EXAMINING EXECUTIVE FUNCTIONING: A RANDOMIZED CONTROLLED TRIAL OF ALCOHOL MISUSE INTERVENTIONS FOR COLLEGE STUDENTS WITH ADHD

Abstract

Background: College students with Attention-Deficit/Hyperactivity Disorder (ADHD) are at an increased risk for alcohol misuse and alcohol-related negative consequences, compared to their neurotypical peers. Deficits in executive functioning (EF)—time management, organization, emotion regulation, self-restraint and self-motivation—may exacerbate this risk. Although Brief Motivational Interventions (BMI) effectively reduce alcohol use among college students, they may not adequately address the unique EF challenges common among students with ADHD. Augmenting BMI with Behavioral Activation (BMI+BA) may offer the additional scaffolding needed to improve EF and reduce harm from drinking. The current study compared BMI+BA to BMI+Supportive Counseling (BMI+SC) to examine: (1) whether baseline EF moderates treatment effects, and (2) whether BMI+BA is more effective in improving EF trajectories compared to BMI+SC.Method: In this randomized controlled trial (RCT), 112 heavy-drinking college students with ADHD were randomized to BMI+BA or BMI+SC. The secondary data analysis used Linear Mixed Models, Latent Growth Modeling, and Piecewise Slope Models to examine 1) the independent and interactive effects of baseline EF and treatment condition on negative consequences, at post-treatment, 1-month, and 3-month follow-up, and 2) whether BMI+BA produced greater improvements in EF trajectories compared to BMI+SC. Results: Baseline EF impairment significantly moderated the impact of treatment on negative consequences, such that clinically elevated EF impairment was associated with a larger reduction in consequences in the BMI+BA condition but not the BMI+SC condition. Across the full sample, EF significantly improved over time. Although there were no significant between-group differences in the overall EF slope detected, the BMI+BA condition showed significant within-group improvement in EF, whereas the BMI+SC condition did not. Piecewise models revealed that EF improvements in the BMI+BA condition primarily occurred after session 4 through the 3-month follow-up and this slope significantly differed from the BMI+SC slope. Exploratory subscale analyses indicated that BMI+BA led to significantly greater follow-up improvements in several EF subscales, with the strongest and most consistent effects observed in organization and time management. Conclusion: This study provides valuable insights into the role of EF in alcohol use interventions for college students with ADHD and helps determine for whom more intensive treatment (BMI+BA) may be necessary. Additionally, results suggest that BA may support EF improvement over time, particularly in domains related to planning and follow-through.