Mixing alcohol and ADHD

Alcohol addiction and ADHD are strongly linked. Some of the symptoms can overlap, and people struggling with ADHD may turn to alcohol to self-medicate. Studies have found that ADHD is about 5-10 times more prevalent in adult alcoholics, and ADHD affects up to 25% of people in treatment for substance or alcohol abuse.

There are several reasons why this link may be present – genetics, symptom management and self-medication all play a role.

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects behaviour, and is under-researched in adults.The DSM classes ADHD under Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence. However, adult diagnoses are rising significantly, with many people waiting for a long time for NHS assessments.

ADHD symptoms fall into three categories – inattentiveness, hyperactivity and impulsiveness. The DSM’s ADHD criteria are geared more towards children – adults usually exhibit fewer of the hyperactivity symptoms, while inattentive symptoms tend to remain.

Specialists state that the symptoms most associated with adult ADHD are:

• Carelessness, lack of attention to detail
• Poor organisation
• Starting new tasks before finishing old ones
• Difficulty focusing
• Frequently losing things
• Forgetfulness
• Restlessness, being on edge
• Speaking out of turn, difficulty keeping quiet and frequently interrupting people
• Mood swings and inability
• Low tolerance for stress
• Impatience
• Risky and impulsive behaviour.

Many of these symptoms overlap with other mood disorders, like depression and anxiety, which can make diagnosis challenging. These symptoms can present significant difficulties for people with ADHD, particularly in the workplace where organisation, attentiveness, punctuality and managing stress are expected.

The potential shared genetic roots of ADHD and alcoholism

ADHD and addiction may have a shared genetic component. Some studies have isolated certain genes that affect the brain’s dopamine reward system as having a role in susceptibility to both ADHD and alcoholism.

It is theorised that people with ADHD are experiencing a dopamine deficit, due to being born with a lower number of dopamine receptors in the reward system of the brain. This is called reward deficiency syndrome – and it is believed this leaves a person susceptible to both addiction and ADHD.

Some studies have suggested that ADHD is about 75-95% due to genetic factors, with environmental factors playing a much smaller role. The lack of dopamine in the brain’s reward system is thought to lead to many of the impulsive behaviours, low tolerance for stress, scattered attention and frustration that people with ADHD suffer from.

Alcoholism is also strongly associated with reward deficiency syndrome. Alcohol significantly increases levels of dopamine in the brain, and people with RDS will often use alcohol to stave off the unpleasant feelings of having low dopamine, like anhedonia. They will come to rely on alcohol to alleviate these feelings while also becoming more dependent on alcohol as their dopamine levels are suppressed even further by repeated drinking. This is a vicious cycle that leads to dependence.

As well as the shared genetic component, many people with ADHD turn to alcohol to cope with mental health problems like anxiety and depression that living with the condition can cause. However, alcohol interacts badly with ADHD, and this can worsen many of the symptoms.

Mixing alcohol with ADHD

Alcohol can be very appealing to people with ADHD. The dopamine increase from alcohol relieves the boredom and restlessness experienced when in a dopamine deficit. Alcohol is experienced as very rewarding in the brain, and this can feel good for a person who engages in intense reward-seeking behaviour. People with ADHD can experience interpersonal and work-related frustrations as a result of their condition – their symptoms present additional challenges that people without ADHD don’t have to think about. This can lead to feelings of frustration, isolation, anxiety and feeling misunderstood. Alcohol can temporarily soothe these feelings – but create further problems, and this cycle of drinking to cope can lead to alcohol addiction.

Studies have found that ADHD increases sensitivity to disinhibiting alcohol effects, which could exacerbate existing challenges with impulse control. Impulsivity and addiction can be bidirectional – ADHD causes problems with impulse control, which can lead to binge drinking, while alcohol’s disinhibiting effects can exacerbate the impulsivity further.

ADHD medication and alcohol

Not everyone takes medication to manage their ADHD. Many people think that stimulants are the only type of medication available for ADHD – but this isn’t true. In the UK there are three types of medications available to manage ADHD symptoms.

Stimulant medication

The most commonly prescribed stimulant for ADHD is methylphenidate. This is because it tends to have less pronounced side effects than the other two stimulants prescribed in the UK, dexamfetamine and lisdexamfetamine. Lisdexamfetamine is processed into dexamfetamine in the body, meaning the medicine is released more slowly into the system, as it has to be converted to dexamfetamine to start taking effect.

All of these medications are central nervous system stimulants and work similarly – but people are more likely to discontinue methylphenidate because they found it didn’t work for them. In contrast, people are more likely to discontinue dexamfetamine because of the side effects.

The side effects for all of these medications are quite similar, although lisdexamfetamine can cause drowsiness and dizziness, which is uncommon for the other medications. Common side effects include decreased appetite, mood swings and aggression, headaches, and gastrointestinal disturbances like nausea or diarrhoea.

Taking stimulant ADHD medication and drinking is not a good idea. This combination is very hard on the cardiovascular system and increases the risk of heart problems, including heart attacks.

Atomoxetine

Atomoxetine is an SNRI that increases levels of noradrenaline in the brain. This helps with concentration and impulse control.

Atomoxetine is effective for ADHD, but not as effective as stimulants. It’s useful for people who have comorbid issues with addiction, heart problems, or people who don’t want to take stimulants. Alcohol should be consumed with caution when taking atomoxetine – it can cause drowsiness if it’s taken at the same time.

Guanfacine

Like atomoxetine, guanfacine increases the activity of norepinephrine in your brain. It also decreases blood pressure – so for this reason it should not be mixed with alcohol as this can lower your blood pressure further and lead to dizziness and drowsiness.

Dual diagnosis

A dual diagnosis of substance abuse is common for people living with ADHD. This presents challenges – many of the symptoms of ADHD and substance abuse overlap, which can make diagnosis challenging. Stimulants are the most effective drug treatment for ADHD – but because they have a high abuse potential, medical professionals are cautious about prescribing them to people with substance misuse issues.

Administering help with alcohol and ADHD requires a lot of nuance and personalisation – risks and benefits need to be weighed, and a full range of treatment options need to be employed. These will include medications, psychosocial treatments and close and careful management and monitoring.

Treating a substance misuse disorder with a co-occurring condition is a delicate process, and professional help gives you the best opportunity for recovery. At UKAT, we understand the challenges you face, and have years of experience treating people with dual diagnoses.

Reach out today to find out more about the tailored, comprehensive support we can offer you.