My relationship with alcohol has always been complicated. Not only do I have a family history of addiction, I have also periodically struggled with my own drinking. I have always been hyper-aware of my drinking behaviors, as one of my worst fears was becoming an alcoholic and hurting the people I love, and up until the pandemic, I was more able to self-correct.
My main focus in this post will be information. There are so many personal stories out there, and I want to keep it focused on the link with ADHD. If you want to read personal stories about alcohol abuse and recovery, the online community Stop Drinking on Reddit is one of the best places on the internet. It is a supportive community of people who have struggled with alcohol abuse, and when I took a time of sobriety last year, it was an invaluable resource. It doesn’t matter if you are just doing a Dry January or working towards permanent sobriety, everyone is welcome. People there are kind, understanding, and knowledgeable. Different perspectives are welcome, and it discourages prescriptive or judgmental advice. Communities like this are proof that the internet is not yet 100% Hot Garbage.
I also highly recommend the book Quit Like a Woman by Holly Whitaker. She quite directly challenges some of the common misconceptions about alcohol abuse in women, as well as offering some critique of the traditional 12 step model when it comes to women in recovery, which I found interesting. It’s relatable, funny, informative, and well written.
If you suspect you may have ADHD, or you have been diagnosed with ADHD and still find yourself struggling with drinking, you are not alone. You, like many of us, are probably using alcohol to self medicate your ADHD symptoms.
To keep things focused, I won’t go on about the specific health risks and consequences of drinking, but if you want a resource for that, I recommend the podcast on alcohol from Huberman Lab, which explains in great detail what it does to your brain from a neuroscience perspective, as well as the effects on your body.
The usual disclaimer that I am not a mental health professional or a physician, and any decisions around your personal health should be discussed with one or both of those people. Cool? Cool.
Drinking During the Pandemic
The pandemic caused a massive uptick in drinking in the United States and elsewhere. We were all trapped in the house and in a weird state of limbo. On top of that, it was absolutely terrifying, but also incredibly boring. Being thrust into a long term traumatic situation got the best of a lot of us. As we know, people drank during the pandemic. Quite a bit. Especially women:
A study in JAMA Network Open in 2020 found that the days in which women drank excessively (defined as four or more drinks in a few hours) increased by 41 percent during lockdown. Another report, from RTI International for the National Institute on Alcohol Abuse and Alcoholism, said that mothers with children under 5 increased their drinking by more than 300 percent during the pandemic.
As life returned to “normal”, a lot of us felt anything but. It’s not a coincidence that ADHD diagnoses increased during the pandemic, since many of us who had been managing our symptoms were no longer able to, and we were turning to substances for comfort. By late 2022, I was in a bad place, which I’ve written about here. I abstained from alcohol for a couple of months, went to the Stop Drinking subreddit daily to check in, read a lot of books, and focused on healing my body and my mind. It was a good decision and helped me begin to focus on taking care of myself. As unpleasant as this time was for me, it led to my diagnosis, and for that I am grateful.
On top of the sober literature I was reading, I started reading about alcohol and ADHD, and boy, that explained a lot. Knowing exactly what alcohol does in the ADHD brain helped me understand better why I was struggling, and why the isolation, trauma, and boredom of the pandemic had made everything worse.
Yep, it’s dopamine again!
If you have ADHD, you have what is called Reward Deficiency Syndrome (the acronym is RDS, not to be confused with RSD, which is Rejection Sensitive Dysphoria. Yes I know that’s confusing). This study on the National Institute of Health website summarizes RDS as follows:
RDS [Reward Deficiency Syndrome] results from a dysfunction in the “brain reward cascade,” a complex interaction among brain neurotransmitters in reward centers of the brain, which directly links abnormal craving behavior with a defect in at least the DRD2 dopamine receptor gene…This defect drives individuals to engage in activities that will increase brain dopamine function. Consuming large quantities of alcohol or carbohydrates (carbohydrate bingeing) stimulates the brain’s production of, and utilization of, dopamine.
For those with ADHD, drinking gives your brain something that you need, at least temporarily. When you have that first cocktail, your brain receives a blast of dopamine. A neurotypical person may feel sleepy, but for us, it can actually increase energy and focus. Studies show that people who get a stimulating effect from alcohol are more prone to have Alcohol Use Disorder. It also can turn down the “chatter” we often experience in our minds. I often described the feeling I would get after a cocktail or two as “someone turning the volume down” in my brain. It also does wonders for things like social anxiety and boredom, both of which were a constant struggle for me. Alcohol helps me mask more effectively (at first), and makes me a little less self conscious. It makes me feel more “normal”. I also found that a glass of wine would help me get started on tasks, like cooking or cleaning the kitchen.
No matter how much you consume, your brain is never going to get the same level of dopamine as it did from that first drink. You are playing a losing game, but your brain doesn’t know that. Every additional drink after the first one provides diminishing returns. Not only does your dopamine level decrease, it actually goes lower than the baseline you started with. You want to get that good feeling back, and your brain knows that booze is a shortcut. So you have a second, maybe a third, maybe a fourth, and before you know it your Good Time has turned into a Very Bad Time.
In fact, it turns out that people with ADHD have an increased sensitivity to the disinhibiting effects of alcohol. One study took a group of people with ADHD and a control group, and gave them both the same amount of alcohol. The study found that the intoxicating effects of the alcohol affected the ADHD group more, and increased the likelihood of impulsive behavior, regardless of blood alcohol content:
Increased sensitivity to the disinhibiting effects of alcohol among drinkers with ADHD might also represent greater behavioral risks associated with alcohol consumption. In addition to the current evidence of greater impairment as BAC peaked under each active dose, it is also likely that this disinhibited state would continue under the dose for a considerable time even when BAC begins to decline. Indeed, studies have demonstrated that cognitive functions show little or no acute recovery from alcohol-induced impairment during a dose, even when BAC begins to decline.
