(PS1-65) Examining Same-day Alcohol-related Negative Consequences in Heavy-drinking College Students with ADHD Taking Prescribed Stimulant Medication

Background: Stimulant pharmacotherapy is considered a first-line treatment for ADHD linked with improved academic and social functioning. While there is evidence that stimulant treatment can reduce the risk of alcohol misuse in individuals with ADHD and improve treatment outcomes for those with co-occurring ADHD and substance use disorders, many providers are hesitant to use stimulant pharmacotherapy to treat ADHD in heavy drinkers and caution patients treated with stimulant medications to abstain from alcohol due to concerns about increased toxicity and misuse potential. Given the ubiquity of alcohol use in college, this may pose a challenge for those treating college students with ADHD, who are at higher risk of alcohol use disorder, binge drinking, experiencing negative alcohol-related consequences, and poor medication adherence. Thus, there is a need for empirical data examining how prescription stimulant medication use relates to alcohol-related outcomes in heavy-drinking college students with ADHD, particularly at the daily level. 

Methods: Participants were a subsample of heavy-drinking college students with ADHD with a current stimulant medication prescription (N=25; ages 18-21, 56% female) participating in a larger naturalistic daily-diary study on hazardous alcohol use. Participants reported daily prescribed stimulant medication use (yes/no), daily alcohol use (yes/no), and total number of alcohol-related negative consequences on drinking days (adapted Brief Young Adult Alcohol Consequences Questionnaire) using mobile daily diaries over two weeks. Multilevel modeling was used to examine same-day and between-subject effects of stimulant medication use on alcohol-related negative consequences. We included sex assigned at birth (male/female), dummy-coded weekend status (Friday-Saturday/Sun-Thursday), and day of study (1-14) as covariates.

Results: Across the daily diary period, participants reported 1-14 days of taking stimulant medication (M=8.36, SD=3.64) and 1-12 drinking days (M=5.92, SD=2.53). Alcohol use on days when participants took stimulant medications was common, with 84% (n=21) of the sample reporting at least one drinking day when they also took their stimulant medication (M=3.28 days, SD=2.37). Participants experienced alcohol-related consequences on 0-6 days and reported an average of 1.86 (SD=1.49) consequences on those days (range:1-8). ICCs were low for daily alcohol consequences (.256) and daily stimulant medication use (.351), suggesting considerable within-person variability across the daily diary period. Within-person, there were no significant associations between taking stimulant medication and alcohol-related consequences on the daily level (b=0.05, SE=0.19, p=0.797). However, at the between-person level, total number of days taking stimulant medications was associated with significantly fewer average alcohol-related consequences (b= -0.10, SE=0.05, p=0.036). 

Conclusion: These findings challenge the notion that prescribed stimulant medications may increase risk among heavy-drinking college students with ADHD and suggest that additional research evaluating the risks and benefits of stimulant pharmacotherapy for heavy drinkers with ADHD is needed.