Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity. It affects around 5% of children and adolescents and often persists into adulthood (1). ADHD is associated with changes in the dopamine and noradrenaline neurotransmitter systems in the brain which are also affected by alcohol (2). This means that alcohol can interact with ADHD symptoms and medication. Understanding the effects of alcohol on ADHD is important for managing symptoms and reducing risks.
What is ADHD?
ADHD refers to a group of behavioral symptoms that include (3):
- Inattention – difficulty focusing, organizing tasks, staying on task
- Hyperactivity – excessive movement, fidgeting, restlessness
- Impulsivity – hasty actions without forethought, difficulty waiting, interrupting
These symptoms impair functioning and development. ADHD begins in childhood with at least some symptoms present before age 12. It often persists into adulthood with 2.5% of adults having ADHD (4). ADHD has a strong genetic component but environmental factors like brain injury and prenatal alcohol exposure may also contribute (5).
The exact causes of ADHD are unclear but imaging studies show differences in brain structure and activity. There are lower levels of dopamine and noradrenaline in parts of the ADHD brain. These neurotransmitters are important for brain processes like attention, motivation and impulse control (6).
ADHD is treated with medications, education, behavioral therapy and classroom accommodations. Stimulant medications like methylphenidate (Ritalin) and amphetamine (Adderall) are commonly prescribed to increase dopamine and noradrenaline. Non-stimulant medications like atomoxetine (Strattera) and guanfacine (Intuniv) are also used (7).
How alcohol affects the brain
Ethyl alcohol in alcoholic drinks acts on the brain through several mechanisms (8):
- Increases release of dopamine, endorphins and GABA
- Decreases glutamate excitability
- Alters serotonin receptors
- Disrupts neuron signaling
This causes the characteristic effects of alcohol including relaxation, sedation, impaired coordination and euphoria from boosted dopamine. Alcohol is a central nervous system depressant that slows down brain activity.
With increasing alcohol intake, blood alcohol levels rise and effects intensify. Coordination worsens, thinking abilities decline and behavior changes. Higher blood alcohol levels cause staggering, double vision, slowed reflexes and slurred speech (9).
As blood alcohol levels keep rising, blackouts, respiratory depression, coma or death can occur. The immediate effects wear off as the liver metabolizes alcohol but intoxication can persist for hours. Long term heavy alcohol use damages the brain and can cause memory problems, movement disorders and dementia.
Alcohol’s effects on ADHD symptoms
Alcohol impacts ADHD in complex ways. Smaller doses may seem to temporarily improve some symptoms like restlessness while larger amounts can worsen symptoms (10). The effects also depend on individual physiology.
Inattention
Initially, alcohol may boost attention, similar to stimulant ADHD medication. It releases dopamine, raising motivation and interest. But as alcohol levels build up, thinking, concentration and focus are impaired. Alcohol disrupts working memory needed for mental tasks and learning (11). Hangover effects the next day also impair cognition and attention.
Hyperactivity
Low alcohol doses may alleviate hyperactivity by reducing restlessness temporarily. But higher blood alcohol levels can increase impulsive behaviors, agitation and hyperactivity (12).
Impulsivity
Alcohol reduces inhibitions which can worsen impulsivity in ADHD. People may engage in risky behaviors like social inappropriateness, criminal acts, drunk driving or substance abuse (13). Alcoholism rates are higher with ADHD partly due to impaired self-control.
Sleep
ADHD often causes sleep onset insomnia. Alcohol’s sedative effects can help initially but disrupt sleep later as metabolism proceeds. Frequent alcohol use compromises sleep quality in ADHD (14).
Risks of combining alcohol and ADHD
Those with ADHD show specific risks from alcohol use including (15,16):
Earlier onset of drinking
Children with ADHD start drinking around 2 years earlier than peers on average. Early alcohol exposure affects brain development and increases long term risks.
Binge drinking
Impulsivity and disinhibition contribute to binge drinking patterns in ADHD with more than 5 drinks per occasion. Binge drinking escalates alcohol’s harmful effects.
Alcoholism
Lifetime rate of alcohol dependence is increased at 16% with ADHD versus 11% in the general population. Chronic drinking can worsen ADHD symptoms.
Substance abuse
ADHD doubles the risk of substance abuse which combines dangerously with alcohol. Around 20-30% of adults with ADHD have co-occurring substance abuse disorders (17).
Injuries
Hyperactivity, recklessness and impaired coordination heighten injury risks from accidents, fights, drunk driving, burns and other traumas.
Interactions with ADHD medications
ADHD stimulants and alcohol both raise dopamine so combined effects are magnified, increasing risks. Possible harmful interactions include (18):
Enhanced intoxication
Alcohol’s depressant effects are intensified by stimulants. People get drunker on less alcohol which increases alcohol poisoning danger.
Masking of intoxication
Stimulants counteract sedation and loss of coordination from alcohol. People may underestimate their true level of intoxication and drink more as a result.
Circulatory effects
Both stimulants and alcohol increase blood pressure and heart rate. Together they elevate cardiovascular stress, raising the risk of heart attack, stroke or sudden death in those with heart disease.
Dehydration
Alcohol and stimulants like amphetamines have dehydrating effects which compound together. Dehydration causes headaches, dizziness and other problems.
Non-stimulant ADHD medications generally have less interaction with alcohol though side effects may still be worsened. Drinking on any ADHD medication should be avoided (19).
Tips for safe drinking with ADHD
Since alcohol impacts ADHD symptoms and management, careful moderation is recommended. Safer drinking guidelines for those with ADHD include:
- Avoid drinking when taking prescribed ADHD medications due to interactions.
- Limit alcohol to 1 drink per day for women or 2 for men to lower health risks.
- Eat before and while drinking to slow alcohol absorption.
- Alternate alcohol with water or non-alcohol drinks.
- Have at least 2 to 3 alcohol-free days per week.
- Abstain fully during periods of high ADHD symptom impairment.
- Avoid binge drinking episodes.
- Seek treatment if alcohol use becomes problematic.
Treatment for alcohol abuse with ADHD
When alcohol abuse is occurring along with ADHD, integrated treatment plans are recommended. These involve (20):
- Managing ADHD symptoms and medication use
- Behavioral therapy for alcoholism and self-control
- Treatment of any co-occurring mood or anxiety disorders
- Family education and support
- Participation in support groups like Alcoholics Anonymous
Medications like naltrexone and acamprosate can help reduce alcohol cravings. Addressing ADHD and alcohol abuse together improves outcomes for both conditions.
Conclusion
Alcohol can interact with ADHD symptoms, medications and risks in complex ways. Initial relaxation and dopamine boosts may provide temporary relief of restlessness but larger amounts of alcohol impair attention, inhibitions and coordination. Those with ADHD show earlier onset of drinking, greater binge drinking tendencies and increased rates of alcoholism and substance abuse. Drinking while taking stimulant ADHD medications is particularly hazardous due to enhanced side effects. Careful moderation of alcohol, managing ADHD symptoms and integrated treatment of any alcohol misuse are recommended for improving wellbeing and safety.