Examining executive functioning: A randomized controlled trial of alcohol misuse interventions for college students with attention-deficit/hyperactivity disorder.

OBJECTIVE: College students with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk for alcohol misuse and alcohol-related negative consequences, partly due to deficits in executive functioning (EF). Although brief motivational interventions (BMI) effectively reduce alcohol use among college students, they may not sufficiently address EF challenges common among students with ADHD. Augmenting BMI with behavioral activation (BMI + BA) may offer the scaffolding needed to improve EF and reduce negative consequences. METHOD: Using a randomized controlled trial design, we compared BMI + BA to BMI + supportive counseling among 112 heavy-drinking college students with ADHD. In this secondary data analysis, we tested whether baseline EF moderated treatment effects and whether BMI + BA produced greater improvements in EF trajectories using linear mixed and latent growth models. RESULTS: Baseline EF impairment significantly moderated treatment effects, such that participants with clinically elevated EF impairment showed greater reductions in alcohol-related negative consequences in the BMI + BA condition. Across the full sample, EF significantly improved over time. Although no between-group differences in overall EF slope were detected, only BMI + BA showed significant within-group EF improvement. Piecewise models indicated that most EF gains in BMI + BA occurred from Session 4 through 3-month follow-up. CONCLUSIONS: This study provides valuable insights into the role of EF in alcohol use interventions for college students with ADHD and helps determine for whom more intensive treatment (BMI + BA) may be necessary. Additionally, results suggest that BA may support EF improvement over time, particularly in domains related to planning and follow-through. (PsycInfo Database Record (c) 2026 APA, all rights reserved).