Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2026 Mar 11;50(3):e70249. doi: 10.1111/acer.70249

Sociability, drinking motives, and alcohol use problems among young adults with and without childhood attention‐deficit/hyperactivity disorder

Samantha M Margherio 1,✉, Sowan Kang 2, Traci M Kennedy 3, Sarah L Pedersen 3, Elizabeth Gnagy 4, Brooke S G Molina 3, Frances L Wang 3
PMCID: PMC12978211  PMID: 41811197

Abstract

Background

Young adults with attention‐deficit/hyperactivity disorder (ADHD) are at increased risk of experiencing alcohol use problems compared to peers without ADHD. Poorer parent‐rated social functioning has been associated both positively and negatively with alcohol use among youth with ADHD. However, individuals' self‐perceptions of their sociability, or comfort in social situations, could be more specifically linked to risky alcohol outcomes via drinking motives. We tested associations among ADHD, self‐reported sociability, social and coping drinking motives, and alcohol use outcomes in young adulthood.

Method

A total of 333 young adults (53% with ADHD diagnosed in childhood; 80% non‐Hispanic White; 10% female participants) reported their sociability, social and coping drinking motives, heavy alcohol use between ages 18 and 21, and their heavy alcohol use and alcohol‐associated problems at age 23. Zero‐inflated negative binomial path models were tested and mediation was evaluated using the joint significance test.

Results

Results supported the possibility of a social motives “protective” pathway, such that young adults with ADHD histories were less likely than peers to endorse social drinking motives and, in turn, reported better alcohol use outcomes. A low sociability–high coping motives association was also supported such that young adults with ADHD histories were more likely than peers to self‐report low sociability and thus higher coping drinking motives, which were associated with worse alcohol use outcomes later.

Conclusions

Considering the perceptions of sociability among young adults with ADHD may help disentangle complex social pathways to alcohol use. Results highlight the need to develop healthy coping strategies among young adults with ADHD.

Keywords: ADHD, alcohol use, drinking motives, social functioning

Young adults with ADHD may have fewer social drinking motives than peers without ADHD, which are associated with less problematic alcohol use. However, young adults with ADHD who are less confident and comfortable in social situations report having more coping drinking motives, which are associated with worse problematic alcohol use later. Building healthy coping skills is an important intervention strategy to reduce problematic alcohol use among young adults with ADHD.

graphic file with name ACER-50-0-g001.jpg

INTRODUCTION

Attention‐deficit/hyperactivity disorder (ADHD) is highly prevalent, with about 8% of children worldwide diagnosed with the disorder (Salari et al., 2023) and 7% of adults meeting symptom criteria (Song et al., 2021). As youth with ADHD enter adulthood, they continue to experience functional impairments, including challenges in interpersonal, occupational, and substance use domains (Cherkasova et al., 2022; Kosheleff et al., 2023). Although findings vary across individual studies of ADHD, a meta‐analytic study indicated individuals with ADHD are about two times more likely to develop an alcohol use disorder by adulthood than peers without ADHD (Lee et al., 2011). It is critically important to understand factors associated with problematic alcohol use among individuals with ADHD to identify targets for prevention and intervention.

Alcohol use during adolescence and early adulthood often occurs among peers (Skrzynski & Creswell, 2020), making social functioning a key variable in the pathway to problematic alcohol use. For individuals with ADHD, challenges in social skills contribute to difficulties making and maintaining friends (McQuade, 2020). This social impairment may catalyze alcohol use via affiliation with peers who adopt heavy drinking (Marshal et al., 2003) or possibly drinking to cope with peer rejection (Skrzynski & Creswell, 2020). Yet, others found poorer parent‐rated social impairment was associated with less substance use for adolescents and young adults with ADHD (Margherio et al., 2020; Molina et al., 2012, 2014; Sibley et al., 2014), presumably via social isolation that limits access to social drinking contexts. This heterogeneity calls for further exploration to understand why social impairment may contribute to, or dampen risk for, problematic alcohol use among individuals with ADHD.

Social–contextual models of alcohol use highlight the importance of one's own feelings (e.g., comfort, ease) in social situations as a facilitator for drinking motives and, in turn, alcohol use (Creswell, 2021). Assessing young adults' own perceptions of their sociability, or comfort and confidence in social situations, and how such perceptions contribute to drinking motives may further our understanding of socially mediated pathways to alcohol use among young adults with ADHD histories. In the current study, we sought to delineate associations among young adults' perceptions of their sociability, and their heavy drinking and alcohol use problems, and to determine whether ADHD diagnosis in childhood predicted these variables in adulthood.

ADHD and alcohol use

ADHD has been linked to problematic developmental trajectories of alcohol use, although there are some mixed findings regarding this association. Compared to peers without ADHD, those with ADHD initiate alcohol use about a year earlier (Sibley et al., 2014), and this early use predicts escalation to heavy use by early adulthood (Molina et al., 2018). By late adolescence (Molina et al., 2007) and young adulthood (Rooney et al., 2012), individuals with ADHD report similar frequencies of drinking yet more alcohol‐related problems than peers without ADHD. Two meta‐analyses demonstrate elevated risk for alcohol use disorder among individuals with ADHD (Charach et al., 2011; Lee et al., 2011), with another suggesting childhood ADHD was a stronger predictor of alcohol use problems in adulthood than any other measured mental health concern (Groenman et al., 2017). Of note, these meta‐analyses indicated some heterogeneity across studies in the association between ADHD and alcohol use outcomes. For example, some studies have failed to support an association between ADHD and adolescent initiation (Biederman et al., 1997), likelihood (Molina & Pelham, 2003), or frequency of alcohol use (Sibley et al., 2014), elevated alcohol use disorder (Hechtman et al., 2016), or weekly heavy drinking (Molina et al., 2018) at age 25, suggesting there may be some subgroups or characteristics that help explain why some youth with ADHD eventually experience problematic alcohol use while others do not.

Indeed, a diagnosis of ADHD is not deterministic for alcohol use problems. In one study of young adults with ADHD, about 34% belonged to groups defined by high binge drinking, while the majority reported infrequent binge drinking (Merrill et al., 2020). Similarly, a latent trajectory analysis found heterogeneity such that some adults with ADHD belonged to a group defined by chronic alcohol problems and severe depression, whereas others experienced minimal alcohol use problems or depression symptoms (Wang et al., 2019). Such multifinality in alcohol use outcomes underscores the importance of understanding the complex, heterogeneous pathways to risk among this population.

The role of social functioning

Individuals with ADHD often experience challenges in their social functioning. In childhood and adolescence, they are more likely than peers to be neglected or rejected, to have fewer friendships, and to be rated as having poor social skills (McQuade, 2020). These challenges in social functioning appear to persist, with young adults with ADHD being rated as more socially impaired by their parents (Merrill et al., 2020), experiencing more challenges in romantic relationships (Wymbs et al., 2021), and being perceived less positively in their social performance in occupational settings (Fabiano et al., 2018) than peers without ADHD. Notably, young adults with ADHD also tend to report interpersonal problems (Sodano et al., 2021) and poor sociability (Jiang & Johnston, 2012) at rates similar to observer reports.

Challenges in social functioning have implications for the development of problematic alcohol use for young adults with ADHD in diverse ways. Across three independent longitudinal studies of individuals with ADHD, poorer parent‐reported social functioning predicted lower alcohol and substance use during adolescence (Margherio et al., 2020; Molina et al., 2012; Sibley et al., 2014) and young adulthood (Molina et al., 2014). These associations, though unexpected initially, may owe to the socially mediated context of alcohol use early in life. In other words, because most alcohol use during adolescence and young adulthood takes place in social settings (Copeland et al., 2018; Skrzynski & Creswell, 2020), youth with ADHD who were perceived by parents as socially impaired may have had limited access to social drinking contexts.

