Two prescription bottles overturned with blue and yellow pills spilling out on the table with a white background representing America's epidemic of prescription drug overuse.

Xanax and Adderall are two of the most popular medications in America. Xanax has reached a point of such cultural dominance that The New York Times wrote of “the United States of Xanax,” and Adderall is so widely used that the Times ran an in-depth piece on “Generation Adderall.” Even though the two drugs have different effects for different purposes, recreational users have taken to combining them, risking two radically different but nonetheless deadly forms of drug abuse.

How Xanax Works

Xanax is a benzodiazepine, a type of drug that works by boosting the effects of a particular neurotransmitter in the brain. The neurotransmitter in question is gamma-aminobutyric acid, or GABA, for short. As a neurotransmitter, GABA sends messages in the form of electrical signals between the brain and the nervous system. GABA’s message is to calm the activity of nerve cells in the central nervous system; people who have an imbalance of nervous activity in their system struggle with depression, anxiety, stress, and other disorders, such as those experienced by women who have severe premenstrual syndrome, known as premenstrual dysphoric disorder. For many people, their brains are capable of producing enough GABA levels to restore optimum functioning of those nerve cells; for many other people, their brains cannot produce enough GABA for this to happen, leaving them with conditions like social anxiety disorder, panic disorder, bipolar disorder, etc., so they need medication to help them.

Xanax works, and is effective and popular, because it stimulates GABA production in the brains of people who cannot produce enough GABA on their own. When the drug goes into effect, there is an increased amount of GABA activity in the brain, which helps users feel calm and relaxed. A side effect is that users feel sleepy and tired. While this is beneficial to people with a form of an anxiety disorder, the feeling of peace is also desirable for people who do not need Xanax, but who want to experience the sensations nonetheless, whether as a form of self-medication or simply recreationally.

Xanax is a strong substance, however. For people who have normal GABA levels, introducing a benzodiazepine into the mix is a bad and risky idea. Unnecessary alprazolam can trick the brain into reducing its own levels of GABA, making even less of the neurotransmitter naturally than was the case before, leaving users to think that they should take more of the Xanax to feel the tranquil effects that everybody else talks about. Of course, this serves only to cut off all natural GABA production, making it impossible to feel any peacefulness without Xanax.

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Xanax Abuse

People who take Xanax without legitimate medical need will still feel an initial rush of euphoria, as the benzodiazepine hits their brain and triggers their reward and pleasure centers. But benzodiazepines like Xanax (sold generically as alprazolam) are intended as a short-term medication to treat severe anxiety, not open-ended “uppers” to alleviate bad moods. Even with a medical setting, Xanax should be taken for no longer than four weeks, as it is an incredibly potent medication and could become habit-forming after continued exposure.

Xanax’s addictiveness is complemented by its effectiveness. It takes less than 30 minutes for the euphoric and initially sedating feelings to kick in, and the effect wears off after a few hours, compelling users to take more Xanax. For recreational users, it is simply a matter of trying to experience the powerfully relaxing sensation that comes with the GABA boost; for people who have legitimate medical needs, increasing their dosage provides relief (however short-lived) for their condition. However, if users increase their Xanax consumption, they run the risk of developing a tolerance for the drug (that is, more and more is required to feel the same effect).

How Adderall Works

On the other end of the spectrum is Adderall, the brand name for a combination of amphetamine and dextroamphetamine; both are stimulants. While benzodiazepines like Xanax work by calming the unbalanced electrical activity in the central nervous system, Adderall is prescribed because it excites the CNS, making people feel active, alert, and productive. While Xanax targets GABA, Adderall goes for dopamine, another neurotransmitter. Dopamine is produced by the brain when a person does something pleasurable, and it creates the sense of anticipation to do that activity again.

Under normal circumstances, the dopamine is reabsorbed by the brain, which coincides with the interest in the activity naturally waning. However, stimulant drugs (whether legal or illegal) force the brain to produce more dopamine than it usually would, and they actively prevent the brain from reabsorbing dopamine, so the feeling of pleasure and the desire for more last for an artificially long period of time. For people who experience this, the sensation of gratification is beyond anything they have felt before, and it drives them to experience it again.

Like Xanax, Adderall has legitimate medical uses. It is prescribed for the treatment of narcolepsy (inability to regulate sleep patterns) and attention deficit hyperactivity disorder. Precise doses of Adderall increase the flow of neurotransmitters to the brain, allowing users to enjoy more focus and concentration than they have when experiencing their ADHD symptoms.

