ADHD & Alcohol
Patients with ADHD have a higher overall risk of alcohol use and abuse than people who do not have the condition. People with ADHD may have a higher risk of developing an alcohol abuse disorder or engaging in substance abuse. Treating alcohol abuse in patients with ADHD requires careful consideration.
ADHD & Alcohol
Patients with ADHD have a higher overall risk of alcohol use and abuse than people who do not have the condition. People with ADHD may have a higher risk of developing an alcohol abuse disorder or engaging in substance abuse. Treating alcohol abuse in patients with ADHD requires careful consideration.
Table of Contents
What is ADHD?
ADHD, or Attention Deficit Hyperactivity Disorder, is characterized by a lack of attention and hyperactivity, including difficulty sitting still, trouble paying attention, or problems with organization.
ADHD may occur in childhood but persist well into adulthood. For adults to receive an ADHD diagnosis, they must have shown some symptoms of the disorder in childhood. However, many people, particularly those with inattentive type ADHD, will go undiagnosed throughout childhood and well into adulthood as they try to manage their symptoms.
Symptoms of ADHD
Symptoms of ADHD may include:
- Difficulty paying attention, even in situations where sustained attention would usually be required
- Trouble staying focused on tasks seen as "boring"
- Difficulty getting organized
- Trouble with executive function, including trouble "getting started" on basic tasks
- Losing track of items they need to complete routine tasks
- Impulsivity
- Difficulty sitting still
- Difficulty remaining quiet, even in situations where being noisy is inappropriate
- Trouble with self-control
People with ADHD may be more likely to engage in reckless or dangerous behaviors. In many cases, they do not see or do not think through the potential implications of those hazardous behaviors. This is because people with ADHD are often “time blind” and have difficulty picturing possible future outcomes (2).
People struggling with ADHD should consult a medical or mental health professional for treatment. Many options are available to manage ADHD symptoms in children and adults.
The Connection Between Alcohol and ADHD
There is a strong correlation between ADHD and the risk of alcohol use and abuse (3).
Patients with ADHD May Use Alcohol Earlier
According to a study performed in 2018, and severe childhood ADHD can lead to earlier alcohol abuse in some patients (4). These risks are similar across genders. Patients with ADHD may fail to realize the potential dangers of alcohol abuse or may have less fear of the consequences, even at that early age. Early alcohol use can lead to higher levels of binge drinking or greater health problems later in life.
ADHD May Increase the Risk of Alcohol Use Disorder
Patients with severe childhood ADHD may be at a much greater risk of developing alcohol abuse later in life (5). ADHD can frequently lead to impulsive behaviors and difficulty considering the future. Patients with ADHD may also be more likely to fail to realize how much alcohol they have consumed, leading to more severe effects.
Alcohol May Increase ADHD Symptoms
Often, under the influence of alcohol, patients with ADHD will show more extreme symptoms, including higher levels of impulsivity. Patients with ADHD may engage in more dangerous behaviors under the influence of alcohol than their peers who do not suffer from the condition. They may notice that they are more impulsive or have a more challenging time focusing after consuming even relatively minor levels of alcohol.
They May Have a Higher Risk of Binge Drinking
Patients with ADHD are often highly impulsive and have lower overall levels of self-control than patients who do not have the disorder. As a result, they may prove much more likely to engage in dangerous behaviors like binge drinking, despite proper education on the potential dangers.
Patients with ADHD may be less likely to realize how much alcohol they have consumed or to pay attention to warning signs that they have a high blood alcohol level. As a result, they may be more likely to drink heavily, even to the point of alcohol poisoning.
Many Patients with ADHD Try to Self-Medicate with Alcohol
Despite the risks associated with high levels of alcohol consumption, many patients with ADHD attempt to self-medicate with alcohol. Patients may see alcohol as a way to cope with some of the symptoms associated with ADHD or to decrease symptoms of anxiety, which often occur alongside ADHD.
Alcohol may also help turn off the “racing mind” often associated with ADHD and may help temporarily alleviate some other ADHD symptoms. Unfortunately, patients who use alcohol to self-medicate may have more difficulty managing their ongoing symptoms and may be more likely to engage in risky drinking behaviors over time.
Many Patients with ADHD Try to Self-Medicate with Alcohol
Patients with ADHD often describe an overall difficulty in fitting in with others. They may have trouble connecting with groups, engaging with others, or feeling like part of things. As a result, they may be more likely to give in to social manipulation or peer pressure. This may make young people, in particular, more likely to engage in risky drinking behaviors, including binge drinking.