Alternatively, social deviancy models suggest that social impairment facilitates alcohol use among individuals with ADHD, such that youth who are socially rejected are more likely to affiliate with peers who engage in deviant or otherwise norm‐violating behaviors, increasing their likelihood of engaging in delinquent behaviors like substance use (Dishion & Dodge, 2005). Although this deviancy–proneness pathway was supported in adolescents with ADHD (Molina et al., 2012), it no longer predicted the frequency of heavy alcohol use in young adulthood (Molina et al., 2014), perhaps because alcohol use during early adulthood no longer represents a “deviant” behavior. By early adulthood, other socially mediated pathways may become more relevant, such as drinking to facilitate normative peer relations.

These divergent, socially mediated pathways among youth with ADHD offer important context to understand the heterogeneity in alcohol use outcomes. Notably, each of the prior studies relied exclusively on parent ratings of youth's social functioning, despite the vast and varied ways that social functioning contributes to alcohol use. For example, models of alcohol use risk, such as the social–contextual framework (Creswell, 2021), highlight the importance of how one feels in a given context (e.g., at ease socially vs. social discomfort), rather than one's skills, as a contributor to drinking to facilitate peer affiliations or cope with negative emotions. Thus, identifying social factors associated with drinking requires consideration of the confidence and comfort young adults feel in social situations as this may contribute to reasons for drinking.

Among young adults with ADHD, qualitative evidence highlights the importance of one's perceived comfort in social situations for facilitating reasons for substance use. In two interview studies of adults with lived experience with ADHD and substance use problems, participants endorsed drinking in order to belong, be accepted, and socialize (Flores‐García et al., 2019; Nehlin et al., 2015). In another qualitative study, young adults with ADHD described using substances to dampen negative emotional states, with participants specifically describing use of substances to feel better after aversive social interactions (Mitchell et al., 2018). Collectively, challenges in social functioning experienced by young adults with ADHD may contribute to alcohol use in a variety of ways. Models of alcohol use and emerging qualitative evidence suggest that understanding one's perceptions of their sociability may be an important contributor to alcohol use outcomes via drinking motives.

Social functioning and alcohol use motives

Alcohol use motives, or reasons for use, serve as proximal predictors of alcohol use outcomes (Cooper et al., 2016). Social motives, or drinking to facilitate interpersonal interactions, are the most commonly reported reasons for drinking (Cooper et al., 2016) and play a key role in socially mediated alcohol use (Creswell, 2021). Coping motives, or drinking to dampen negative affect, are particularly predictive of alcohol use problems (Cooper et al., 2016).

Social and coping motives may help explain the association between social functioning and different alcohol use outcomes. Individuals who feel at ease socially or possess high levels of extraversion endorse social drinking motives (Creswell, 2021; Hussong, 2003; Stewart & Devine, 2000). These social drinking motives contribute to greater alcohol use frequency and quantity in the short term (though not necessarily alcohol use problems; Bresin & Mekawi, 2021), likely because drinking in social contexts facilitates greater quantities of alcohol consumption (Creswell, 2021; Monk et al., 2020). Conversely, individuals who feel discomfort in social situations may endorse few social motives for drinking, which could facilitate less alcohol use during young adulthood when drinking often occurs in social situations (Mason et al., 2020). Regarding coping motives, individuals who are uncomfortable in or avoid social situations may endorse drinking to cope to dampen the negative affect associated with social anxiety or rejection (Collins et al., 2021; Lyvers et al., 2018; Stewart et al., 2006; Young et al., 2015). In turn, high levels of coping motives directly predict alcohol use problems specifically, beyond the influence of alcohol consumption (Bresin & Mekawi, 2021).

In sum, one's perceived sociability, or confidence and comfort in social situations, may help explain the contradictory findings regarding the role of social functioning in alcohol use outcomes among individuals with ADHD. Whereas prior research has relied on parent‐reported social functioning, the individual's own reported sociability may contribute to their drinking outcomes via their drinking motives. Given challenges with social skills and a potential history of negative peer feedback (McQuade, 2020), young adults with ADHD may experience discomfort and limited confidence in social situations, which could contribute to less alcohol use via lower social drinking motives, yet possibly more alcohol use problems via higher coping drinking motives.

Current study

We sought to examine the contribution of self‐perceived sociability to different alcohol use outcomes among young adults with ADHD. To assess this aim, we used the Pittsburgh ADHD Longitudinal Study (PALS), the only longitudinal study that has collected detailed data on substance use as well as constructs pertinent to the development of substance use over time among individuals with and without ADHD. Therefore, PALS allows an unprecedented opportunity to test associations in a sample rigorously diagnosed with ADHD in childhood and followed longitudinally over developmental periods when alcohol use behaviors are escalating. We examined the indirect associations between childhood ADHD and alcohol use outcomes (heavy drinking and alcohol use problems) via self‐reported sociability and drinking motives (concurrently assessed). Models were tested both adjusting for prior alcohol use and unadjusted to evaluate the degree to which such hypothesized pathways were robust to the influence of prior use. We expected young adults with ADHD to report lower self‐perceived sociability than their peers, and that their self‐perceived sociability would predict their alcohol use outcomes in two ways: (1) associations suggestive of a low sociability–low social motives pathway such that low sociability would be associated with less frequent heavy drinking via lower social drinking motives and (2) associations suggestive of a low sociability–high coping motives pathway such that individuals reporting low sociability would endorse high levels of coping motives and thus greater alcohol use problems.

METHOD

Participants

ADHD group

Participants with childhood ADHD were diagnosed with DSM‐III‐R or DSM‐IV ADHD in Pittsburgh, PA between 1987 and 1996. Participants were 9.40 years old on average (SD = 2.27 years) at the initial evaluation. ADHD probands were selected for longitudinal follow‐up with annual interviews into early adulthood (age 23) due to their diagnosis of ADHD and participation in a summer treatment program for children with ADHD (Pelham & Hoza, 1996). Diagnoses for ADHD were determined using the disruptive behavior disorders (DBD; Pelham et al., 1992) symptom questionnaire for teachers and parents and a standardized semi‐structured diagnostic interview with parents administered by a doctoral‐level clinician. Two doctoral‐level clinicians independently reviewed all ratings to confirm diagnoses, and a third reviewed the file in case of disagreement. Exclusion criteria included a full‐scale IQ of <80, a history of seizures or other neurological problems, and/or a history of pervasive developmental disorder, schizophrenia, or other psychotic or organic mental disorders (e.g., delirium, substance‐induced disorders, other medical conditions such as brain injuries).

Of those eligible for follow‐up in the PALS (n = 516), 71% participated (n = 364; M = 8.35 years after childhood diagnosis, SD = 2.79). A small percentage could not be located (n = 23) and 129 refused or failed to participate. Participants with childhood ADHD were compared with nonparticipating individuals with ADHD on demographic and diagnostic variables. Only 1 of 14 comparisons was statistically significant (p < 0.05), such that participants had a slightly lower average conduct disorder symptom rating (Cohen's d = 0.30). At the first PALS follow‐up interview, which occurred on a rolling basis between 1999 and 2003, the mean age was 17.75 years (SD = 3.39 years, range = 11 to 28 years).

Non‐ADHD group

Individuals without ADHD were recruited into the PALS when individuals with ADHD were recruited for follow‐up. Non‐ADHD group participants were recruited on a rolling basis and were demographically similar to the ADHD group (age, gender, race and parental education). At the time of recruitment, “gender” was dichotomous with “male” or “female” response options, which is a limitation of this study. Non‐ADHD group participants were recruited from the greater Pittsburgh area from several sources, including pediatric practices (41%), advertisements in local newspapers and the hospital staff newsletter (28%), local universities and colleges (21%), and other methods (11%), such as schools and word of mouth. A telephone screening administered to parents gathered demographic characteristics, history of diagnosis and treatment for ADHD and other behavior concerns, presence of exclusionary criteria as previously listed for the ADHD participants, and a checklist of ADHD symptoms. Individuals who met DSM‐III‐R criteria for ADHD (eight or more symptoms reported by either the parent or young adult) were excluded. There were no statistically significant differences between the 364 individuals with childhood ADHD and the 240 non‐ADHD comparison group participants on age, gender, race, and highest parental education.

