What is ADHD?
More likely than not, you know or have known someone with attention deficit/hyperactivity disorder or ‘ADHD.’ ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. About five percent of people with ADHD continue to have functionality issues into their adult years. A key indicator of adult ADHD is that the symptoms occur in multiple settings: both at home and at work or in school. Given nearly 30 million people in the United States have alcohol use disorder (also known as ‘AUD’), and 10.5 million people have adult ADHD, it’s important we discuss the connection between the two conditions.
While there are public questionnaires that can be used to identify adult ADHD, the official diagnosis should come from a psychiatrist or mental health professional. Some of the items on the questionnaire are related to inattention and memory problems. Some other symptoms include hyperactivity, mood swings, and impulsivity.
It’s important to know there is nothing to be ashamed of if you have adult ADHD. The symptoms of adult ADHD are often linked to specific biological factors. For example, ADHD-related attention and memory problems originate from improper functioning of the frontal lobe of the brain. Research also has shown reduced connectivity between the prefrontal cortex and striatum neural circuits in adult ADHD patients, which is associated with impulsivity. This is to say that ADHD does not equate to laziness or lack of follow through. It’s biologically and genetically influenced. In fact, ADHD has a high heritability rate of 74%, meaning about 74% of the individual differences that we observe in people with ADHD may be attributable to genetic differences. Now that we have a general understanding of ADHD, let’s discuss how it may co-occur with alcohol use.
How Are Alcohol Use and ADHD Related?
Evidence from family studies confirms an association between co-occurring ADHD and alcohol use disorder. Alcohol use disorder or ‘AUD’ is a condition characterized by drinking more than you want to, for longer than you want to, despite wanting to cut down. Data about the link between AUD and ADHD shows:
- Elevated rates of alcohol use disorder are consistently found in parents of youth with ADHD.
- Conversely, children and adolescents of parents with alcohol use disorder are more likely to be diagnosed with ADHD, and exhibit multiple findings consistent with ADHD: lower attention spans; higher levels of impulsivity, aggressiveness, and hyperactivity.
This supports the hypothesis that both AUD and ADHD are familial and genetically influenced. However, the interpretation of family studies is complicated by the possible influence of prenatal exposure to alcohol use. For example, the offspring of alcohol and cocaine-dependent mothers are at increased risk for psychiatric conditions, including ADHD. Factors such as poverty, quality of prenatal care, and environmental conditions can also contribute to risk of ADHD.
Are People With ADHD More Likely to Develop Alcohol Use Disorder?
Genetic risk factors contributing to ADHD traits (or more severe ADHD symptoms) have commonalities that increase the risk for AUD. For example, compared to control groups, individuals with AUD and ADHD had reduced frontostriatal connectivity—which mediates motor, cognitive, and behavioral functions within the brain.
Additionally, the brain areas responsible for suppressing impulsivity—the dorsal lateral prefrontal cortex and the anterior cingulate cortex—have been found to be under-functioning in both ADHD and AUD populations. Moreover, abnormal genetic variations of certain dopamine receptor genes have been linked to impulsive personality, which is found in higher frequencies in both people with ADHD and AUD.
Severity is correlated as well. AUD symptoms are typically more severe in ADHD patients than those without ADHD. Additionally, people who have both diagnoses can take more than twice as long to achieve their alcohol reduction goals than those with a single AUD diagnosis.
What Are the Effects of Alcohol on ADHD?
Evidence suggests that some adult ADHD patients use alcohol to de-intensify psychiatric symptoms and distress related to their condition. Managing ADHD can result in unique conflicts and challenges, and it’s plausible that some people with ADHD may develop alcohol use disorder to cope. Consistent with this theory, adolescents with ADHD report using alcohol for mood adjustment—in essence, “self-medicating”— to achieve a euphoric or detached effect.
This is especially concerning, because alcohol consumption during adolescence is a precursor for future heavy drinking in individuals with ADHD.
Alcohol consumption in adolescence has multiple effects, including:
- Reductions of gray matter volumes and delayed white matter growth
- Increase of attentional deficits
- Poorer cognition regarding memory
- Poorer visuospatial functioning, including task-accomplishing speed and attention span
ADHD can have similar side effects. Therefore, using alcohol while navigating ADHD can lead to worse developmental and cognitive outcomes in these areas. If you or someone you love is navigating AUD and ADHD, you should seek support as early as possible. You are not alone.
Alcohol and ADHD Medication Interactions
In addition to alcohol’s cognitive impact on people with ADHD, alcohol can also interact with ADHD medications. Multiple medications are FDA-approved by psychiatrists and other mental health providers to treat ADHD.
The following list includes several commonly prescribed ADHD medications and the possible effects if taken when alcohol is consumed:
|Medication||Possible Interaction Effect|
|Methylphenidate/Dexmethylphenidate||Dizziness, drowsiness, impaired concentration|
|Amphetamine/Dextroamphetamine/Lisdexamfetamine||Increased risk for heart problems|
|Clonidine||Dizziness, fainting, changes in regular heartbeat|
|Guanfacine||Dizziness, fainting, changes in regular heartbeat|
Note: At Monument, we connect you to licensed physicians, like myself, to create a plan to safely cut back on alcohol consumption. While we’re here to discuss your complete medical history, we do not assign or confirm diagnoses nor prescribe medication for ADHD. With your informed medical consent, we are always willing to coordinate care with your health professional treating your ADHD needs.
Alcohol Recovery for People with ADHD
The good news is, there are many treatment options to support alcohol recovery for individuals with ADHD. These resources include medication, therapy, and peer support.
Medication For ADHD Treatment
One of the most commonly prescribed medications for ADHD is atomoxetine. There’s evidence that atomoxetine is effective for those also in alcohol recovery. A study done by Massachusetts General Hospital found that individuals with AUD and ADHD who took atomoxetine had a 26% reduction in heavy drinking days. After 7-8 weeks of treatment, ADHD symptoms and alcohol cravings were also both minimized. Along with atomoxetine, there are additional medications that may be helpful for ADHD, including methylphenidate and dexamphetamine.
It’s important to speak to your prescribing physician about the benefits and risks of each medication.
Medication to Help Stop Drinking
There are also medications to treat AUD that can be helpful to someone navigating co-occurring AUD and ADHD. These medications, such as naltrexone, are proven to be effective in reducing alcohol cravings, heavy drinking days, and relapse risk. There is also some evidence that naltrexone can help with managing ADHD hyperactive symptoms and reduce side effects of ADHD medications like methylphenidate and dextroamphetamine. At Monument, you can speak with a physician and receive a naltrexone prescription online if safe and appropriate for you.
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Therapy for AUD & ADHD
AUD and ADHD can cause or intensify mental health challenges, and therapy can be a powerful tool for getting relief. In particular, Cognitive Behavior Therapy (CBT) can be helpful for treating both conditions simultaneously. A 2018 study found that CBT could significantly reduce ADHD symptoms, improve executive function, and decrease anxiety and depression. Similarly, studies show that CBT can help you reduce heavy drinking days, manage urges to drink, and develop coping skills. At Monument, you can meet with a therapist specialized in CBT who can help you address both AUD and ADHD.
However you decide to get support, it’s important to remember that both AUD and ADHD are medical conditions and not personal failings. There are evidence-based treatment options, like alcohol therapy, that can help you reduce symptoms and live a life you love. The clinicians on the Monument treatment platform, such as myself, are here to support you at every step.
Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use for a patient with active liver disease must be carefully considered in light of its hepatotoxic effects.
In the treatment of alcohol dependence, adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness, and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list