How Difficulties in Emotion Regulation and Distress Tolerance Induce Substance Use among Undergraduate Young Adults with Attention-deficit/Hyperactivity Disorder: A Systematic Narrative Review

Abstract

College students face multiple stressors that increase vulnerability to emotional dysregulation, substance use, and other health-risk behaviours. Emerging adults with attention-deficit/hyperactivity disorder (ADHD) may be particularly vulnerable due to persistent difficulties in emotion regulation (ER) and distress tolerance (DT). This systematic narrative review, adhering to the PRISMA framework, examined the relationship between ER, DT, and health-risk behaviours among college students with ADHD. Findings from 21 peer-reviewed studies indicate that students with ADHD demonstrate maladaptive ER strategies and lower DT compared to their peers. Emotional dysregulation was associated with increased substance use, impulsivity, and risk-taking behaviours. Low DT further intensified the impact of negative emotional states on maladaptive coping. Impaired problem-solving and heightened emotional reactivity contributed to adverse functional outcomes. Findings underscore the need for developmentally targeted prevention and intervention efforts addressing ER and DT deficits in college students with ADHD. Integrating mindfulness-based, dialectical behavioural, and cognitive-behavioural strategies into campus mental health services may reduce long-term impairment and promote resilience.