Subsample for the current study

To maximize available data given the structure of PALS, participants were included in the present study if they provided self‐report of sociability, drinking motives, and alcohol use at the same time point between the ages of 18 and 21 years old and alcohol use and alcohol use problems at age 23. This sampling resulted in 333 participants (178 ADHD; 155 non‐ADHD). Data were not available if participants (sample sizes are non‐exclusive) were over age 21 at the time of their first assessment (n = 68), the measure of alcohol use problems was added after a participant turned age 23 (n = 120), or the participant did not endorse any lifetime alcohol use and therefore did not complete questionnaires about motives (n = 48). An additional 168 participants did not provide a report of sociability between ages 18 and 21 either because they completed only higher priority measures or they missed their interview, and/or did not participate in the study wave at age 23 (n = 115). Across 10 measured baseline and demographic variables, this subsample differed from PALS participants not included in this study on two variables, such that the subsample was less likely to have ADHD (54% vs. 69%; p < 0.05) and slightly less likely to have conduct disorder (10% vs. 13%; p < 0.05) diagnoses. Sociodemographics for the sample are presented in Table 1.

TABLE 1.

Participant demographics and descriptive statistics.

Participant characteristics Overall (N = 333), N (%) ADHD (n = 178), N (%) Non‐ADHD (n = 155), N (%)
Race and ethnicity
Asian American 2 (1%) 1 (1%) 1 (1%)
Black or African American 38 (11%) 22 (12%) 16 (10%)
Hispanic or Spanish American 2 (1%) 1 (1%) 1 (1%)
Multiple Races 19 (6%) 14 (8%) 5 (3%)
White (non‐Hispanic) 268 (80%) 138 (78%) 130 (84%)
Not listed 4 (1%) 2 (1%) 2 (1%)
Married parents with > high school degree (at eligibility) 190 (57%) 93 (52%) 97 (63%)
Female 32 (10%) 17 (10%) 15 (10%)
Conduct disorder diagnosis 56 (17%) 56 (32%) 0 (0%)
T1 age 19.07 (1.32) 19.09 (1.17) 19.04 (1.14)
T1 sociability (range −4.0 to −1.0) −3.11 (0.37) −3.05 (0.60) −3.17 (0.61)
T1 social motives (range 0–4) 2.37 (0.68) 2.21 (0.81) 2.53 (0.81)
T1 coping motives (range 0–4) 1.49 (0.38) 1.48 (0.64) 1.50 (0.59)
T1 heavy drinking frequency (range 0–8) 2.28 (2.73) 2.05 (2.73) 2.55 (2.74)
T2 heavy drinking frequency (range 0–8) 3.19 (2.75) 2.92 (2.77) 3.47 (2.72)
T2 rate of alcohol use problems 74% 66% 82%
T2 number of alcohol use problems (if any endorsed; range 1–21) 6.41 (12.20) 6.69 (13.93) 6.17 (10.72)
Open in a new tab

Note: T1 = Time 1, age 18–21. T2 = Time 2, age 23.

Procedure

Informed consent was obtained, and all participants were assured confidentiality except in cases of impending danger or harm to self or others (reinforced with a Department of Health and Human Services Certificate of Confidentiality). Interviews were conducted by postbaccalaureate research staff. Self‐report questionnaires were completed with paper‐and‐pencil or computerized versions. In cases where distance prevented participant travel, information was collected through mailed and telephone correspondence; home visits were offered as needed. The University of Pittsburgh Institutional Review Board approved all study procedures.

Measures

Sociability

Young adult self‐reported sociability was assessed using the Self‐Perception Profile for Adults, Sociability subscale (Messer & Harter, 2021). The Sociability subscale includes four items designed to assess one's behavior and comfort in the presence of others. Items are presented in a “some adults/other adult” format (e.g., “Some adults feel that they are enjoyable to be with BUT other adults often question whether they are enjoyable to be with”; “Some adults are not very sociable BUT other adults are sociable”). Respondents are asked to indicate which statement (i.e., the “some” or the “other”) fits them best and choose whether the statement is “sort of true” or “really true” for them, with responses scored on a four‐point scale (−4 to −1). Participants completed this subscale once between ages 18 and 21. The internal reliability estimates are adequate in adult samples (Cronbach's α range = 0.73–0.82; Messer & Harter, 2021) and ours (Cronbach's α = 0.69). Scores reflect the average item rating such that higher scores on the sociability subscale indicate worse social functioning.

Drinking motives

Young adults completed the Drinking Motives Questionnaire (DMQ; Cooper, 1994) at ages 18–21. The DMQ is a 20‐item questionnaire that assesses motives for drinking across four subscales: social, coping, enhancement, and conformity motives. Young adults who endorsed a lifetime history of alcohol use were asked to rate their motives for drinking (e.g., social motives: “Because it improves parties and celebrations”; coping motives: “To forget about your problems”) on a Likert‐scale ranging from 1 (almost never/never) to 5 (almost always/always). Subscale scores were created by averaging the responses to the five items per subscale. Participant completed this measure once between ages 18 and 21 (at the same age as completion of the sociability questionnaire). The DMQ has demonstrated excellent psychometric properties in its original self‐report version (see Cooper, 1994), with good internal reliability in our sample (Cronbach's α = 0.90 for sociability and 0.87 for coping). Social and coping motive subscales were used, with higher scores indicating greater motives.

Heavy drinking and alcohol use problems

Participants reported on their heavy drinking in the past 12 months from ages 18–23 (“In the past 12 months, how often did you drink five or more drinks when you were drinking?”). Responses ranged from 0 “not at all” to 11 “several times a day.” Age 23 reports were used as an outcome variable. To index prior heavy drinking, a covariate was also created by choosing the assessment that matched the age at which sociability was measured.

Among participants endorsing a lifetime history of alcohol use, past year alcohol use problems were assessed using the Young Adult Alcohol Problems Screening Test from ages 18–23 (YAAPST) (Hurlbut & Sher, 1992). The YAAPST assesses whether participants experienced 28 alcohol problems across interpersonal, educational, occupational, and physical (e.g., withdrawal, tolerance) domains. Each participant was coded as having experienced an alcohol problem (1 = “yes”) or not (0 = “no”) in the past year. Item responses were summed to reflect the total number of alcohol problems endorsed. About 74% of participants reported experiencing any alcohol use problems at age 23.

Covariates

Given potential for differential alcohol outcomes based on gender (Ottosen et al., 2016) and childhood conduct disorder (Lee et al., 2011), as well as overall racial differences in alcohol use patterns (Chen & Yoon, 2021), these variables were included as covariates in analyses. Specifically, covariates included participants' self‐reported gender (male = 0; female = 1), minoritized racial or ethnic identity (non‐Hispanic White = 1 and All others = 0), childhood conduct disorder diagnosis, and age at time sociability and motives were assessed. Childhood conduct disorder reflected whether youth met diagnostic criteria for conduct disorder in childhood, based on a standardized semi‐structured diagnostic interview administered to parents by a PhD‐level clinician and by retrospective parent report for the non‐ADHD group. No participants in the non‐ADHD group met criteria for conduct disorder in childhood. The age at which participants reported their sociability and drinking motives ranged from 18 to 21 years old (M = 19.07; SD = 1.32). This age was used as a covariate to account for this variation.

Data analytic strategy

Path models of the indirect associations between childhood ADHD and alcohol outcomes through the sociability and motives variables were tested. Covariates were adjusted in all analyses, which were conducted in Mplus 8.2 (Muthén & Muthén, 2017) (see Figures 1 and 2). Models were conducted both with and without covarying for prior alcohol use (i.e., frequency of heavy alcohol use between ages 18 and 21 when sociability and motives were assessed) to assess whether the hypothesized temporal pathways withstood effects of prior alcohol use. Significance of the indirect effects was tested using the joint significance procedure, which determines mediation based on whether the independent variable is significantly (p < 0.05) related to the intervening variable, and whether the intervening variable is significantly related to the dependent variable. The joint significance test is well powered to test mediation with low Type 1 error rates (Fritz & MacKinnon, 2007; MacKinnon et al., 2002).

FIGURE 1.

