ADHD and alcohol: Emotional regulation efforts pay off in quality of life points

The emotion dysregulation and impulsivity are highly associated with alcohol use disorder (AUD). This study explored the role of impulsivity and emotion dysregulation and the interaction with adult probable ADHD on alcohol-related quality of life (QoL). In this observational trial, we analyzed data from the randomized TRAIN study, which compared efficacy of two cognitive training programs in patients AUD recently detoxified at 5 centers in France from February 2019 to February 2023, and who completed child and adult ADHD screening data (WURS + ARSR, n = 206 of 226). We collected baseline data on AUD severity, age, sex, quality of life (AQoLS), cognitive impairment (MoCA), impulsive behavior (UPPS-P) and emotion dysregulation (ERQ expressive suppression subscore, DERS-impulse). Patients with probable and without ADHD were compared. We performed multiple linear regression explaining the total AQoLS score (dependent variable) by impulsivity (UPPS-P score), emotion regulation (DERS-impulse), and expressive suppression (ERQ expressive suppression subscore), and their interaction with ADHD, adjusted on MoCA, sex, age. Forty (19%) patients were above the screening threshold for ADHD. The impact of alcohol on QoL was greater in them than in those without ADHD (57.3 (21.9) vs. 46.4 (19.6), p = 0.002). High impulsivity and emotion dysregulation dimensions were both significantly associated with poorer QoL. ADHD interacted significantly with expressive suppression to worsen the impact of alcohol on QoL (p = 0.04). The dysfunctional attempts to compensate for the strong dysregulation of emotions in ADHD lowers QoL in AUD.