufficiently serious on its own (with the potential for seizures and other complications), but when you add one or more substances, withdrawal may be even more complex and distressing.
- During withdrawal from Xanax and Adderall, an individual could experience extreme anxiety and panic, unmanageable sleep problems, irritability, aggression, and the possibility of seizures.13 With a potentially severe side effects profile, the combined acute withdrawal syndrome may require professional medical support. A medical detox program may be the safest environment in which to address polysubstance dependence.13
- Someone preparing for college finals or a major event at work may not think twice about combined use of Adderall and Xanax, but every step of the way, the practice is problematic. Work and studying are important, but your safety should always be at the top of your priority list. If you find yourself unable to cope without reaching for Xanax and/or Adderall, there is help. Reach out today.
- Drug Enforcement Administration. (2013). Benzodiazepines.
- National Institute on Drug Abuse. (2016). Research Report Series: Misuse of Prescription Drugs.
- U.S. National Library of Medicine: DailyMed. (2018). Xanax.
- National Institute on Drug Abuse for Teens. (2017). Prescription Depressant Medications.
- Substance Abuse and Mental Health Services Administration. (2014). Emergency departments see increased visits involving the nonmedical use of sedative alprazolam.
- Drug Enforcement Administration. (2017). Drugs of Abuse.
- U.S. National Library of Medicine: DailyMed. (2016). Adderall.
- National Institute on Drug Abuse for Teens. (2017). Prescription Stimulant Medications (Amphetamines).
- National Institute on Drug Abuse. (2016). Drug and Alcohol Use in College-Age Adults in 2016.
- PBS.com. (2014). Adderall not cocaine: inside the lives of the young wolves of Wall Street.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- The Government of South Australia. (n.d.). The Dangers of Mixing Drugs.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.