Protective Behavioral Strategies and Alcohol Problems in Heavy Drinking College Students: The Role of ADHD Symptoms and Sex Differences

Abstract

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related negative consequences, but key correlates of risks for this population are unknown. The use of protective behavioral strategies (PBS) is designed to mitigate the negative consequences of drinking, but people with ADHD may be at-risk for underutilizing PBS. This study evaluated group differences in PBS use and alcohol variables by ADHD status and biological sex. Participants were full-time undergraduate students (49% female; ages 18-22) with (n=42) and without (n=37) ADHD. Students were screened for high-risk alcohol use and completed measures of alcohol use, alcohol-related negative consequences, and PBS. Despite no significant differences among drinking variables, students with ADHD reported more alcohol-related negative consequences compared to their similarly-drinking peers. Males reported more drinks per week but had comparable binge drinking and intoxication episodes to females, where surprisingly, females reported significantly more alcohol-related negative consequences than males. As predicted, students with ADHD and males reported using fewer total PBS than non- ADHD peers and females. Contrary to expectations, moderation analyses showed no significant moderation for ADHD status on sex differences and PBS use, nor did ADHD status significantly moderate the effect of PBS use in reducing alcohol-related negative consequences. Future research should examine possible mechanisms underlying the association between ADHD and PBS utilization (i.e., emotion dysregulation, impulsivity).