The effects of alcohol in neurotypical people begin to dissipate as the BAC returns to normal. The ADHD brain does not immediately respond to the BAC going down, and so we remain impaired, which increases our chances of impulsive behaviors and accidents. Alcohol affects your prefrontal cortex, which is responsible for executive function, something that we already struggle with. It can also lead to heightened reactivity and a loss of emotional control. Neurotypical people can experience this too, of course, as you know if you have ever consoled a drunk friend or gotten into a stupid argument when drinking. Some of my most legendary meltdowns have been under the influence of alcohol.
As the alcohol begins to wear off, your dopamine levels plummet even further. On top of that, you have wreaked havoc on your GABA receptors, which is going to increase anxiety. The next morning, you may wake up with a hangover, but it’s not just nausea or a headache. It can come with crippling anxiety, depression, and even worse executive functioning, which is going to make you want to - you guessed it - have another cocktail or two to manage the symptoms. This is when unlimited mimosa brunch sounds like a terrific idea, even though you’ll likely wind up back where you started. It’s a terrible cycle, and one many people with ADHD are caught in. According to one study, 42% of people with ADHD binge drink every time they drink.
Even though alcohol hurts us in the long term, it is tempting when it can provide immediate relief from unbearable symptoms. It’s difficult to not reach for the easy “fix” when nothing else is working. There needs to be a lot more understanding and compassion of the suffering of untreated ADHD, and that being properly treated actually significantly decreases the likelihood that you will abuse substances. Untreated ADHD also lowers your life expectancy, by as much as 13 years, and substance abuse is a major reason. A staggering 50% of adults and adolescents with a substance abuse disorder also have ADHD.
Dr. Russell Barkley - one of the foremost ADHD researchers - did a YouTube video on reduced life expectancy in people with ADHD. I’ll link it here. I watched this in my early days of research and found it pretty sobering (no pun intended).
If I have ADHD, does that mean I shouldn’t drink?
I can’t answer that question for you, but anything that is causing issues in your life at the very least needs to be investigated. But you already know that. I suspect that if you are reading this post, you have already taken an “AM I AN ALCOHOLIC??” quiz on the internets. Not that I ever did that.
Now for my most controversial opinion: no program or rehab is going to fix untreated ADHD. Don’t get me wrong - if you have ADHD, or suspect you have it, and are struggling with drinking, quitting alcohol is a healthy choice, and you should find support in AA or another group if you need it. If you are experiencing physical withdrawals, you may need immediate medical care. However, your brain is going to try to find the dopamine elsewhere, and unless you have a treatment plan in place for your ADHD, your symptoms that caused you to self medicate will continue. You may not be drinking alcohol, but now you may find yourself overspending, engaging in risky behaviors, abusing marijuana or other drugs, etc. If you do make the decision to give up drinking forever, you will be more successful if you have all the information and proper treatment.
There are too many barriers to getting diagnosed and treated, which is a grave injustice, and access to care needs to improve. It is my great hope that through using our voices and telling our stories, we can demonstrate how treating this disorder effectively may actually help people with substance abuse disorders find better avenues to recovery.
My relationship to alcohol - like most things in my life at the moment - is a work in progress. Since starting medication, my relationship to alcohol (and food, as I discussed in another post) is a lot healthier. I no longer binge eat or binge drink. ADHD took so much out of my control, but the more I learn, the better equipped I am to handle my struggles. I feel more confident and in control.
I am not fully sober, but I know that option is there if I want it. Now that I’m not getting the stabilizing effects of the dopamine, alcohol doesn’t “work” the way it used to. I don’t feel any relief from it, and I am able to stop and ask myself “Do I actually want a glass of wine?”, and a lot of the time, the answer is no. Some nights, I take a low dose THC edible to wind down, or I do yoga, or both. If I abstain from alcohol, I know that I will get a great night’s sleep, and I won’t wake up feeling sluggish or unfocused. I also have to be careful because of my medication, as drinking on stimulants can cause increased heart rate and other side effects.
The more I heal, the more protective I am over my body and mind. I have so many more tools at my disposal now, and I can let go of the shame and guilt I felt. Shame keeps so many of us from getting the help we need.
If you think you have a problem with alcohol, you are not alone. Don’t be afraid to ask for help if you need it, and there are a wide variety of treatment models available to you.
RESOURCES FOR HELP
RESOURCES CITED:
Quit Like a Woman by Holly Whitaker
Huberman Lab - Episode 86 - What Alcohol Does to Your Body, Brain and Health
“Women - Do We Need an Intervention?” - The New York Times
Changes in Adult Alcohol Use and Consequences during the COVID-19 Pandemic in the US - JAMA Health
Trend of Increased Alcohol Consumption Held Steady as Pandemic Dragged On - RTI International
Attention-deficit-hyperactivity disorder and reward deficiency syndrome - National Institute of Health/National Library of Medicine
Alcohol Use Disorder - Mayo Clinic
Hyperactive Dopamine Response Linked to Alcoholism - Psychology Today
Increased Sensitivity to the Disinhibiting Effects of Alcohol in Adults with ADHD - National Institute of Health/National Library of Medicine
20+ Questions about Mixing ADHD and Alcohol - Sunnyside
How ADHD Affects Life Expectancy - ADDitude Magazine
GABA and Alcohol - How Drinking Leads to Anxiety - Georgetown Behavioral Hospital
The Truth About ADHD and Addiction - ADDitude Magazine