Because they may engage in riskier behaviors when drunk, patients with ADHD may find themselves highly pressured to drink when out with friends. Adolescents, in particular, may find those behaviors amusing and may not realize their full risks.
ADHD Often Occurs Comorbidly with Other Conditions
Patients with ADHD are more likely to also have depression and anxiety (7). Unfortunately, those conditions may further increase binge drinking and alcohol addiction risk. For example, patients with high levels of depression may drink to escape that “dark cloud” feeling or to avoid persistent feelings of worthlessness.
Patients with anxiety may feel that alcohol quiets their nervous systems and helps them deal with those symptoms. Unfortunately, excess alcohol consumption can also make those symptoms much worse.
ADHD and Addiction
Patients with ADHD are, in general, much more likely to engage in a variety of addictive behaviors (6). ADHD brains, in general, crave dopamine. Unfortunately, the brain may not produce high enough levels of the substance on its own.
Addictive behaviors, including drug or alcohol consumption, may trigger that jolt of dopamine in the brain. Since the ADHD brain continues to crave that dopamine hit, the patient will continue to engage in those dangerous behaviors. Even as the impact of alcohol or drug consumption wears off and the dopamine hit becomes milder.
Often, addictive substances can create an effect that may mellow some symptoms often associated with ADHD. For example, patients with ADHD may have a greater likelihood of suffering from comorbid anxiety or depression. Patients may feel alcohol can help them cope with those symptoms or manage high-stress levels. Unfortunately, high levels of alcohol consumption can worsen stress and may lead to further complications.
Furthermore, patients with ADHD may have more difficulty recognizing potentially addictive or dangerous behaviors. Often, the ADHD brain has a hard time quantifying, regulating, and managing risk. As a result, patients with ADHD may have difficulty realizing that they have tipped from “normal social enjoyment” of addictive substances into a dangerous addiction.
They may also be more likely to engage in addictive behaviors, including gambling, shopping, internet, gaming, and more. Addressing underlying ADHD symptoms may make it easier for many patients to address those addictions successfully, decreasing their symptoms and allowing them to live more productive lives.
Alcohol and ADHD Medication
Many patients with ADHD use medications to help treat and manage their symptoms. Unfortunately, alcohol can have a negative impact on many of those medications or when combined with those medications.
Stimulant Medication
Stimulant medications are commonly used to help treat ADHD symptoms since they help increase central nervous system activity and make it easier for patients with ADHD to regulate attention and executive function. Many patients find that those stimulant medications make it much easier for them to function, especially at work or school. Unfortunately, ADHD medications and alcohol may react poorly together.
In some cases, alcohol consumption along with ADHD medication can lead to strong side effects. Many patients report racing heart rates or trouble sleeping. Alcohol can also intensify those medications’ effects, leading to increased overdose risk. Furthermore, alcohol and stimulant medications like Ritalin or Adderall used to treat ADHD can increase the risk of stroke, heart attack, and high blood pressure.
Non-Stimulant Medication
Non-stimulant medication used to treat ADHD may have fewer overall side effects when combined with alcohol. Most notably, patients who combined those medications experienced higher levels of nausea. However, combining these medications can lead to depression and other mental health problems, making concentrating more challenging and increasing ADHD symptoms.
Treating ADHD and Alcoholism
To treat alcoholism in a patient with ADHD, it is often necessary to treat both conditions. Failing to provide treatment for ADHD and any co-occurring disorders can substantially increase the risk of relapse. Furthermore, failure to address ADHD symptoms may make it more difficult for patients to rebuild their lives following that addiction.
Diagnosis
For some patients, a complete diagnosis is the first step in treating ADHD and alcoholism. Not only does the patient need to identify challenges like alcohol abuse disorder, but the patient may also need an ADHD diagnosis. Often, that ADHD diagnosis will come for the first time while getting treatment for substance use disorders. Patients not diagnosed as children may have more difficulty getting the treatment and support they need as adults, increasing the risk of self-medicating.
Having a diagnosis of ADHD often offers two benefits. First, it helps the patient understand why they experience things the way they do. ADHD may also lead to several emotional struggles, including experiencing emotion more intensely and rejection-sensitive dysphoria. After receiving a diagnosis, many patients feel better prepared to deal with the challenges they may have ahead of them.