FIGURE 1

Open in a new tab

Sociability and motives pathways from ADHD to alcohol use outcomes, unadjusted for prior heavy drinking. Solid pathways = p < 0.05. Dashed pathways = p > 0.05. All coefficients are standardized. Not all tested pathways are presented in the figure for visual clarity. See Table 2 for additional path coefficients.

FIGURE 2.

FIGURE 2

Open in a new tab

Sociability and motives pathways from ADHD to alcohol use outcomes, adjusted for prior heavy drinking. Solid pathways = p < 0.05. Dashed pathways = p > 0.05. All coefficients are standardized. Not all tested pathways are presented in the figure for visual clarity. See Table 2 for additional path coefficients.

The alcohol problems outcome variable was modeled using zero‐inflated negative binomial (ZINB) regressions. Maximum likelihood estimation was used to address missing data. ZINB models account for both the number of zeros present and the overdispersion of the data for these variables by specifying two forms of the outcome variable: a count variable, adjusted for overdispersion, and a binary variable (UCLA Institute for Digital Research & Education, 2020). As a result, the alcohol problems model assessed the likelihood of experiencing any alcohol problems (i.e., a higher score reflecting the excess zeros, indicating not at risk of alcohol problems) as well as individual differences in the number of alcohol problems experienced. The heavy alcohol use outcome variable was modeled using robust maximum likelihood to address nonnormality.

RESULTS

Table 2 and Figure 1 display the indirect associations between childhood ADHD, sociability, drinking motives, and alcohol use outcomes, unadjusted for prior alcohol use. Childhood ADHD was directly associated with lower self‐reported sociability (β = 0.15, 95% CI: 0.04, 0.26, p = 0.01). In turn, lower sociability was associated with greater coping drinking motives (β = 0.24, 95% CI: 0.13, 0.35, p < 0.01), but not social motives. Coping motives were associated with a greater number of alcohol problems among those experiencing any problems (β = 0.47, 95% CI: 0.18, 0.76, p < 0.01). Thus, according to the joint significance test, the mediated effect from childhood ADHD to lower sociability to higher coping motives and to a greater number of alcohol problems was significant.

TABLE 2.

Results of unadjusted and adjusted models.

Age 23 absence of alcohol problems Age 23 number of alcohol problems Age 23 heavy alcohol use
Unadj. Adj. Unadj. Adj. Unadj. Adj.
Predictor β (SE)
Childhood ADHD 0.27 (0.13)* 0.28 (0.13)* 0.28 (0.18) 0.31 (0.18) −0.02 (0.06) −0.03 (0.06)
Age 18–21 sociability −0.02 (0.15) −0.05 (0.19) 0.09 (0.15) 0.16 (0.16) −0.04 (0.06) 0.02 (0.05)
Age 18–21 social motives −0.51 (0.13)** −0.43 (0.16)** 0.46 (0.18)* 0.24 (0.22) 0.32 (−0.08)** 0.09 (0.08)
Age 18–21 coping motives 0.12 (0.17) 0.18 (0.21) 0.47 (0.15)** 0.37 (0.17)* 0.06 (0.08) −0.01 (0.07)
Gender 0.04 (0.11) 0.05 (0.11) −0.15 (0.20) −0.15 (0.20) −0.08 (0.06) −0.05 (0.05)
Race 0.16 (0.16) 0.17 (0.15) 0.33 (0.21) 0.21 (0.21) 0.13 (0.06)* 0.04 (0.05)
Childhood conduct disorder −0.01 (0.10) −0.01 (0.10) −0.13 (0.19) −0.13 (0.19) −0.03 (0.06) −0.04 (0.05)
Age at T1 0.13 (0.09) 0.16 (0.10) 0.20 (0.13) 0.06 (0.14) 0.02 (0.06) −0.12 (0.05)*
Age 18–21 frequency heavy drinking _ −0.18 (0.17) _ 0.47 (0.17)** _ 0.54 (0.06)**
Age 18–21 sociability Age 18–21 social motives Age 18–21 coping motives
Childhood ADHD 0.15 (0.06)* −0.12 (0.07)** −0.07 (0.07)
Gender 0.03 (0.05) −0.11 (0.06)* −0.09 (0.05)
Race 0.12 (0.05)* 0.14 (0.07)* 0.02 (0.05)
Childhood conduct disorder −0.10 (0.06) 0.05 (0.06) 0.11 (0.07)
Age at T1 −0.06 (0.05) 0.15 (0.06)** 0.20 (0.05)**
Age 18–21 sociability _ 0.03 (0.06) 0.24 (0.06)**
Open in a new tab

Note: Unadjusted model: AIC = 4320.42; BIC = 4522.25; Adjusted model: AIC = 5716.21; BIC = 5967.55. Higher sociability = worse self‐report sociability (i.e., comfort and confidence in social situations); higher social and coping motives = more social and coping reasons for drinking.

*

p < 0.05.

**

p < 0.01.

Although sociability was not associated with social motives, childhood ADHD directly predicted lower social drinking motives (β = −0.19, 95% CI: −0.32, −0.06, p < 0.01). In turn, lower social drinking motives predicted reduced frequency of heavy drinking at age 23 (β = 0.32, 95% CI: 0.17, 0.45, p < 0.01), reduced likelihood of experiencing alcohol problems at age 23 (β = −0.51, 95% CI: −0.77, −0.25, p < 0.01), and reduced number of alcohol problems among those experiencing any problems (β = 0.46, 95% CI: 0.10, 0.82, p = 0.03). Thus, the associations between childhood ADHD and better alcohol use outcomes were significantly mediated by lower social drinking motives.

In sum, childhood ADHD predicted degree of alcohol problems via indirect associations consistent with two hypothesized pathways: (1) a low social motives pathway such that young adults with childhood ADHD reported fewer social motives for drinking, which predicted less frequent heavy drinking, a reduced likelihood of experiencing alcohol problems, and a lower number of alcohol use problems; and (2) a low sociability–high coping motives pathway, such that young adults with childhood ADHD reported lower sociability, which was associated with increased drinking to cope, and a greater number of alcohol use problems at age 23.

We re‐ran the analyses, controlling for heavy drinking at ages 18–21 to assess the degree to which findings held above and beyond prior alcohol use. In these adjusted models (see Figure 2), social motives remained significantly associated with the likelihood of experiencing age 23 alcohol problems (β = −0.43, 95% CI: −0.73, −0.12, p = 0.02) and coping motives remained a significant predictor of the number of alcohol use problems among those experiencing any problems (β = −0.37, 95% CI: 0.03, 0.71, p = 0.04). Social motives were no longer significantly associated with the number of alcohol use problems among those experiencing any problems or with heavy drinking in this model, possibly due to the high correlation between social drinking and heavy drinking at ages 18–21 (see Figure 2). The associations consistent with a low social motives pathway only remained for the likelihood of experiencing any alcohol problems, while the associations consistent with a low sociability–high coping motives pathway were robust when accounting for past alcohol use.

DISCUSSION

We sought to examine the contribution of self‐perceptions of sociability in hypothesized pathways to alcohol use among young adults with childhood ADHD. We hypothesized that young adults with ADHD would report lower sociability than their peers, and this lower sociability would translate to alcohol use in two divergent ways. We hypothesized associations consistent with a low sociability–low social motives pathway, such that lower self‐reported sociability would be associated with less heavy drinking via less social drinking motives, and associations consistent with a low sociability–high coping motives pathway, such that lower sociability would be associated with more alcohol problems via coping motives. Within this longitudinal study of young adults with and without childhood ADHD, results did not fully support the hypothesized low sociability–low social motives pathway. While young adults with ADHD reported lower sociability, this variable was unrelated to concurrent social drinking motives. Still, young adults with ADHD were less likely to endorse drinking alcohol for social reasons. However, results were in line with the hypothesized low sociability–high coping motives pathway such that young adults with ADHD reported lower sociability, which in turn was associated with higher levels of concurrent coping motives and in turn more alcohol use problems later. This latter finding withstood controlling for prior heavy drinking. These results help explain the heterogeneous alcohol use outcomes for individuals with ADHD by delineating potentially diverging social pathways to either better or worse alcohol use outcomes.

