Understanding the Link Between ADHD and Alcohol Abuse

Do you have ADHD and struggle with alcohol abuse? If so, you’re not alone. Read up on the link between these disorders as well as treatment options.

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At face value, you might not necessarily think there’s a strong connection between attention-deficit/hyperactivity disorder (ADHD) and alcohol use disorder (AUD). However, these disorders commonly go hand in hand. Studies show that up to four in 10 people with ADHD develop AUD (43%), and one-fifth (20%) of people with alcohol use disorder have ADHD.

The link between ADHD and AUD is no coincidence since they each share factors that influence one another and result in a vicious cycle –– but why exactly is the correlation so strong? Read on to learn about the connection between ADHD and alcohol abuse, how alcohol can worsen ADHD symptoms, treatment, and more.

What is the link between ADHD and alcohol abuse?

ADHD is characterized by inattention, impulsivity, and hyperactivity. This means that people with ADHD may have trouble paying attention, staying focused, sitting still, or acting without thinking first –– among other symptoms that can be difficult to cope with. 

“People with ADHD may use alcohol to self-medicate symptoms like restlessness, anxiety, trouble sleeping, or trouble focusing,” says Charlie Health Medical Director Dr. Eli Muhrer, M.D. “Alcohol releases dopamine in the brain, which can feel temporarily rewarding to someone with ADHD, as they often have lower natural levels of dopamine compared to those who do not have ADHD.” 

When someone with ADHD uses alcohol and then feels better in some way or another, this can reinforce alcohol use, Dr. Muhrer says, leading to more and more consumption. This alcohol consumption can easily cross over into alcohol abuse territory.

How does ADHD contribute to alcohol use disorder?

Having ADHD is a risk factor for substance use disorders (SUDs), including alcohol abuse (clinically known as alcohol use disorder). AUD (sometimes referred to as alcohol addiction, alcohol dependence, or alcoholism) occurs when someone drinks alcohol and can’t control how much they consume or stop drinking, even despite negative consequences. ADHD increases the risk of alcohol use disorder due to:

1. Impulsivity

Many people with ADHD struggle with impulsivity and engage in risky behaviors. “Acting without thinking can lead to trying substances like alcohol without considering the risks,” Dr. Muhrer says.

2. Difficulty coping

ADHD, especially when untreated, can be very emotionally taxing and take a toll on someone’s life. “Undiagnosed or untreated ADHD may leave people struggling without tools to manage their symptoms, increasing the chance of turning to substances to cope,” Dr. Muhrer says. People with an ADHD diagnosis may still turn to alcohol. 

3. Reward sensitivity

“ADHD brains crave stimulation and reward, and substances can provide an artificial boost of pleasure,” says Dr. Muhrer. This is due to the naturally low levels of dopamine in people with ADHD.

4. Co-occurring conditions

The majority of people with ADHD –– up to 80% –– also have a co-occurring mental health condition, which can further contribute to the development of a SUD.

Can alcohol abuse worsen ADHD symptoms?

Alcohol abuse and ADHD can result in a vicious cycle. Although someone with ADHD might experience some initial relief from drinking alcohol, misuse leads to both short-term and long-term worsening of ADHD symptoms and other mental health symptoms. 

Short-term impacts of alcohol on ADHD

• Further impaired focus: “Alcohol slows down brain function, making it harder to focus, stay organized, and complete tasks—things ADHD already impairs,” says Dr. Muhrer.
• Reduced self-control: Drinking alcohol can lower inhibitions in anyone, but for people with ADHD who already struggle with impulsivity, this can cause extra trouble. This may lead to risky, potentially dangerous, impulsive decisions while under the influence. 
• Sleep issues: Alcohol consumption, especially in large quantities, negatively impacts sleep quality. Not only is this a problem for mental health overall, but sleep deprivation can also worsen ADHD symptoms, especially inattention.  
• Interactions with ADHD medication: It isn’t safe to mix alcohol with ADHD medications, including commonly prescribed stimulants like Adderall and Ritalin. Since alcohol is a depressant, it can reduce the effects of the stimulant, thereby hindering symptom relief. On the flip side, stimulants can reduce the depressant effect of alcohol, which may cause someone to consume more alcohol, potentially leading to alcohol poisoning.  

Long-term effects of alcohol misuse on ADHD and mental health in general:

• Worsened ADHD symptoms: Since alcohol worsens symptoms short-term due to rebound impacts of consumption, continued use can increase symptoms long-term. For example, alcohol can worsen focus, organization, and memory, Dr. Muhrer says. 
• Higher risk of co-occurring disorders: Chronic heavy alcohol use alters brain chemistry. This can result in a higher risk of depression or anxiety, says Dr. Muhrer.

