Attention-deficit/hyperactivity disorder (ADHD) and alcohol can create many problems for teenagers and their families. While substance use can lead to mental and emotional issues for anyone, the combination of ADHD and alcohol can be particularly harmful for teens given that their brains are still developing.
Young people with ADHD tend to be drawn to drinking for the pleasurable sensations it creates, only to discover that alcohol can increase ADHD symptoms such as impulsivity, difficulty focusing, and memory issues. Moreover, mixing alcohol with ADHD medications can impair the effectiveness of those medications and lead to severe health problems.
To better understand the impact ADHD and alcohol have on teens and how parents can best support their children if they’re struggling, we spoke with Ke’ala Cabulagan, a licensed clinical social worker and therapist at Sunrise, an Embark Behavioral Health residential treatment center in Utah. Having worked in the substance use field and counseled teens and young adults with ADHD, Cabulagan has an informed perspective on the effects of ADHD and alcohol — as well as ADHD and alcoholism — on teenagers.
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How Does Alcohol Affect Those With ADHD?
How does alcohol affect ADHD in teenagers? It’s helpful to first understand why people who have the disorder may turn to drinking. Cabulagan noted that research has indicated that those who have ADHD use the neurotransmitter dopamine faster than those who don’t. Dopamine provides brains with a sense of pleasure, so having a shortage of it may motivate people with ADHD to seek pleasurable sensations from other sources.
“These sources may be sugary foods, risky behaviors, drugs, or alcohol,” Cabulagan said. “But while alcohol can feel very pleasurable to someone with low amounts of dopamine, it can also have negative short-term and long-term effects.”
Following is an overview of how alcohol affects ADHD in teens.
Even in the short term, liquor has a detrimental effect on teens with ADHD. This is partly because many people with this disorder already have delays in memory and processing speed. Alcohol worsens these ADHD symptoms, resulting in possible memory issues and difficulty focusing.
“Alcohol also lowers inhibitions, which in the short term can lead a teen who’s already prone to impulsivity to engage in risky behaviors,” Cabulagan said.
When it comes to memory issues, ADHD, and alcohol, ADHD affects the prefrontal cortex of the brain, which is responsible for higher-order functions such as problem solving, impulse control, and working memory, which involves temporarily stored information that’s ready for immediate use. As a result, poor working memory is often an ADHD symptom. Since alcohol also impairs the prefrontal cortex, drinking can compound working memory issues for a teen with ADHD. Cabulagan noted this short-term effect will likely become a long-term one, as it will worsen over time if substance use becomes more severe.
The prefrontal cortex, which becomes impaired by alcohol, also influences a teen’s ability to focus. Cabulagan stated the prefrontal cortex is not fully developed until a person’s mid-20s and receives a lot of fine-tuning during adolescence. This makes teenagers with ADHD particularly vulnerable to losing focus while under the effects of alcohol.
For teens who drink regularly, ADHD and alcohol can come with significant long-term effects. These include alcoholism, also known as alcohol use disorder, and binge drinking.
According to Cabulagan, the adolescent brain is still developing, making it more vulnerable to liquor than an adult brain. Thus, the earlier a person begins drinking, the more likely they are to develop problems with alcoholism later in life.
For teens who use ADHD medications such as Ritalin or Adderall, the risk of alcoholism increases. These prescription drugs are stimulants, while alcohol is a depressant. Thus, mixing Adderall or Ritalin with alcohol can seemingly offset the depressant effects of liquor, making teens believe they can drink more. As teenagers begin drinking on a regular basis or become unable to control how much they drink, ADHD and alcoholism become two very real challenges they must address.
The risk of having ADHD and alcoholism continues past the teen years. A study published in Alcohol and Alcoholism indicated that 1 in 3 young adults with ADHD developed alcohol use disorder (36%), compared to 19% of those without ADHD.
Binge drinking is defined by the National Institute on Alcohol Abuse and Alcoholism as a pattern of consuming alcohol that brings blood alcohol concentration (BAC) to 0.08% or higher. According to the 2021 National Survey on Drug Use and Health, 3.8% of adolescents ages 12-17 and 29.2% of young adults ages 18-25 reported binge drinking in the past month.
ADHD and binge drinking in teens are often linked together, in part because impulsivity can lead teenagers who have ADHD to overdrink. ADHD and binge drinking can lock these young people into a cycle of drinking. Following a binging session, teenagers may feel guilty, depressed, or anxious about their behavior. If these feelings become overwhelming, they may decide to drink more, creating a destructive pattern.
Why Alcohol and ADHD Medications Shouldn’t Mix
When combined, ADHD medications and alcohol can have many negative physical, emotional, and mental health effects on teens. In addition, according to Cabulagan, when you mix ADHD pills and alcohol, the pills become less effective. For instance, stimulants like Adderall are meant to improve communication between brain cells. Since liquor slows down chemical signals in the brain, mixing it with Adderall weakens the stimulant’s ability to address ADHD symptoms.