Low social motives were directly associated with better alcohol use outcomes, which may help explain the inconsistent association between ADHD and alcohol use outcomes in the literature. Specifically, individuals with ADHD may endorse fewer social reasons to drink during a developmental period when alcohol use is predominantly in social settings (Skrzynski & Creswell, 2020). The strength of these indirect effects on both heavy drinking and number of alcohol problems via social motives was attenuated when accounting for prior heavy drinking, perhaps due to the bidirectional association between motives and alcohol use that compounds over time (Crutzen et al., 2013). In contrast, after covarying for earlier heavy drinking, individuals with ADHD continued to show lower social drinking motives, which in turn predicted a lower likelihood for alcohol problems.

Contrary to our expectations, self‐reported sociability was not associated with young adults' social drinking motives. While this lack of findings seemingly contradicts social contextual models of alcohol use (Creswell, 2021), such limited effects further underscore the field's scant understanding of correlates with social drinking motives (Cooper et al., 2016). Our findings add to this literature, suggesting socially oriented drinking motives are not related to individuals' comfort and confidence in social situations. Perhaps, some young adults with ADHD report fewer social drinking motives because they experience fewer opportunities for social drinking as measured by the DMQ (e.g., “because it improves parties and celebrations”), rather than because they perceive themselves as less sociable per se. Young adults with ADHD may have fewer opportunities for social drinking than peers without ADHD for a variety of reasons, including being more likely to live at home (Altszuler et al., 2016), less likely to be on a college campus (Howard et al., 2016), or more likely to have social skill difficulties (Harpin et al., 2016) that preclude invitations to social gatherings. Collectively, regardless of their perceived sociability, young adults with ADHD may have fewer opportunities or reasons to socially drink, which corresponds to better drinking outcomes concurrently.

Alternatively, young adults with ADHD were more likely than peers without ADHD to perceive themselves as less sociable, which was associated with greater coping motives and, in turn, more alcohol use problems, above and beyond prior heavy drinking. These findings correspond to those in samples not selected on the basis of ADHD whereby self‐reported discomfort or anxiety in social settings were associated with coping drinking motives (Collins et al., 2021; Lyvers et al., 2018; Stewart et al., 2006; Young et al., 2015), which are associated with more alcohol use problems (Bresin & Mekawi, 2021). However, these findings offer a different perspective on social pathways to alcohol use among youth with ADHD when compared to prior studies (Margherio et al., 2020; Sibley et al., 2014), including one that also used the PALS sample at younger (adolescent) ages (Molina et al., 2012) and reported both positive and negative associations between parent‐reported social impairment and alcohol use.

Three key differences may explain why these findings regarding the role of social functioning and alcohol use in individuals with ADHD differ from prior research. First, the prior studies used parent‐reported social functioning during adolescence, yet such positive associations disappeared when one study, which also used data from the PALS, measured parent‐reported social functioning during young adulthood (Molina et al., 2014). The role of social functioning in alcohol use likely varies across development as contexts for alcohol use change, including more frequent opportunities for drinking across both solitary and social settings as individuals age into adulthood and alcohol use becomes (or approaches) being a legal behavior in the United States (Fleming et al., 2021). Thus, our results may help explain those of Molina et al. (2014) such that emerging adults with ADHD report fewer social reasons for drinking which limits the social functioning–alcohol use link at this developmental stage. Second, prior studies relied on parent report of social impairment or skills, whereas the current study used young adults' own report of comfort and confidence in social situations. Whereas parent report may focus on observable indicators of social functioning, such as invitations to parties or going out with peers, one's own report may capture the internal states and beliefs associated with social situations that may differ from parents' behavioral observations and be particularly relevant for motives for drinking. Each of these indices (i.e., observer‐reported social functioning and self‐reported comfort in social settings) may offer distinct pieces of information to understand the complexities involved in social pathways to alcohol use. Third, our findings suggested sociability was only associated with alcohol outcomes via coping motives, which were not assessed in prior studies but may be a critical link between social functioning and alcohol use outcomes at this developmental stage when experience with alcohol may drive increased use to ameliorate negative affect (Hussong et al., 2011).

The association between social functioning and alcohol outcomes for youth with ADHD appears to vary as a function of the developmental context, the reporter of social functioning, and the aspect of social functioning being measured. In one longitudinal study of boys with ADHD, researchers found that boys experiencing reduced self‐reported, but not teacher‐reported, social competence over time reported more depressive symptoms 3 years later (McQuade, 2020). In another longitudinal study of youth with and without ADHD, those with ADHD whose self‐reported social competence declined during adolescence experienced more depressive symptoms over time (Hoza et al., 2010). Taken together, as youth with ADHD develop, they may experience maturational changes in their self‐perceptions, and those experiencing decreased perceptions of social competence may also experience worse negative affect, potentially leading to increased alcohol use to cope with negative emotions.

Clinical implications

These findings in line with a low sociability–high coping motives pathway to later alcohol use problems highlights potential treatment targets. Whereas social functioning has historically been an intractable treatment target for youth with ADHD (Morris et al., 2021), two recent randomized controlled trials found treatment gains in social functioning for adolescents with ADHD who were assigned to intensive, multi‐component interventions (Barney et al., 2024; Evans et al., 2024). Interestingly, both trials also reported small, deleterious treatment effects on alcohol/substance use by young adulthood (Kelley et al., 2024; Margherio et al., 2025). More work examining treatment moderators and mechanisms is needed before we can suggest that addressing social functioning in individuals with ADHD could deter alcohol use problems.

Rather, sociability of young adults with ADHD was only associated with alcohol use outcomes via concurrent coping motives, underscoring the importance of building adaptive coping strategies within treatment. For example, innovative treatments for young adults with ADHD that use motivational interviewing and behavioral activation (Meinzer et al., 2021) could be promising. Specifically, focusing on coping strategies in response to aversive social interactions may be important for prevention of problematic alcohol use. As suggested by others (Ramsay, 2010), it may be especially important to offer additional scaffolding, in‐session practice, and point‐of‐performance feedback when teaching coping skills with young adults with ADHD.

Limitations and future directions

We used data from the only longitudinal study that has specifically focused on understanding pathways to alcohol use and other substance use outcomes among individuals with and without ADHD histories. Despite the analytic opportunities afforded by this unique longitudinal study, future research would benefit from expansion to samples with more gender, racial, and ethnic diversity than the current sample. In our sample, young adults identifying as White reported greater sociability and social drinking motives compared to peers, suggesting these patterns may operate differently across cultures and highlighting the need for more work in this area. For example, for racially and ethnically minoritized young adults with ADHD, these pathways may be happening against a backdrop of chronic discrimination which may influence one's perceived sociability, coping motives, alcohol use, and their associations (Sudhinaraset et al., 2016). We used a dichotomous variable to represent gender that did not distinguish between assigned sex at birth and gender identity. As measured, our sample included mostly male participants and we were unable to examine moderation by gender, yet the social profiles of women with ADHD may differ from men (Kok et al., 2016), and women may report more coping yet fewer social motives than men (Kuntsche et al., 2006), suggesting a need to explore these pathways by gender. In addition, our measure of heavy drinking included asking participants how often they consumed five or more alcoholic beverages on one occasion, despite sex differences in the definition of heavy drinking. This categorization therefore may have excluded some female participants who engaged in sex‐specific cutoffs for heavy drinking.

This subsample had slightly lower rates of conduct symptoms relative to the larger PALS sample, which could impact generalizability to young adults with ADHD and co‐occurring conduct problems. Our prior work with this sample indicated that conduct problems and diagnoses in childhood were negligible predictors of young adult alcohol use frequency and alcohol use disorder symptoms (Molina et al., 2007). More specifically, self‐reported delinquency (which overlaps with conduct symptoms) was not associated with heavy drinking in early adulthood beyond ADHD and social impairment (Molina et al., 2014). Thus, given the social landscape of alcohol use during early adulthood, these associations between sociability, motives, and alcohol use may not differ based on the presence of conduct symptoms. Additionally, because we were interested in differing pathways to problematic alcohol use, this sample included only those young adults who reported any alcohol use. We therefore cannot speak to protective factors that prevent young adults with ADHD from engaging in any alcohol use, although this is an important area for future study. Finally, the PALS sample included mostly individuals with the combined subtype of ADHD at the initial assessment, which prevented consideration of how subtypes may differentially influence the pathways examined in this study. These subtypes fluctuate greatly over time (Lahey et al., 2005), and thus, better understanding how ADHD presentations during young adulthood influence sociability and drinking motives is an area for future research.