Counseling
Ongoing counseling can help address many problems that may increase the risk of alcohol abuse disorder. Frequently, talk therapy and support can help patients address the concerns that may have led to binge drinking.
Through ongoing counseling, patients may learn how to cope better with anxiety symptoms. They also learn how to deal with depression, or better manage executive functions and other tasks. Which can help them feel more in control and less likely to turn to alcohol.
Medication
In some cases, medication can help patients address ADHD symptoms. Prescription medication, managed by a doctor, can often help patients manage executive function tasks and take care of the many challenges they may have to contend with in everyday life due to those ADHD symptoms. In some cases, medication may also help with the alcohol withdrawal process.
Support Groups
support groups of people who may have faced similar challenges. For many patients, it helps to know that they aren’t alone and that others have struggled with similar problems in the past. Patients with ADHD may also benefit from the assurance that they are not “weird.” Furthermore, support groups can provide many patients with healthy coping mechanisms that may make it easier for them to cope with future challenges.
Rehabilitation Services
Sometimes, it is necessary for patients who suffer from alcohol abuse disorder to spend time in rehabilitation before they can return to their everyday lives and those normal stressors. Support through alcohol detox can help many patients manage their symptoms more comfortably, decreasing the odds of relapse and making it less likely that patients will suffer a dangerous medical event. Rehabilitation can offer time to reset, consider life patterns, and adjust those patterns to lead to more successful relationships, jobs, and more.
Outpatient Treatment and Support
Long-term rehabilitation and support can help increase patients’ odds of making a full recovery and eliminating obstacles on the road out of alcohol addiction. Going through ongoing outpatient treatment and support can also provide patients with ADHD with outside accountability, which may help decrease the risk of relapse by imposing outside oversight.
Family Support
Often, overcoming alcohol addiction is easier when patients have friends and loved ones on their side. Often, it is helpful to go through family therapy so that family members can work through the challenges they may have faced due to a loved one’s alcohol addiction. Family members prepare to provide more comprehensive, ongoing support to a family member who may continue to struggle with that addiction or condition.
Furthermore, family therapy can help heal some of the divisions that may occur within the family during the height of alcohol addiction. With the support of family members, patients with ADHD can often more successfully overcome their addictions and deal with underlying symptoms. Family members may also be better positioned to identify rising ADHD symptoms and provide their loved ones with guidance and support in coping with those challenges.
References
[1] Magnus, W., Nazir, S., Anilkumar, A. C., & Shaban, K. (2022). Attention Deficit Hyperactivity Disorder. In StatPearls. StatPearls Publishing. Accessed from https://pubmed.ncbi.nlm.nih.gov/28722868/.
[2] Ptacek, R., Weissenberger, S., Braaten, E., Klicperova-Baker, M., Goetz, M., Raboch, J., Vnukova, M., & Stefano, G. B. (2019). Clinical Implications of the Perception of Time in Attention Deficit Hyperactivity Disorder (ADHD): A Review. Medical science monitor : international medical journal of experimental and clinical research, 25, 3918–3924. https://doi.org/10.12659/MSM.914225
[3] Smith, B. H., Molina, B., & Pelham, W. E., Jr. (2002). The Clinically Meaningful Link Between Alcohol Use and Attention Deficit Hyperactivity Disorder. Alcohol Research & Health, 26(2), 122–129. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683828/
[4] Elkins IJ, Saunders GRB, Malone SM, et al. Associations between childhood ADHD, gender, and adolescent alcohol and marijuana involvement: A causally informative design. Drug and Alcohol Dependence. 2018 Mar;184:33-41. DOI: 10.1016/j.drugalcdep.2017.11.011. PMID: 29402677; PMCID: PMC5818293. https://europepmc.org/article/PMC/5818293.
[5] Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical psychology review, 31(3), 328–341. https://doi.org/10.1016/j.cpr.2011.01.006
[6] Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current psychiatry reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6
[7] Powell, V., Agha, S. S., Jones, R. B., Eyre, O., Stephens, A., Weavers, B., Lennon, J., Allardyce, J., Potter, R., Smith, D., Thapar, A., & Rice, F. (2021). ADHD in adults with recurrent depression. Journal of affective disorders, 295, 1153–1160. https://doi.org/10.1016/j.jad.2021.09.010