But the effects of increased mental acuity prove desirable to a lot of people for nonmedical uses. Adderall has become a widely used drug on college campuses and in the high-stakes corporate world, where students and executives have to work mentally taxing jobs with little sleep. So abused is Adderall on college campuses that it has become known as a “study drug,” with fulltime college students no older than 22 being twice as likely to take Adderall to help them with their academics than people of the same age who are not in college. Because Adderall is legal to purchase, 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 Abuse

Much like Xanax, Adderall can become very addictive, both for people who legitimately need its stimulant effects to get through their sleep or attention disorders and for people who want the euphoria and chemical excitement. As with most drugs, it is possible to develop a tolerance for Adderall; that is, the brain becomes used to the constant stimulation and adapts to the new normal, so addicted users have to consume more and more Adderall to try and feel the same effects they did when they first started taking it. If a user who does not have sleep or attention problems subjects their brain to constant doses of Adderall, that user is in danger of radically altering their brain’s neurocircuitry, causing drastic changes to behavior and the development of mental health issues like depression. Chronic Adderall use can also lead to suicidal ideation and behaviors, which may compound with pre-existing stress issues for people who take Adderall off-label.

Unfortunately, most 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, because of drug tolerance, they expose themselves to even greater risks of addiction and psychological damage.

Abuse and risks like these are what have prompted the Drug Enforcement Administration to place Adderall on its Schedule II list of controlled substances, subjecting the drug to the second highest level of restriction and enforcement. Schedule II acknowledges legitimate medical uses of Adderall, but warns that because there is a high potential for abuse, and the risk of severe physical and psychological dependence on Adderall, prescriptions are required to obtain Adderall.

Not withstanding the respective risks of the individual drugs, there are people who combine their Xanax consumption with Adderall, or vice versa. They often do so because they have severe anxiety or panic disorders and are under the impression that the sedative effects of the alprazolam and the stimulant effects of the amphetamine/dextroamphetamine combination will offer greater relief together than apart.

Another reason is that people often think that using Xanax and Adderall together will “level out” the effects of each individual medication. If the stimulant effects are too strong, they might take Xanax, or increase their pre-existing consumption of Xanax, to balance out the excitement and hyperfocus. Similarly, if they feel withdrawal effects from not taking Adderall like insomnia and anxiety, they might try a depressant like Xanax to try and reduce the distress.

In terms of specific use, Xanax has not been approved by the Food and Drug Administration to treat sleep disruptions. Even though alprazolam can cause drowsiness, as it almost certainly will due to the way it stimulates GABA production to calm central nervous system excitation, taking Adderall to feel more alert and active will not achieve the desired effect.

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Mixing Adderall and Xanax

Mixing Adderall and Xanax is very risky for a number of reasons. Adderall interacts with many different drugs, and if a user is prescribed Adderall, it is safer to increase or decrease the dosage of the Adderall by itself than to add new medications to the mix. The idea of combining uppers (stimulants) and downers (sedatives) in the form of medications mirrors the practice of “speedballing,” following an illegal stimulant like cocaine with a deadly sedative like heroin; however, both methods are laden with dangers. Users are often not aware of how much of a drug they are taking and often veer too much toward increasing either their stimulant or their sedative intake. The effects of stimulants tend to be stronger than those of depressants, so a person might not think they are experiencing the calm and peace associated with a benzodiazepine like Xanax and take more Xanax as a result; then, they may take more Adderall to try and balance things out again.

Going back and forth between stimulants and sedatives increases the risk of an overdose because users are unable to pace their consumption, often overcompensating for whichever effect is stronger at the time. Additionally, taking Xanax and Adderall in combination puts users at risk for heart damage. Adderall speeds up heart rate while the GABA boost from Xanax tells the heart to slow down. Mixing these two drugs can lead to heart dysrhythmias (irregular beating rhythms) or even heart failure.

Using both Adderall and Xanax can decrease the effectiveness of both drugs since the effect of one can cancel out the effect of the other. People in the practice of combining the drugs further endanger themselves by increasing their consumption, never finding the spot where both effects are in harmony.

The problem speaks to the inherent danger of what happens when people mix Adderall and Xanax. They are trapped between two powerful magnets, which work very well when taken properly but can be devastating when taken recreationally. If you feel tempted to try one drug because the effect of the other is “too strong,” your doctor will almost certainly recommend a lower dosage of the drug you are currently on. This is the best way to address any concerns about the impact of your current medication. Mixing it with another medication is always risky, and mixing it with a medication that is designed to have a very different effect will cause significant physical and psychological disruption.