How Alcohol Abuse Makes ADHD Harder to Diagnosis and Treat
Alcohol use disorder is a brain disorder that makes it challenging to stop misusing alcohol even when it interferes with responsibilities and routines and causing negative consequences.1 Attention deficit hyperactivity disorder (ADHD) is a disorder where behaviors such as inattention, hyperactivity, and impulsivity occur frequently.2 ADHD and alcohol use disorder are commonly co-occurring mental health conditions.
Some researchers believe if you are diagnosed with ADHD you may be more vulnerable to developing a substance use disorder.3
In this article:
- The Connection Between Alcoholism and ADHD
- Risk Factors of Alcoholism and ADHD
- Potential Problems with Alcoholism and ADHD
- Diagnosing Alcoholism and ADHD
- ADHD in Different Age Groups
- ADHD Misdiagnosis
- Treatment for Alcoholism and ADHD
The Connection Between Alcoholism and ADHD
Research shows one mental health disorder can lead to the other. For example, having symptoms of ADHD as a youth can put you at higher risk for developing an alcohol use disorder (AUD) and vice versa.3
Additional findings show that:3
- 43% of youth with attention deficit or hyperactivity symptoms will develop an AUD.
- 20% of adults with an AUD also have ADHD symptoms.
Imaging of the brain has discovered abnormalities in the inhibitory, dopamine, and reward areas that are similar in individuals with ADHD and substance use histories, including AUD.4
Risk Factors of Alcoholism and ADHD
A risk factor is any characteristic that increases the likelihood of experiencing adverse outcomes. ADHD and alcohol use disorder share certain risk factors. For example:3
- Alcohol or substance misuse while pregnant increases the risk for fetal alcohol spectrum disorder, which overlaps with ADHD symptoms, in the child.
- Early exposure to traumatic events can lead to an increase in ADHD symptoms. Also, if you were exposed to trauma and experience post-traumatic stress disorder (PTSD), you are more likely to develop a substance use disorder.
- If you have ADHD, you have a dysregulated neurological reward system. Using alcohol further dysregulates the reward center through profound chemical activation. This dysregulation may intensify urges and cravings to use alcohol for individuals with ADHD and alcoholism.
Impulsivity is a common symptom of ADHD. Impulsivity can affect substance use decisions, behaviors, and patterns. Because alcohol impairs cognitive function, particularly areas of decision-making and judgment, ADHD symptoms like impulsivity may worsen when intoxicated.4
Specific impulsivity factors are associated with both ADHD and substance abuse, including:4
- Lack of planning, or a difficulty to conceptualize a plan for the future and anticipate the consequences of specific actions
- Lack of perseverance, or difficulty sustaining tasks or goals over a long period of time
- Negative urgency, or the tendency to take risks and make emotional decisions when distressed
- Positive urgency, or the tendency to take risks and make emotional decisions when feeling heightened positive emotions
A review of studies found protective factors that can help people with ADHD avoid AUDs. Protective factors are positive things that deter adverse outcomes; these are the opposite of risk factors. Parental involvement, early intervention after starting alcohol misuse, and delaying the age at which someone starts using alcohol reduce the chances of someone with ADHD developing an AUD. 14
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Potential Problems with Alcoholism and ADHD
Alcohol may increase and worsen the symptoms of ADHD. In the long term, if the symptoms of these co-occurring conditions are not well managed, this can increase risks of:5, 6
- Having difficulty forming and maintaining healthy relationships
- Struggling to achieve your goals at school or in the workplace
- Becoming injured or being involved in accidents while intoxicated
- Experiencing additional mental health symptoms or developing a co-occurring disorder
- Experiencing consequences related to impulsive or high-risk behavior, such as encounters with the criminal justice system
Sleep disorders like insomnia are prevalent if you have ADHD and alcohol use disorder. Even after being treated for ADHD and AUD, problems with sleep can linger.5
Combining ADHD medications, such as Adderall and Ritalin, with alcohol can lead to dangerous outcomes, like the following:7
- Blood pressure increases
- Memory and learning process issues
- Neurotransmitter depletion
- Cellular stress
- Heart rate abnormalities
- Blood toxicity or poisoning
Diagnosing Alcoholism and ADHD
Mental health professionals evaluate all of the substances someone with ADHD uses. Some substances, like certain stimulants, can mimic ADHD. An assessment of a psychiatric disorder must occur during a time of abstinence from substances to ensure than none of the symptoms you are experiencing are substance-related.8
When seeking treatment for alcohol use disorder, your mental health provider will likely wait until you have been abstinent from alcohol for a set period of time before assessing your ADHD symptoms.