We cannot determine causal pathways to alcohol use given potential for bidirectional associations among these variables. Indeed, self‐perceptions of sociability and motives for drinking may influence one another both concurrently and temporally. Disentangling the temporal sequencing of social functioning, motives, and alcohol use would be improved by momentary sampling designs. Future studies leveraging such designs among young adults with ADHD may also be equipped to capture the environmental (e.g., social vs. solitary) and emotional contexts of alcohol use, which will aid in our understanding of the conditions under which social functioning contributes to worse or better alcohol use outcomes. Additionally, although our use of self‐reported social functioning is novel and important in the context of young adults with ADHD, future studies should capture multi‐informant, multi‐faceted measures of social functioning given potential biases in adults' self‐reported sociability (Abu‐Ramadan et al., 2023). Research is also needed that considers moderators that could buffer the low sociability–high coping motives pathway, such as examining quality of friendships (Hussong et al., 2001) or general self‐esteem (Schick et al., 2022). Ultimately, although this study sheds light on divergent social pathways to alcohol use among young adults with ADHD, much more work is needed to further disentangle for whom, why, and under what conditions aspects of social functioning lead to greater alcohol use among these individuals.

Additionally, as individuals with ADHD continue to experience impairing symptoms throughout the lifespan, it is critical to examine how these patterns change over the course of development. In our ongoing work with this sample, we found that parent‐rated social impairment early in adulthood continued to play a role in alcohol problems later at age 29 for individuals with ADHD (Molina et al., 2025). As the social contexts of alcohol use change as individuals enter middle adulthood, including an increase in solitary drinking frequency that is associated with drinking to cope (Skrzynski & Creswell, 2021), individuals with ADHD and low sociability may therefore be even more likely to traverse the negative reinforcement pathway to alcohol use suggested by the current study's findings. We encourage researchers to continue examining the complex links between ADHD and alcohol use beyond early adulthood.

CONCLUSION

We examined associations consistent with a hypothesized pathway between childhood ADHD and young adult alcohol use outcomes, focusing on the roles of sociability (i.e., comfort and confidence in social situations) and social and coping drinking motives. Young adults with ADHD were less likely to endorse social drinking motives than peers without ADHD, which was associated with less frequent heavy drinking and fewer alcohol use problems. However, ADHD also contributed to worse alcohol use outcomes via sociability and coping motives, such that young adults with ADHD reported poorer sociability than peers, which was associated with greater coping motives and, in turn, more alcohol use problems. Findings help inform the complex associations between social functioning and alcohol use outcomes among individuals with ADHD, highlighting both dampening and escalating social factors in the pathway to problematic alcohol use.

FUNDING INFORMATION

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was principally supported by grants R37 AA011873, K01 AA027757, K23 AA029133, and R25AA028464.

CONFLICT OF INTEREST STATEMENT

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Margherio, S.M. , Kang, S. , Kennedy, T.M. , Pedersen, S.L. , Gnagy, E. , Molina, B.S.G. et al. (2026) Sociability, drinking motives, and alcohol use problems among young adults with and without childhood attention‐deficit/hyperactivity disorder. Alcohol: Clinical and Experimental Research, 50, e70249. Available from: 10.1111/acer.70249

Frances L. Wang & Brooke S. G. Molina served as co‐senior authors.

The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components.

DATA AVAILABILITY STATEMENT

Data are not publicly available. Study analysis code is available upon request from the first author.

