The relation between ADHD symptoms and alcohol and cannabis use outcomes in a cross-sectional study of college students: The mediating role of experiential avoidance

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for alcohol and cannabis misuse compared to peers. College students with ADHD are particularly vulnerable to problematic alcohol/cannabis use, given widespread misuse of these substances. Experiential avoidance has been 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/cannabis use. This study examined whether experiential avoidance mediates the relation between ADHD symptoms and alcohol and cannabis use and related problems (e.g., driving under the influence). In addition, we examined two exploratory aims: (a) whether mediation effects differ by sexual/gender minoritized status (SGM; e.g., lesbian, bisexual, transgender) and (b) whether mediation effects differ by ADHD symptom dimension (i.e., hyperactive/impulsive, inattentive). Participants (N = 2,158; M age = 19.72) were college students in the U.S. with and without ADHD who reported past-month alcohol or cannabis use. Participants completed an online, self-report survey at a single time point. Experiential avoidance mediated the relation between ADHD symptoms and alcohol- and cannabis-related problems. Moderated mediation analyses showed that indirect effects 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 the non-SGM group compared to the SGM group. Finally, indirect effects were larger when inattentive symptoms were entered in mediation models versus hyperactive/impulsive symptoms. Implications for future research and clinical practice are discussed.