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ADHD in Different Age Groups
ADHD criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are slightly different for children, adolescents, and adults. Symptoms include inattention and hyperactivity-impulsivity that interfere with functioning. 9
Of the symptoms listed, adults 17 years of age or older must have at least five symptoms, and children and teens 16 years of age and younger must have six. The symptoms for inattention include:9
- Making careless mistakes
- Being unable to stay focused
- Lacking the ability to listen even when looking at the speaker
- Being disorganized and unable to follow through with tasks
- Avoiding participation in activities that require a lot of mental effort
- Losing things necessary to complete a project
- Being easily distracted
- Forgetting things
The symptoms for hyperactivity and impulsivity include:9
- Moving some part of the body repetitively, like hands or feet
- Standing up unexpectedly
- Running to inappropriate locations for children; feeling restless for adolescents and adults
- Struggling to stay quiet
- Being constantly on the go with excessive energy
- Talking a lot, sometimes too much
- Blurting out questions, answers, or information
- Inability to wait
- Inserting themselves in the activities or conversations of others
ADHD can appear quite different at each age. Adults with undiagnosed or misdiagnosed ADHD may experience frustration with trying to stay organized and focused. They may experience chronic lateness, disorganization, the inability to start and complete tasks, and a tendency to try to find quick-fix solutions. To others, an adult with ADHD may appear to have a chaotic lifestyle.10
Other mental health disorders have symptoms that mimic those of ADHD. According to reports, depression and anxiety disorders, antisocial personality disorder, borderline personality disorder, developmental disabilities, and certain medical conditions have similar symptoms to ADHD.11 Many adults may be inaccurately diagnosed with a psychiatric disorder. Personality disorders have a high rate of co-occurrence with alcohol use disorder.
In addition, substance use and AUDs can produce symptoms like inattentiveness, confusion, memory issues, restlessness, sleep disorders, and mania.11
Evaluation for co-occurring disorders is often part of addiction treatment. If you have a current ADHD diagnosis, your care team may evaluate whether that diagnosis is accurate to your experience. If you have many of the symptoms of ADHD, a mental health professional may formally evaluate you based on the DSM-5 criteria. An understanding of your neurochemistry and behavioral tendencies that can come from an accurate diagnosis can help inform your holistic treatment plan.
Treatment for Alcoholism and ADHD
Figuring out the right treatment plan must be done by a team of doctors and mental health professionals who will consider both ADHD and the substances misused, including alcohol. Someone misusing alcohol may forget to take ADHD medicine or may take too much. Alcohol can make medicine ineffective over time.12
Treatment includes a multi-layered program of services which may include medications. Regarding medications to treat ADHD for people with AUD:12
- Stimulants like amphetamines can be problematic for people with an AUD since stimulants are considered addictive. The use of amphetamines can lead to a new set of risks, like increased tolerance, the potential for misuse, and the onset of cravings for alcohol or other substances.
- Non-stimulant options for treating ADHD with co-occurring AUD include antidepressants, Clonidine and antianxiety medicines, and Modafinil for conditions like narcolepsy.