REFERENCES

  1. Abu‐Ramadan, T.M. , Lefler, E.K. , Knouse, L.E. & Hartung, C.M. (2023) Positive illusory bias and self‐handicapping in adults with adhd: a scoping review of the literature and recommendations for research and clinical practice. Journal of Psychopathology and Behavioral Assessment, 45, 917–936. [Google Scholar]
  2. Altszuler, A.R. , Page, T.F. , Gnagy, E.M. , Coxe, S. , Arrieta, A. , Molina, B.S.G. et al. (2016) Financial dependence of young adults with childhood adhd. Journal of Abnormal Child Psychology, 44, 1217–1229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barney, S. , Sibley, M.H. , Coxe, S.J. , Meinzer, M.C. & Pelham, W.E., Jr. (2024) High versus low intensity summer adolescent adhd treatment effects on internalizing, social, and self‐esteem problems. Journal of Clinical Child & Adolescent Psychology, 53, 389–396. [DOI] [PubMed] [Google Scholar]
  4. Biederman, J. , Wilens, T. , Mick, E. , Faraone, S.V. , Weber, W. , Curtis, S. et al. (1997) Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four‐year prospective follow‐up study. Journal of the American Academy of Child & Adolescent Psychiatry, 36(1), 21–29. [DOI] [PubMed] [Google Scholar]
  5. Bresin, K. & Mekawi, Y. (2021) The “why” of drinking matters: a meta‐analysis of the association between drinking motives and drinking outcomes. Alcoholism: Clinical and Experimental Research, 45, 38–50. [DOI] [PubMed] [Google Scholar]
  6. Charach, A. , Yeung, E. , Climans, T. & Lillie, E. (2011) Childhood attention‐deficit/hyperactivity disorder and future substance use disorders: comparative meta‐analyses. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 9–21. [DOI] [PubMed] [Google Scholar]
  7. Chen, C.M. & Yoon, Y.H. (2021) Surveillance Report# 116: Trends in underage drinking in the United States, 1991–2019. Bethesda, MD: NIAAA. [Google Scholar]
  8. Cherkasova, M.V. , Roy, A. , Molina, B.S. , Scott, G. , Weiss, G. , Barkley, R.A. et al. (2022) Adult outcome as seen through controlled prospective follow‐up studies of children with attention‐deficit/hyperactivity disorder followed into adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 61, 378–391. [DOI] [PubMed] [Google Scholar]
  9. Collins, J.‐L. , Sherry, S.B. , Mckee, K. , Thompson, K. & Stewart, S.H. (2021) Do drinking motives and drinking contexts mediate the relationship between social avoidance and alcohol problems? Evidence from two studies of undergraduate drinkers. International Journal of Mental Health and Addiction, 19, 560–578. [Google Scholar]
  10. Cooper, M.L. (1994) Motivations for alcohol use among adolescents: development and validation of a four‐factor model. Psychological Assessment, 6(2), 117–128. [Google Scholar]
  11. Cooper, M.L. , Kuntsche, E. , Levitt, A. , Barber, L.L. & Wolf, S. (2016) Motivational models of substance use: a review of theory and research on motives for using alcohol, marijuana, and tobacco. The Oxford Handbook of Substance Use and Substance Use Disorders, 1, 375–421. [Google Scholar]
  12. Copeland, M. , Fisher, J.C. , Moody, J. & Feinberg, M.E. (2018) Different kinds of lonely: dimensions of isolation and substance use in adolescence. Journal of Youth and Adolescence, 47, 1755–1770. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Creswell, K.G. (2021) Drinking together and drinking alone: a social‐contextual framework for examining risk for alcohol use disorder. Current Directions in Psychological Science, 30, 19–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Crutzen, R. , Kuntsche, E. & Schelleman‐Offermans, K. (2013) Drinking motives and drinking behavior over time: a full cross‐lagged panel study among adults. Psychology of Addictive Behaviors, 27, 197. [DOI] [PubMed] [Google Scholar]
  15. Dishion, T.J. & Dodge, K.A. (2005) Peer contagion in interventions for children and adolescents: moving towards an understanding of the ecology and dynamics of change. Journal of Abnormal Child Psychology, 33, 395–400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Evans, S.W. , Dupaul, G.J. , Benson, K. , Owens, J.S. , Fu, Q. , Cleminshaw, C. et al. (2024) Social functioning outcomes of a high school‐based treatment program for adolescents with adhd. Journal of Clinical Child & Adolescent Psychology, 53, 413–428. [DOI] [PubMed] [Google Scholar]
  17. Fabiano, G.A. , Hulme, K.F. , Sodano, S.M. , Caserta, A. , Hulme, K. , Stephan, G. et al. (2018) An evaluation of occupational behavior in individuals with and without attention deficit/hyperactivity disorder. Human Performance, 31, 165–178. [Google Scholar]
  18. Fleming, C.B. , Mason, W.A. , Stevens, A.L. , Jaffe, A.E. , Cadigan, J.M. , Rhew, I.C. et al. (2021) Antecedents, concurrent correlates, and potential consequences of young adult solitary alcohol use. Psychology of Addictive Behaviors, 35, 553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Flores‐García, L. , Lensing, M.B. , Bjerke, T.N. , Kvalnes, M. & Eisemann, M. (2019) Positive and negative aspects of substance use and treatment goals among substance use disorder patients with and without attention deficit hyperactivity disorder: a qualitative study. Cogent Psychology, 6, 1682765. [Google Scholar]
  20. Fritz, M.S. & MacKinnon, D.P. (2007) Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Groenman, A.P. , Janssen, T.W. & Oosterlaan, J. (2017) Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta‐analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 556–569. [DOI] [PubMed] [Google Scholar]
  22. Harpin, V. , Mazzone, L. , Raynaud, J.P. , Kahle, J. & Hodgkins, P. (2016) Long‐term outcomes of ADHD. Journal of Attention Disorders, 20, 295–305. [DOI] [PubMed] [Google Scholar]
  23. Hechtman, L. , Swanson, J.M. , Sibley, M.H. , Stehli, A. , Owens, E.B. , Mitchell, J.T. et al. (2016) Functional adult outcomes 16 years after childhood diagnosis of attention‐deficit/hyperactivity disorder: MTA results. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 945–952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Howard, A.L. , Strickland, N. , Murray, D.W. , Tamm, L. , Swanson, J.M. , Hinshaw, S.P. et al. (2016) Progression of impairment in adolescents with adhd through the transition out of high school: contributions of parent involvement and college attendance. Journal of Abnormal Psychology, 125, 233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hoza, B. , Murray‐Close, D. , Arnold, L.E. , Hinshaw, S.P. , Hechtman, L. & Group, M.C. (2010) Time‐dependent changes in positively biased self‐perceptions of children with attention‐deficit/hyperactivity disorder: a developmental psychopathology perspective. Development and Psychopathology, 22, 375–390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hurlbut, S.C. & Sher, K.J. (1992) Assessing alcohol problems in college students. Journal of American College Health, 41, 49–58. [DOI] [PubMed] [Google Scholar]
  27. Hussong, A.M. (2003) Social influences in motivated drinking among college students. Psychology of Addictive Behaviors, 17, 142–150. [DOI] [PubMed] [Google Scholar]
  28. Hussong, A.M. , Hicks, R.E. , Levy, S.A. & Curran, P.J. (2001) Specifying the relations between affect and heavy alcohol use among young adults. Journal of Abnormal Psychology, 110, 449–461. [DOI] [PubMed] [Google Scholar]
  29. Hussong, A.M. , Jones, D.J. , Stein, G.L. , Baucom, D.H. & Boeding, S. (2011) An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors, 25, 390. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Jiang, Y. & Johnston, C. (2012) The relationship between adhd symptoms and competence as reported by both self and others. Journal of Attention Disorders, 16, 418–426. [DOI] [PubMed] [Google Scholar]
  31. Kelley, M. , Sibley, M.H. , Coxe, S.J. , Basu, H. , Margherio, S.M. , Evans, S.W. et al. (2024) High vs. low intensity behavior therapy delivered to adolescents with adhd: potential adverse long‐term effects on substance use outcomes. Research on Child and Adolescent Psychopathology, 53, 701–713. [DOI] [PubMed] [Google Scholar]
  32. Kok, F.M. , Groen, Y. , Fuermaier, A.B. & Tucha, O. (2016) Problematic peer functioning in girls with adhd: a systematic literature review. PLoS One, 11, e0165119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Kosheleff, A.R. , Mason, O. , Jain, R. , Koch, J. & Rubin, J. (2023) Functional impairments associated with adhd in adulthood and the impact of pharmacological treatment. Journal of Attention Disorders, 27, 669–697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Kuntsche, E. , Knibbe, R. , Gmel, G. & Engels, R. (2006) Who drinks and why? A review of socio‐demographic, personality, and contextual issues behind the drinking motives in young people. Addictive Behaviors, 31, 1844–1857. [DOI] [PubMed] [Google Scholar]
  35. Lahey, B.B. , Pelham, W.E. , Loney, J. , Lee, S.S. & Willcutt, E. (2005) Instability of the DSM‐IV subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62, 896–902. [DOI] [PubMed] [Google Scholar]
  36. Lee, S.S. , Humphreys, K.L. , Flory, K. , Liu, R. & Glass, K. (2011) Prospective association of childhood attention‐deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta‐analytic review. Clinical Psychology Review, 31, 328–341. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lyvers, M. , Hanigan, C. & Thorberg, F.A. (2018) Social interaction anxiety, alexithymia, and drinking motives in australian university students. Journal of Psychoactive Drugs, 50, 402–410. [DOI] [PubMed] [Google Scholar]
  38. MacKinnon, D.P. , Lockwood, C.M. , Hoffman, J.M. , West, S.G. & Sheets, V. (2002) A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Margherio, S.M. , Brickner, M.A. , Evans, S.W. , Sarno Owens, J. , Dupaul, G.J. & Allan, N.P. (2020) The role of emotion regulation in alcohol use among adolescents with attention‐deficit/hyperactivity disorder. Psychology of Addictive Behaviors, 34, 772. [DOI] [PubMed] [Google Scholar]
