Application of Behavioral Economic Theory to College Student Drinkers with and without ADHD: A Daily Diary Study

Abstract

Aims: Young people with ADHD are vulnerable to the initiation and escalation of hazardous alcohol use in college, posing high direct and indirect costs to these individuals and society. Behavioral economic theory proposes key etiological and maintenance factors of hazardous alcohol use that have never been examined at the daily level in connection to ADHD: alcohol demand, substance-free enjoyment and activity engagement, and behavioral activation. Method: College student drinkers with (n=51) and without (n=50) ADHD completed 14 consecutive days of daily diaries (n=1,414). We conducted a series of multilevel path models to examine (1) the effect of ADHD on average daily alcohol demand, substance-free enjoyment and activity engagement, and behavioral activation; (2) the effect of average daily alcohol demand, substance-free enjoyment and activity engagement, and behavioral activation on alcohol use and alcohol-related negative consequences; and (3) the moderating effect of ADHD on these same-day associations. Results: On average, drinkers with ADHD experienced more daily alcohol-related negative consequences relative to non-ADHD drinkers. ADHD was also associated with less daily substance-free enjoyment and behavioral activation. Regardless of ADHD status, there were significant associations among each behavioral economic risk factor and alcohol use and alcohol-related negative consequences, though effects differed at the within and between person levels. There were no moderating effects of ADHD on these same-day associations. Conclusion: This is the first study to apply daily diary methodology to examine behavioral economic risk factors among drinkers with versus without ADHD. Results expose areas of daily impairment specific to drinkers with ADHD and meaningfully advance theoretical conceptualizations of ADHD and hazardous alcohol use. Future research identifying daily associations among environmental triggers and alcohol problems in an ecologically valid manner has tremendous potential to inform the development of adaptive interventions delivered to the right people at the right time.