Emerging adulthood is a developmental period associated with increased engagement in health risk behaviors, particularly in college students with attention-deficit/hyperactivity disorder (ADHD), a disorder characterized by low distress tolerance and significant difficulty managing emotions. However, research has not examined how these factors impact propensity to engage in health risk behaviors in college students with ADHD. Thus, this study examined the independent and joint effects of ADHD status, emotion regulation, and distress tolerance on the propensity of college students to engage in health risk behaviors (alcohol use, impulsive eating, and drug behaviors). Participants included 143 undergraduate students (81.8% female; 44.1% with ADHD) who completed an online questionnaire via REDCap. Individuals with ADHD reported significantly higher use of maladaptive emotion regulation strategies and lower levels of distress tolerance than the comparison sample. Moderation models using the PROCESS macro for SPSS examined whether the associations between emotion regulation abilities and distress tolerance with health risk behavior engagement were moderated by ADHD diagnostic history. The relation between distress tolerance and engagement in drug use behaviors was moderated by ADHD status, such that for individuals with ADHD, poorer distress tolerance was associated with more drug use. ADHD status also moderated the association between maladaptive emotion regulation strategies and cognitive restraint in eating. For individuals without ADHD, more maladaptive emotion regulation was marginally predictive of less engagement in cognitive restraint around food, but this relation, was not significantly for college students with ADHD. Findings from this study provide insight into intervention targets for college students with ADHD, ultimately resulting in significantly decreased societal and personal health costs.