The Relation Between ADHD Symptoms and Alcohol and Marijuana Use Outcomes Among College Students: The Mediating Role of Experiential Avoidance

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at significantly greater risk for alcohol and marijuana misuse and abuse compared to their peers. College students with ADHD may be particularly vulnerable to problematic alcohol and marijuana use, given the widespread use and abuse of these substances by college students generally and liability associated with ADHD specifically. Experiential avoidance, or avoidance of unwanted thoughts, feelings, and other internal experiences, is positively associated with ADHD symptoms and substance use problems. However, it is unclear what role experiential avoidance plays in the relation between ADHD and alcohol and marijuana use. This study examined whether experiential avoidance mediates the relation between ADHD symptoms and (1) alcohol and marijuana use frequency, (2) alcohol- and marijuana-related problems (e.g., driving while intoxicated), and (3) heavy alcohol use. In addition, this study examined two exploratory aims: (1) whether mediation effects differ by sexual/gender minority status (SGM; e.g., lesbian, bisexual, transgender, gender non-conforming) and (2) whether mediation effects differ by ADHD symptom dimension (i.e., hyperactive/impulsive, inattentive). Participants (N = 2,158; M age = 19.72) were college students with and without ADHD in the United States who reported past month alcohol or marijuana use. Participants completed online, self-report questionnaires that assessed ADHD symptoms, experiential avoidance, alcohol and marijuana use, and alcohol- and marijuana-related problems. Experiential avoidance was found to mediate the relation between ADHD symptoms and alcohol- and marijuana-related problems. Moderated mediation analyses showed that conditional indirect effects of mediation models did not differ according to SGM status; however, SGM status moderated the relation between ADHD symptoms and experiential avoidance, such that the relation was more robust for non-SGMs compared to SGMs. Finally, analyses revealed that indirect effects were larger when inattentive symptoms were entered in mediation models compared to hyperactive/impulsive symptoms. Implications of these findings for future research and clinical practice are discussed