Managing Medications

Maximize the Benefits of Your Teen’s Stimulants

Combining ADHD stimulants with other drugs compromises symptom management and poses an array of health risks to teens with attention deficit.

Research has not concluded whether teens and young adults with attention deficit disorder (ADHD or ADD) are at greater risk than their peers for substance use and misuse. But the fact remains that all teens are at some risk for drug and alcohol use, and those taking prescribed psycho-pharmaceuticals are at greater risk.

Some think stimulant medications pose little concern because they have no “build up” period. Compared to, say, antidepressants, stimulants are here today, gone tomorrow. So it seems reasonable that the medication your teen took in the morning would be eliminated from the body by the time he or she took a drink or lit a cigarette after school. However, combining stimulants with alcohol, marijuana, benzodiazepines, or nicotine presents immediate and long-term health risks for teens and adults.

Stimulants Mask the Effects of Alcohol

Combining a depressant (alcohol) with a stimulant cancels out the effect of each. Ingesting alcohol along with stimulants is a recipe for alcohol poisoning. Stimulants mask the symptoms of alcohol intoxication by increasing alertness, awareness of one’s surroundings, and memory, all of which gives a teen the impression that he is less drunk than he is.

If teens continue to consume alcohol thereafter, they may drink well past their individual safe thresholds before sensing danger. Alcohol also raises the threat of stimulant overdose by muting the physical and emotional signs that a lethal or near-lethal dose has been consumed.

The danger doesn’t end after stimulant washout, regardless of whether your teen is taking short-acting or extended-release medication. The medications stick around well after the noticeable effect has ended. Short-acting stimulants have a half-life of around 11 hours, meaning that every 11 hours stimulant levels in the body are reduced by half. So, a 20 mg dose is reduced to 10 mg at hour 11, to 5 mg at hour 22, and 2.5 mg at hour 33. This means that consuming alcohol within a 24-hour period during which stimulants have been taken can raise the risk of elevated blood pressure, seizures, anxiety, and even psychosis.

[Free Resource: Boost Your Teen’s Executive Functions]

Marijuana: Working Against Stimulants

Marijuana use, which is more common now than ever before, also masks behavioral expressions of stimulant misuse, especially agitation and aggression. Clinically significant levels of THC, the major psychoactive ingredient in marijuana, may remain in the body for up to 72 hours. While the idea of a “weed hangover” is controversial, THC-induced brain fog, headache, and fatigue are possible within a 72-hour elimination period. Regular use of pot can make it difficult for the client and the prescriber to differentiate between the symptoms of an ongoing hangover, a clinically significant depression unrelated to marijuana use, and the waning efficacy of a prescribed stimulant. That makes it much harder for anyone to know how well your stimulant is working, and how much more (or less) to prescribe.

Marijuana poses a second threat to the treatment of clients with ADHD. While some teens and young adults claim that pot improves their focus and reduces their hyperactivity, our experience in working with lots of college students suggests a more likely outcome: lethargy. The effects vary from one strain to another, but the primary effect of marijuana is to mellow out its user. For ADHD teens trying to take medication and modify behavior to function better in school and at work, being chill is not a recipe for success. When we ask clients to abstain for a period of time so we can get their meds right, many of them drop out of treatment or seek a prescription elsewhere. Not admitting to drug use is a bad idea when someone is prescribing the use of other mind-altering substances.

Benzodiazepines: The Pinball Effect

Like alcohol, benzodiazepines (lorazepam, alprazolam, diazepam, clonazepam) can mask signs of stimulant overdose. Doses of benzodiazepines that are used to “come down” from a stimulant high are sometimes higher than the recommended dosage of this class of medication. Worse, this can set up the teen or young adult for an abrupt discontinuation of these drugs, which can, in severe situations, lead to seizures, and in worst cases, death.

As with marijuana, the misuse of benzodiazepines counteracts the positive effects of stimulant use in terms of attention, motivation, and performance. While a small number of clients may need these drugs once in a while, as “rescue meds” for panic attacks or severe anxiety, chronic use in a client who also uses stimulants may create a pinball effect between over-stimulation and rescue, particularly if the meds are taken outside a carefully controlled regimen.

[What You Should Know About ADHD Meds if You Have a History of Substance Abuse]

Nicotine, Caffeine: Too Much Stimulation

Nicotine was long ago dubbed a “gateway drug” to other substances, and that title may not be far off, particularly with regard to stimulant abuse and dependency. This is because all stimulants, including nicotine, enhance dopamine levels and activity in the brain, which may increase feelings of awareness. In fact, nicotine administered through a transdermal patch has been shown to improve symptoms in adults with ADHD. It has not been used as a treatment, however, because of its many negative side effects. When starting treatment for ADHD, teens and young adults should be cautioned about the risk of upping their stimulant intake by nicotine use. The negatives include agitation and excess focus, as well as cardiovascular risks, like high blood pressure and stroke.

Many with ADHD have, before seeking treatment, found caffeine helpful. But “therapeutic” doses of caffeine don’t work as well as stimulants and have more side effects. We’ve required some clients who overuse caffeine to detox before we move forward with medication. After they’re treated, we caution them to consider all caffeine use as an additional dose of stimulant medication. For most teens and adults, the implication of a slightly elevated blood pressure and heart rate—the side effects of stimulant medications—is negligible. However, it becomes more dangerous when combined with energy drinks, caffeine tablets, or pre-workout supplements.

Most adolescents and adults who are prescribed stimulants are trying to decrease the frequency and severity of their ADHD-related impulsivity, low motivation, and lack of mindfulness. Combining stimulants with any other substance can derail those goals.

[ADHD and Caffeine: Does Caffeine Work as a Treatment for Attention Deficit Disorder (ADD)?]

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