One study found that participants taking atomoxetine (Strattera), a non-stimulant medication, were able to reduce cravings for alcohol and experienced improved ADHD symptoms. In the same study, participants who relapsed on alcohol reported worsening of ADHD symptoms.13
Psychosocial treatments to treat ADHD in people with AUD include:12
- Psychoeducation—These educational sessions teach people of all ages about ADHD and alcohol use disorders, how they affect the brain and the body, and healing requirements.
- Cognitive behavioral therapy (CBT)—A form of talk therapy, CBT can be challenging for some people with ADHD because it requires attention, focus, and continued participation. However, this type of therapy is adjustable by the length of time and type of activities to meet the needs of people with both ADHD and AUD. Skill-building is a focus with modified CBT, including time management and organization skills.
Alcohol detoxification can happen in a medically supervised treatment center or on an intensive outpatient basis. After detox, you can transition to a non-medical level of care.
After detox, many individuals enter inpatient rehab, where you begin learning early recovery and relapse prevention skills. Here you can receive individualized treatment for co-occurring disorders of alcohol use and ADHD.15
Partial hospitalization and intensive outpatient programs follow inpatient treatment. You can live at home and continue receiving individual and group support and therapies to develop skills to use in recovery. At every level of treatment, you will be able to participate in 12-step facilitation groups, family therapy, and alternative treatments.15
Treatment begins with an extensive evaluation from a licensed mental health professional who can accurately diagnose your symptoms to create a unique treatment plan.
If you have the symptoms of an AUD, call 800-839-1686Who Answers? to speak to a specialist about finding addiction treatment services.
Susanne Reed has a Ph.D. in Education and a Master’s degree in Psychology. She worked for more than 20 years in the mental health and substance abuse fields as a counselor, director, and Addiction Counseling business owner. She has been a blog and article writer since 2016 for individual therapists, treatment facilities, sober living homes, and addiction specialists, as well as other industries. She is an adjunct professor in Psychology for a local college. She has been published in magazines such as Spotlight on Recovery, P31, and GRIT, and has written books that are available on Amazon.
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- Luderer, M., Ramos Quiroga, J. A., Faraone, S. V., Zhang James, Y., & Reif, A. (2021). Alcohol use disorders and ADHD. Neuroscience Biobehavior review, 31, 130-227.
- Pedersen, S. L., Walther, C. A., Harty, S. C., Gnagy, E. M., Pelham, W. E., & Molina, B. S. (2016). The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity. Addiction, 111(9), 1582-1589.
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- Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., & Sutfin, E. L. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and alcohol dependence, 131(1-2), 71-77.
- Althobaiti, Y. S., & Sari, Y. (2016). Alcohol interactions with psychostimulants: an overview of animal and human studies. Journal of addiction research & therapy, 7(3), 281.
- Mariani, J. J., & Levin, F. R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. The American journal on addictions, 16 Suppl 1(Suppl 1), 45-56.
- Centers for Disease Control and Prevention. (2021). Attention deficit hyperactivity disorder. Symptoms and Diagnosis of ADHD.
- National Institute of Mental Health. (2021). Attention deficit hyperactivity disorder in adults: what you need to know.
- Gentile, J. P., Atiq, R., & Gillig, P. M. (2006). Adult ADHD: diagnosis, differential diagnosis, and medication management. Psychiatry 3(8), 25-30.
- 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.
- Wilens, T. E., Adler, L. A., Tanaka, Y., Xiao, F., D’Souza, D. N., Gutkin, S. W., & Upadhyaya, H. P. (2011). Correlates of alcohol use in adults with ADHD and comorbid alcohol use disorders: exploratory analysis of a placebo-controlled trial of atomoxetine. Current medical research and opinion, 27(12), 2309-2320.
- Kuppa, A., & Maysun, A. (2019). Risk of Alcohol Abuse in Humans with Attention-deficit/Hyperactivity Disorder Symptoms. Cureus, 11(10), e5996
- Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).