• Difficulty in breaking addiction patterns: Long-term alcohol abuse and using alcohol as a coping mechanism can make it harder to stop.
• Long-term brain impact: “Chronic alcohol use can damage areas of the brain that control attention and executive functioning, which are already ‘underactive’ in ADHD,” Dr. Muhrer says. This can also impact brain regions involved in planning and self-regulation, he adds. 

What are the best treatments for co-occurring ADHD and alcohol abuse?

Seeking treatment for these disorders is crucial to avoid short-term and long-term worsening of symptoms. “Treating both ADHD and AUD together is ideal because the conditions interact and can make each other worse,” Dr. Muhrer says. “In general, treatment plans should address ADHD and AUD simultaneously, with adjustments for the person’s specific needs.” Here are some quick considerations for treating both concurrently. 

1. Work with an experienced provider

It’s important to work with a provider with experience treating both ADHD and AUD. Look for mental health professionals who have additional certifications in addiction treatment and who specialize in co-occurring disorders. These therapists can help you target both impulsivity and emotional regulation, which are key symptoms in both ADHD and AUD, says Dr. Muhrer.

2. Find structured support

“Routine-building and behavioral strategies are crucial for managing ADHD while maintaining sobriety,” Dr. Muhrer says. You can build these skills through individual therapy and/or group programs like Alcoholics Anonymous. 

3. Use caution with ADHD medications

Although stimulants are commonly prescribed for ADHD, they may not be the best fit for someone with a history of substance abuse due to their potential for addiction. Dr. Muhrer says a prescriber might opt for a non-stimulant ADHD medication that has a lower risk of misuse.

What are treatment options for alcohol use disorder?

Professional treatment is paramount for alcohol abuse. Without proper interventions, AUD can be fatal. Treatments include:

1. Therapy

Psychotherapy, especially cognitive behavioral therapy (CBT) and motivational interviewing can help treat AUD, Dr. Muhrer says. CBT helps identify and change unhealthy, unhelpful ways of thinking that are contributing to alcohol abuse and any other mental health symptoms. In turn, you can develop healthier thought patterns and behaviors. Motivational interviewing helps you uncover motivation for getting sober and commit to abstaining from drinking alcohol. 

2. Group programs

12-step programs or other sober support groups can help give you skills for staying sober while also providing you with a support network of other people in your shoes. Some examples are:

• Alcoholics Anonymous (AA) 
• Refuge Recovery
• Yoga 12-step recovery (Y12SR)
• SMART Recovery

3. Medications

If your prescriber decides it’s the best course of action, they may prescribe medications to help you stay away from alcohol and prevent relapse. Dr. Muhrer says examples of these medications are:

• Naltrexone
• Acamprosate
• Disulfiram

4. Inpatient or outpatient programs

Some people may require more structured programs for alcohol withdrawal, detox, and recovery, says Dr. Muhrer. Quitting alcohol, especially abruptly, can be dangerous. Structured programs can help you safely and more comfortably withdraw.

What are treatment options for ADHD?

ADHD treatment typically includes therapy, medication, or a combination of both. These treatments aim to reduce ADHD symptoms and improve executive functioning.

1. Therapy

An important part of therapy for ADHD is psychoeducation, meaning learning more about your ADHD. You will also learn various skills that can help you improve your functioning and quality of life. ADHD therapy might touch on:

• Building organization and time management skills
• Improving emotional regulation
• Managing and reducing impulsivity
• Improving self-esteem and confidence
• Having healthier relationships
• Addressing negative, unhealthy thought patterns

CBT is also useful for ADHD, as well as for working through symptoms of co-occurring conditions like depression and anxiety.  

2. Medications 

ADHD meds fall into two main categories: stimulants and non-stimulants. Stimulant medications are fast-acting and come in immediate-release or extended-release formulas. Examples of common stimulants are:

• Adderall
• Ritalin
• Vyvanse
• Concerta

However, as previously mentioned, stimulants aren’t always the best choice for people with a history of any type of substance abuse since stimulants carry a high risk of addiction and abuse. In cases where providers advise against stimulants, non-stimulants can also provide relief from ADHD symptoms. Examples of non-stimulant medications are:

• Strattera
• Qelbree
• Intuniv
• Kapvay

Your psychiatrist will decide which medication is the best fit for you. Make sure to take any ADHD meds exactly as prescribed by your doctor. 

How Charlie Health can help

If you or a loved one struggles with ADHD and alcohol use disorder, Charlie Health is here to help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people who are dealing with serious mental health conditions, including substance use disorders and co-occurring disorders. 

Our clinicians meet you where you are on your recovery journey, creating personalized treatment plans to help you recover. We incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. Additionally, we provide medication management when needed. With this kind of holistic treatment, you can recover from AUD and learn to manage your ADHD. Fill out the form below or give us a call to start today.