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To Have A Drink Or Not? Navigating Holiday Drinking

Are you looking forward to holiday celebrations? An annual party at work or get together with friends and family? Chances are, these gatherings will have beer, wine, or mixed drinks as options from a bar or kitchen counter. When you are also coping with the symptoms of ADHD, having a plan ahead of time helps to make drinking choices that are best for you.

Moderate drinking is part of our culture. Some people choose not to imbibe at all, based on health, family history, medication interactions, or religious or philosophical ideals. Women who are pregnant or hoping to become pregnant should not drink, along with those who are designated drivers, and no one under the age of 21 should drink (plus, it’s the law). When you are also coping with impulsivity, poor time management skills, or just want to feel more relaxed it can lead to poor choices concerning alcohol.

How can you prepare for social situations where there is moderate drinking? We took a look at what research and experts are saying.

Moderate alcohol use and medication for ADHD

Moderate drinking is frequently defined as two drinks per day for a man and one drink per day for a woman, due to both body size and metabolism. A drink is normally measured as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of hard liquor such as gin, whiskey, or rum. One mixed drink could be the equivalent of two or more drinks, depending on how many shots of alcohol are included.

If you use medication as part of your treatment plan, you need to be aware of how one of the above drinks could interact with your medication. You should also talk with your doctor about combining moderate drinking and medication use; if your doctor is not available, the pharmacist who fills your prescription can also discuss known possible interactions. Researchers do see an increase in side effects when medication and alcohol are combined, though they are minimal. However, it’s still enough to exercise caution.

Denise Leung, MD, an assistant professor of psychiatry at Columbia University Medical Center in New York, says she recommends her patients limit themselves to one drink per event.

"If [a patient] takes a short-acting stimulant in the morning, I'd recommend they wait until the evening before they consider the one drink of alcohol,” Dr. Leung says. “With a long-acting stimulant, I would recommend they wait at least 12 hours.”

Having a drink while medication is active in your system can intensify the effects of the alcohol but at the same time delay your body’s natural responses that let you know you have had too much. Risks include imbibing too much and approaching alcohol poisoning or misjudging your sobriety when it comes time to drive home. The breaking down process in the body could actually lead to higher blood alcohol content for someone taking medication, as opposed to someone who hasn’t taken medication. This includes both stimulant and non-stimulant medications.

David W. Goodman, MD, an assistant psychiatry professor at Johns Hopkins School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland, says his patients have felt ill or uncomfortable the day after having a couple of drinks because of the interaction of medication and alcohol. Dr. Goodman is a former a member of the CHADD Board of Directors.

"Some patients tell me they feel more hung over in the morning than usual, even if they've separated their stimulant and alcohol use by several hours,” he says.

Drinking with cautionor choosing to abstain

Most people who enjoy beer, wine, or mixed drinks on the occasion can do so with minimal risk. There’s even some research stating that moderate drinking could have some health benefits. But, if you do not already drink, they are not enough to begin drinking as part of your diet.

Women who are pregnant should not drink at all because of a risk of fetal alcohol syndrome and other birth defects to their developing baby, including ADHD. Those who have had trouble controlling the amount they drink or are in recovery from alcohol or another substance should also refrain from drinking. 

If you have questions about your use of alcohol, bring them up with your doctor who can guide you best. Though a very common part of our diet, alcohol is still a drug and should be treated with caution when deciding to partake.

“Learning moderation, if possible, is key,” says Edward Hallowell, MD, a psychiatrist and author on ADHD. “Otherwise abstinence becomes the rule.”

More information on moderate drinking:

This article appeared in ADHD Weekly on November 16, 2017.

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