4 - (SYM 34) Trajectories of Reward-related Functioning in Motivational Interventions for College Drinkers with ADHD

Background: College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol problems. The optimal therapeutic approach for reducing alcohol problems in students with ADHD, and change mechanisms, are largely unknown. Engagement in alcohol-free (alternative) activities is protective against alcohol use (Acuff et al., 2019). Brief motivational interventions (BMIs) among students unselected for ADHD are generally efficacious in enhancing motivation to reduce drinking and engage in rewarding alternatives. However, ADHD-related traits can interfere with BMIs, perhaps due to limited organizational/planning supports. Thus, BMIs may require adjunctive therapeutic components to help students with ADHD engage in rewarding substance-free activities that both enhance wellbeing and effectively compete with drinking.
In this study, we developed and tested the effects of two alcohol interventions on trajectories of engagement in a repertoire of goal-directed behaviors designed to increase adaptive and rewarding life experiences (i.e., reward functioning). We also evaluated whether enhancing reward functioning across interventions predicted reductions in psychosocial impairment and alcohol problems 3-months post-treatment.


Methods: Heavy drinking college students with ADHD (N=113; 49% male) completed self-reports of reward functioning at each session and ratings of psychosocial impairment and alcohol problems 3-months post-treatment. Participants were randomized to 1) BMI and supportive counseling (BMI+SC) or 2) BMI and behavioral activation (BMI+BA). In both conditions, students received a MI session for alcohol use and a session on ADHD psychoeducation delivered in MI-style. In BMI+BA, students received 2 additional sessions of BA focusing on increasing access to rewarding activities, paired with organizational supports for follow-through. In the BMI+SC condition, students received 2 supportive counseling sessions (i.e., non-directive helping skills) without BA content.


Results: A piecewise model best approximated the data. Regardless of condition, participants engaged in more rewarding, goal-directed behavior over treatment, which in turn predicted reduced psychosocial impairment 3-months following intervention (est.=-.39, p < .007). There were no effects of treatment condition on trajectories of reward functioning.

Conclusion: These findings support enhancing a person’s engagement in rewarding, value-directed alternatives in interventions for drinkers with ADHD.