The Pittsburgh ADHD Longitudinal Study: Predicting alcohol misuse, problems and disorder in mid-adulthood

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There is a striking dearth of longitudinal studies of alcoholism ontogeny to mid-adulthood from earlier developmental periods. The extent to which heavy drinking in adolescence and early adulthood persists into later life, and the reasons for its progression to mid-adulthood when employment and family responsibilities are approaching the “ascendant” midlife phase, is vastly under-studied. This is particularly problematic considering that high-risk drinking has increased 37% and AUD 47% among 30-44 year olds. NIAAA has prioritized a developmental approach to the identification of mechanisms underlying alcohol misuse and problems and co- occurring mental health conditions across the lifespan (Goals 1-2, Objective 1a). Cross-sectional research suggests shifting mechanisms of vulnerability with age, from positive to negative reinforcement processes. The Pittsburgh ADHD Longitudinal Study (PALS) is uniquely suited to address these important questions for a high-risk population: adults with a childhood diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). The PALS was designed to prospectively study the onset, course, and causes of AUD in a large cohort of children with ADHD -- an established risk factor for adolescent and young adult AUD. The sample is currently aging through their 30s with > 90% retention (360 ADHD, 224 nonADHD) and provides a unique opportunity to test hypotheses about changing mechanisms of AUD risk and recovery over a large age span, into the late 30s, without empirical precedent. We propose to capitalize on the current age of the PALS sample to take advantage of this opportunity, with a novel emphasis on understanding the intersection of impulsivity and mood as it relates to ADHD risk for AUD. In addition to a wealth of prospectively assessed self- and informant-reported variables collected longitudinally in the PALS, the proposed new, expanded assessments stretching into mid-adulthood will include an ecological momentary assessment protocol (EMA) and behavioral task indices of impulsivity. The proposed 20-day EMA burst embedded in the prospective longitudinal design will characterize the dynamic nature and temporal ordering of alcohol risk processes (e.g., shift in impulsivity) not captured in traditional assessments and will integrate environmental (e.g., interpersonal stress) and individual factors (e.g., negative mood, sleep disturbances) to which individuals with ADHD may be more sensitive. Coupled with integrated examination of etiological processes across important developmental windows (adolescence, young adulthood, mid-adulthood), the prospective, expanded assessments (at ages 35, 37, and 39, with a 20-day EMA at age 35 or 37) will enhance understanding of developmental processes in relation to worsening and improving course of heavy drinking and alcohol problems through mid-adulthood when life altering consequences become especially costly. Results hold promise for developing personalized medicine treatment targets that may be particularly efficacious for reducing AUD risk among adults with a history of ADHD.