Expert: Dr Billy Levin - 6/21/2011

Question
Doctor, I am a 34 y/o male, living in Australia, diagnosed with ADHD approx 10 years ago. I am literally yo-yo ing from differing drugs, dosages and side effects. I was originally prescribed Ritalin 10mg tablets (3 times a day) - problem was I metabolized it way too quickly. Therefore - drug worked min time, and drop off was felt strongly.  Doctor topped up dosages hopping to counter it and make drug last longer - but withdrawal effects increased as well, with no real benefit in desired drugs theraputic effect. rather I needed more to get same effect! Then my doctor had a compounding chemist compound the Ritalin into a slow release tablet - again no real benefit, just wore off quickly and the wear off was very noticeable.  
Then in 2003/2004 Concerta came on to the Australian market - so we tried these too. Same thing ended up happening, the higher the dose, the benefit would be felt for less and less time, but withdrawal/coming off effect would be hell (insomnia, irritability, lethargy ect). Doctor then prescribed anti-depressants to counter downers - but after doing my own research into this (in regards to drug interactions) I found the anti depressant was actually countering/nullifying Concertas actual benefit.
I recently changed psychiatrists - no one seems to know how to help me!! I am back at university trying to complete my undergraduate bachelors degree (economics/marketing bachelors degree).
I am having massive issues with ups/downs, procrastinations ect... I have (and I am not proud or happy I am doing this) started playing with Concerta/Ritalin/Alcohol (small shots 5ml to enhance Drugs effects). I am aware this is not sustainable nor a good approach - but can I do? I am so damned frustrated, I had previously avoided taking the drug as an upper but recently I'm using more and more this way - and I know it's not good! It plays havoc with me afterwards as I spiral down.
I am taking 1 x 36mg Concerta in the morning (with L-Tyrosine 1000mg), then within 1-2 hours 5x10mg Ritalin tablets (with/out alcohol shot) whilst eating fruit (apples/complex carbs) + sugar free energy drinks, then pending what I'm doing - if I am studying (which is most days), I wait for the down feeling and then take another 4-5 10mg Ritalin tablets (making sure I eat something low sugar - pref natural and raw fruit), lunch same thing but take a 36mg + 18mg Concerta followed within 1-2 hours 5x 10 mg Ritalin tablets ( + vitamins, b-vitamins, L-Tyrosine 1000mg, L-Carnatine 1000mg, Gingo Bilko supplement 1000mg) then same thing wait for down/spiral effect top up with corresponding amount of Ritalin. This continues throughout the day.
The overall effect is I am able to study and focus well - but if I over do it then I become 'hyper focused'. Also I find I am not able to interact well with others, very nervous, very irritable - but not aggressive - just subdued and I find I need to be doing something productive with a purpose -as in reading, writing or doing something that's structured and makes me think - my thinking is clear and rational - I am not 'wired high' with excess energy or anything of the sort. To come down (now this is what I really don't like) iI am drinking alcohol to counter the down/withdrawal effects and help me sleep. I am drinking pre-mixed vodka-cola-flavored drinks or just downing shots of sambuca liquor in quick succession.
In a long winded question - what should I do? I find the Ritalin working but I am taking a lot - and it's effects
keep changing from day to day (pending what I'm eating - carbs, sugar, types of food ect and actual physical
activity level). Sometimes more works and I am now finding myself - for the first time chasing a 'feeling' - which I am really not comfortable with, BUT the alternative without  meds is being spacey, unreliable, cloudy, in a haze, very distracted, always eating and unproductive.
I need to know 1. Is the fast metabolizing normal/can it be managed better with better drug management, 2. Should I leave the Concerta altogether (it's really expensive here) and just take Ritalin only, 3. Can other drugs act as a prolonger for the drug 4. Is there  a better/more long term way to deal with the downer effect rather than alcohol?
Please- any advise or direction u give me will be helpful, I am committed to work towards a healthy productive lifestyle but I need to know what and how to do it! Rather than the trial and error approach I've had for the last 10 years.
(background info: I am married with 2 small kids (5&2) - as u can imagine my mood/energy swings in temperament , attitude play havoc. My wife is supportive but from my own perspective - I really don't like the effects this is having on my developing relationship with my kids - ie one mins affectionate/playful next irritated, angry and mood wise aggressive (not physically).
Please help - I am at wits end!!,,,
Regards
frank (34 year old male - Australia)
supportive as my wife is I really want to be able to sustain a proper

Answer
Please forgive me I am certainly not going to help you on the interner. Your description suggests total chaos,misuse and possibly abuse of medications made worse by the unacceptable use of alcohol that can only make the medication less effective. Antidepressants as you stated making matters is also not possible.  The only senseble advice I can give is to see a medical expert to solve your problems. Only correct titrated monitored and optimal doses work. Never should a layman without any medical qualifications be let loose with medication. Who prescribes these dosages and medicatins for you. Get expert help.