  40. Margherio, S.M. , Morse, S. , Dupaul, G.J. & Evans, S.W. (2025) Effects on alcohol and substance use of a school‐based training intervention for adolescents with adhd. Journal of Substance Use and Addiction Treatment, 168, 209523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Marshal, M.P. , Molina, B.S. & Pelham, W.E., Jr. (2003) Childhood adhd and adolescent substance use: an examination of deviant peer group affiliation as a risk factor. Psychology of Addictive Behaviors, 17, 293–302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Mason, W.A. , Stevens, A.L. & Fleming, C.B. (2020) A systematic review of research on adolescent solitary alcohol and marijuana use in the United States. Addiction, 115, 19–31. [DOI] [PubMed] [Google Scholar]
  43. McQuade, J.D. (2020) Peer functioning in adolescents with ADHD. In: Becker, S.P. (Ed.) ADHD in adolescents: development, assessment, and treatment. New York: The Guilford Press, pp. 128–147. [Google Scholar]
  44. Meinzer, M.C. , Oddo, L.E. , Vasko, J.M. , Murphy, J.G. , Iwamoto, D. , Lejuez, C.W. et al. (2021) Motivational interviewing plus behavioral activation for alcohol misuse in college students with ADHD. Psychology of Addictive Behaviors, 35(7), 803. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Merrill, B.M. , Molina, B.S. , Coxe, S. , Gnagy, E.M. , Altszuler, A.R. , Macphee, F.L. et al. (2020) Functional outcomes of young adults with childhood adhd: a latent profile analysis. Journal of Clinical Child and Adolescent Psychology, 49(2), 215–228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Messer, B. & Harter, S. (2021) Self‐perception profile for adults: manual and questionnaires. 2012 . University of Denver.
  47. Mitchell, J.T. , Weisner, T.S. , Jensen, P.S. , Murray, D.W. , Molina, B.S. , Arnold, L.E. et al. (2018) How substance users with adhd perceive the relationship between substance use and emotional functioning. Journal of Attention Disorders, 22, 49S–60S. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Molina, B.S. & Pelham, W.E., Jr. (2003) Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology, 112(3), 497–507. [DOI] [PubMed] [Google Scholar]
  49. Molina, B.S. , Howard, A.L. , Swanson, J.M. , Stehli, A. , Mitchell, J.T. , Kennedy, T.M. et al. (2018) Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the mta longitudinal study. Journal of Child Psychology and Psychiatry, 59, 692–702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Molina, B.S. , Pelham, W.E. , Gnagy, E.M. , Thompson, A.L. & Marshal, M.P. (2007) Attention‐deficit/hyperactivity disorder risk for heavy drinking and alcohol use disorder is age specific. Alcoholism: Clinical and Experimental Research, 31, 643–654. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Molina, B.S. , Pelham, W.E., Jr. , Cheong, J. , Marshal, M.P. , Gnagy, E.M. & Curran, P.J. (2012) Childhood attention‐deficit/hyperactivity disorder (ADHD) and growth in adolescent alcohol use: the roles of functional impairments, ADHD symptom persistence, and parental knowledge. Journal of Abnormal Psychology, 121, 922. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Molina, B.S. , Walther, C.A. , Cheong, J. , Pedersen, S.L. , Gnagy, E.M. & Pelham, W.E., Jr. (2014) Heavy alcohol use in early adulthood as a function of childhood ADHD: developmentally specific mediation by social impairment and delinquency. Experimental and Clinical Psychopharmacology, 22, 110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Molina, B.S. , Walther, C.A. , Wang, F.L. , Kennedy, T.M. , Curran, P.J. , Gnagy, E.M. et al. (2025) Pathways to alcohol use and problems in adulthood for children with attention‐deficit/hyperactivity disorder (ADHD): the role of common impairments above and beyond adhd symptom persistence. Journal of Psychopathology and Clinical Science, 134, 651–662. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Monk, R.L. , Qureshi, A. & Heim, D. (2020) An examination of the extent to which mood and context are associated with real‐time alcohol consumption. Drug and Alcohol Dependence, 208, 107880. [DOI] [PubMed] [Google Scholar]
  55. Morris, S. , Sheen, J. , Ling, M. , Foley, D. & Sciberras, E. (2021) Interventions for adolescents with ADHD to improve peer social functioning: a systematic review and meta‐analysis. Journal of Attention Disorders, 25, 1479–1496. [DOI] [PubMed] [Google Scholar]
  56. Muthén, L.K. & Muthén, B. (2017) Mplus user's guide: statistical analysis with latent variables, user's guide. Los Angeles, CA: Muthén & Muthén. [Google Scholar]
  57. Nehlin, C. , Nyberg, F. & Öster, C. (2015) The patient's perspective on the link between adhd and substance use: a qualitative interview study. Journal of Attention Disorders, 19, 343–350. [DOI] [PubMed] [Google Scholar]
  58. Ottosen, C. , Petersen, L. , Larsen, J.T. & Dalsgaard, S. (2016) Gender differences in associations between attention‐deficit/hyperactivity disorder and substance use disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(3), 227–234. [DOI] [PubMed] [Google Scholar]
  59. Pelham, W.E., Jr. , Gnagy, E.M. , Greenslade, K.E. & Milich, R. (1992) Teacher ratings of DSM‐III‐R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 31(2), 210–218. [DOI] [PubMed] [Google Scholar]
  60. Pelham, W.E., Jr. & Hoza, B. (1996) Intensive treatment: a summer treatment program for children with ADHD. In: Hibbs, E.D. & Jensen, P.S. (Eds.) Psychosocial treatments for child and adolescent disorders: empirically based strategies for clinical practice. Washington, DC: American Psychological Association, pp. 311–340. [Google Scholar]
  61. Ramsay, J.R. (2010) CBT for adult ADHD: adaptations and hypothesized mechanisms of change. Journal of Cognitive Psychotherapy, 24, 37–45. [Google Scholar]
  62. Rooney, M. , Chronis‐Tuscano, A. & Yoon, Y. (2012) Substance use in college students with ADHD. Journal of Attention Disorders, 16(3), 221–234. [DOI] [PubMed] [Google Scholar]
  63. Salari, N. , Ghasemi, H. , Abdoli, N. , Rahmani, A. , Shiri, M.H. , Hashemian, A.H. et al. (2023) The global prevalence of ADHD in children and adolescents: a systematic review and meta‐analysis. Italian Journal of Pediatrics, 49, 48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Schick, M.R. , Nalven, T. & Spillane, N.S. (2022) Drinking to fit in: the effects of drinking motives and self‐esteem on alcohol use among female college students. Substance Use & Misuse, 57, 76–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Sibley, M.H. , Pelham, W.E., Jr. , Molina, B.S. , Coxe, S. , Kipp, H. , Gnagy, E.M. et al. (2014) The role of early childhood ADHD and subsequent CD in the initiation and escalation of adolescent cigarette, alcohol, and marijuana use. Journal of Abnormal Psychology, 123, 362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Skrzynski, C.J. & Creswell, K.G. (2020) Associations between solitary drinking and increased alcohol consumption, alcohol problems, and drinking to cope motives in adolescents and young adults: a systematic review and meta‐analysis. Addiction, 115, 1989–2007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Skrzynski, C.J. & Creswell, K.G. (2021) A systematic review and meta‐analysis on the association between solitary drinking and alcohol problems in adults. Addiction, 116, 2289–2303. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Sodano, S.M. , Tamulonis, J.P. , Fabiano, G.A. , Caserta, A.M. , Hulme, K.F. , Hulme, K.L. et al. (2021) Interpersonal problems of young adults with and without attention‐deficit/hyperactivity disorder. Journal of Attention Disorders, 25, 562–571. [DOI] [PubMed] [Google Scholar]
  69. Song, P. , Zha, M. , Yang, Q. , Zhang, Y. , Li, X. & Rudan, I. (2021) The prevalence of adult attention‐deficit hyperactivity disorder: a global systematic review and meta‐analysis. Journal of Global Health, 11, e04009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Stewart, S.H. & Devine, H. (2000) Relations between personality and drinking motives in young adults. Personality and Individual Differences, 29, 495–511. [Google Scholar]
  71. Stewart, S.H. , Morris, E. , Mellings, T. & Komar, J. (2006) Relations of social anxiety variables to drinking motives, drinking quantity and frequency, and alcohol‐related problems in undergraduates. Journal of Mental Health, 15, 671–682. [Google Scholar]
  72. Sudhinaraset, M. , Wigglesworth, C. & Takeuchi, D.T. (2016) Social and cultural contexts of alcohol use: influences in a social–ecological framework. Alcohol Research: Current Reviews, 38, 35–45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  73. UCLA Institute for Digital Research & Education . (2020) Zero‐inflated negative binomial regression| mplus data analysis examples . [Online]. UCLA. Available: https://stats.idre.ucla.edu/mplus/dae/zero‐inflated‐negative‐binomial‐regression/ [Accessed November 15 2020].
  74. Wang, F.L. , Pedersen, S.L. , Joseph, H. , Gnagy, E.M. , Curran, P. , Pelham, W.E., Jr. et al. (2019) Role of ADHD in the co‐occurrence between heavy alcohol use and depression trajectories in adulthood. Alcoholism: Clinical and Experimental Research, 43, 342–352. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Wymbs, B.T. , Canu, W.H. , Sacchetti, G.M. & Ranson, L.M. (2021) Adult ADHD and romantic relationships: what we know and what we can do to help. Journal of Marital and Family Therapy, 47, 664–681. [DOI] [PubMed] [Google Scholar]
  76. Young, C.M. , Dibello, A.M. , Traylor, Z.K. , Zvolensky, M.J. & Neighbors, C. (2015) A longitudinal examination of the associations between shyness, drinking motives, alcohol use, and alcohol‐related problems. Alcoholism: Clinical and Experimental Research, 39, 1749–1755. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data are not publicly available. Study analysis code is available upon request from the first author.

Articles from Alcohol, Clinical & Experimental Research are provided here courtesy of Wiley

RESOURCES