In addition, combining ADHD medications and alcohol can raise the risk of alcohol poisoning and serious side effects. Depending on the pill being used, side effects may include:
- Heightened blood pressure.
- Increased/irregular heart rate.
- Heart attacks.
ADHD and Alcohol Risk Factors
While ADHD does not automatically lead to alcoholism, having ADHD does increase the risk of turning to alcohol to deal with problems — and a teenager could eventually struggle with both ADHD and alcoholism. For teens who have ADHD, significant risk factors include:
- Impulsivity: When it comes to ADHD and impulsivity, because teens with the disorder are already prone to impulsive behavior, they’re at a greater risk for drinking heavily when in situations that promote drinking. In addition, because alcohol increases impulsive behavior, impulsivity can worsen as the teen continues to drink.
- Self-medication: Hyperactivity, lack of focus, and other ADHD symptoms are uncomfortable, which can lead some teens to try self-medicating with alcohol. Other teenagers with the disorder may turn to drinking to deal with social or academic problems, only to find this worsens their ADHD symptoms.
- Alcohol sensitivity: Some teens with ADHD have alcohol sensitivity, which prevents their bodies from efficiently breaking down alcohol. This can cause unpleasant reactions, such as flushed skin, hives, and low blood pressure. Alternatively, if teenagers discover they enjoy how strongly alcohol affects them, they can develop a greater risk for alcohol use disorder.
How Parents Can Help Their Teens
Understanding why teens with ADHD are at greater risk for turning to alcohol is key to parents being able to help them if they do end up drinking — and if they end up with ADHD and alcoholism.
“The first line of defense is getting ADHD interventions as early as possible,” Cabulagan said.
She emphasized that if teens are prescribed ADHD medication, it’s important they have stable medication routines, as this can help them navigate impulsivity and be less likely to drink.
To further help teenagers with ADHD deal with alcohol issues, Cabulagan offered the following tips:
1. Express empathy for what your teen is experiencing: Cabulagan encouraged parents to research ADHD as much as possible to understand what their teenager is going through. Then, they can sit down with their child and show empathy by saying something such as “It makes sense that you’re angry” or “I understand that you’re having a tough time right now.” Cabulagan said this is an important step because “It communicates that parents care about the relationship, are listening, and understand the other person. Research suggests that kids with ADHD are particularly prone to invalidation and rejection, so leading with empathy is critical.”
2. Talk to your teen about alcohol: Cabulagan noted when parents talk to their teenager about alcohol, they can validate their child’s need to have fun and feel good without condoning dangerous behaviors like drinking and driving. By acknowledging the importance of their teen’s perspective, parents can encourage productive discussions that help prevent destructive behaviors that can lead to issues such as a teenager having ADHD and alcoholism.
3. Discuss the importance of not mixing ADHD medication and alcohol: Being aware that combining ADHD medication and alcohol can lead to overdrinking, alcohol poisoning, heart-related issues, and other dangers gives teens incentive to not drink while on ADHD medication.
4. Teach nutrition as self-care: Diets rich in vegetables, fruits, and fish are associated with brain health and improved focus. Increasing such food choices in your teenager’s diet can improve their feelings of well-being and curb impulsive choices such as a tendency to drink.
5. Get to know your teen’s friends: Knowing that your child’s friends may expose them to alcohol can help you plan ahead. Cabulagan encouraged parents and teens to agree on what teenagers will do in situations where liquor is available. Teens may choose not to drink at parties or have a sober friend act as a designated driver. Parents may require teenagers respond to texts to report on their activities. These steps can help teens navigate impulsivity and handle challenges related to ADHD and alcohol.
6. Find a therapist: Cabulagan encouraged parents to find therapists skilled in ADHD and alcohol use treatment. For types of therapy that can be helpful, she recommended dialectical behavior treatment (DBT), which helps parents and teens “walk the middle path” by acknowledging and understanding the perspectives of both parties. She’s also found that cognitive behavioral therapy (CBT), which helps teens replace harmful thought patterns with more positive ones, and relapse prevention therapy, a type of CBT, offer effective treatments for alcohol use disorders.
ADHD and Alcohol: Wrapup
Managing ADHD is difficult, and for teenagers who turn to alcohol for relief, their problems become compounded. Not only does liquor reduce the effectiveness of ADHD medication, it can also increase impulsivity and memory issues and possibly lead to long-term problems such as alcoholism.
While helping teens deal with ADHD and alcohol can be challenging, Cabulagan emphasized that with proper treatment and support, teenagers can manage any issues.
“As teenagers get treated for ADHD and their brains continue developing and growing, some of their impulsive tendencies tend to improve,” she said. “So, hold on to hope and be patient. There are a lot of good resources and support for you as you figure it out, so you’re not alone. It’s not an easy road, but it does get better.”
Embark is the most trusted name in teen and young adult mental health treatment. We’re driven to find the help your family needs. If you’re looking for support, contact us today!