Alcohol use disorder (AUD) is the clinical term for alcohol addiction, sometimes also called alcoholism. People who struggle with this condition may binge drink (consume more than four servings of alcohol in a two-hour period) or consume more than two drinks every day, consistently. They may also struggle with both forms of problem drinking.
People who struggle with AUD likely have high tolerances for alcohol, may be in denial that they have a problem, and may talk about consuming alcohol a lot. These, and other symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), can help clinicians identify potential alcohol use disorders in their clients.
Several mental conditions increase the risk of struggling with AUD. Mood disorders like depression, anxiety, and bipolar disorder are most often associated with AUD, but other mental disorders, like schizophrenia or attention deficit hyperactivity disorder (ADHD), also increase a person’s risk for developing problem drinking behaviors, including AUD.
ADHD begins in early childhood; even when a person receives a diagnosis in adulthood, they have likely struggled with the condition for most of their life. Undiagnosed ADHD increases a person’s risk for developing AUD, other forms of substance abuse, and even eating disorders later in life. People who struggle with AUD are 5-10 times more likely to have co-occurring ADHD compared to the general population. It is important for children to receive diagnoses of ADHD as early as possible because appropriate treatment reduces the risk for struggles with alcohol and drugs.
ADHD and Alcohol Use Disorder
Attention deficit hyperactivity disorder (ADHD) is a brain disorder with patterns of high energy, inattention, and impulsive behaviors.
- Inattention: This is characterized as wandering off task, lack of persistence, disorganization, and trouble sustaining focus. Children may struggle in school while adults may suffer from low self-esteem, relationship problems, and constant work changes or problems.
- Hyperactivity: This is a high level of physical energy that manifests as moving around constantly, even when it is inappropriate. In children, this may show up as tapping, excessive talking, or fidgeting. Adults may be restless, performing constant physical activity.
- Impulsivity: This involves making hasty decisions, including risky experiences; there is a desire for immediate reward and an inability to delay gratification. Children may be unable to stop talking, may interrupt their peers, or may succumb easily to pressure from their peers. Adults with ADHD manifest similar behaviors and do not consider the long-term consequences.
ADHD is a complex mental condition, which may involve genetics, family history, and environmental triggers. Typically, one-third to one-half of people who receive childhood diagnoses of ADHD still need to manage the condition when they are in adulthood; however, with appropriate therapy and medication, adults with ADHD can lead normal, healthy lives.
While appropriate treatment reduces the risk, adolescents and adults with ADHD are still at a higher risk for co-occurring AUD. A study found that 14 percent of teenagers between 15 and 17 years old with ADHD also began abusing alcohol, and struggled with alcohol dependence or AUD into adulthood. Another study on adolescents with ADHD found that the average age of first use of alcohol was around 14.9 years old; about 40 percent of adolescents with diagnosed ADHD began abusing alcohol in their teenage years compared to 22 percent of adolescents without ADHD.
While another study found no difference in rates of alcohol consumption among young adults, average age of 25, regardless of ADHD diagnosis, adolescents who begin abusing alcohol are at a greater risk for continuing to abuse alcohol, develop a dependence, and develop an addiction. A study examining twins – one with ADHD and the other without – found an 88 percent increased risk of alcohol abuse or problem drinking among the twins with ADHD.
The combination of early diagnosis (as early as 4 years old, but typically around 6-7 years old), appropriate prescription medication like Adderall or Vyvanse, and ongoing behavioral therapy helps children reduce their risk of abusing substances. While impulsive behaviors may put them at a higher risk compared to the average population, receiving education about this potential problem, along with medicines that treat impulsivity, has been found to reduce the risk of substance abuse. When people with diagnosed ADHD properly took medication, substance abuse risk was reduced 35 percent in men and 31 percent in women, according to a survey of 3 million individuals published in the American Journal of Psychiatry.
- Poor time management
- Excessive restlessness or activity
- Poor planning ability
- Low tolerance for frustration
- Frequent mood swings
- Quick temper
- Difficulty with other sources of stress
Self-medicating with drugs or alcohol to manage these struggles is common in people with mental conditions, including ADHD.
Treatment for Co-Occurring AUD and ADHD
Some reports have created concern among parents, school teachers, and others that children with ADHD who take medication like Vyvanse or Ritalin are at risk for substance abuse because they receive prescription medicines. While in the general population, amphetamine-based medicines can release neurotransmitters like serotonin and dopamine that can trigger addiction, those with ADHD do not have the same reaction to stimulant medications. When prescribed alongside behavioral therapy, stimulant medications control impulsivity and hyperactivity.
In those who are not diagnosed in childhood or who do not receive treatment, impulsivity contributes to the risk of substance abuse, including alcohol abuse. Hyperactivity may also lead a person to abuse alcohol to self-medicate the experience.
Treating AUD in a person with ADHD may include prescribing stimulant medications or some of the non-stimulant medicines that have been approved. Medically supervised detox is needed to reduce the risks of alcohol withdrawal, and it is also important because stimulant prescriptions do not mix with alcohol. Therapy in a rehabilitation program that specializes in co-occurring disorders will help individuals learn to manage their disorder.
Other therapeutic approaches, focusing on ADHD symptoms, include:
- Keeping routines
- Making lists to stay on task
- Using a calendar to keep schedules organized
- Using reminder notes in a specific organized pattern
- Finding specific places for bills, keys, important paperwork, and more
- Breaking large tasks into smaller steps to complete individual pieces in a timely manner
Those with ADHD will likely need ongoing behavioral treatments to manage the condition, but these treatments can also greatly benefit recovery from substance abuse.