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Looking Beneath the Anxiety: ADHD and Self-Medication
In my counselling work, I have noticed an increase in clients presenting with anxiety alongside attention-deficit/hyperactivity disorder (ADHD). Alongside chronic worry and overwhelm, many describe relying on alcohol, drugs, gambling, shopping or other potentially harmful behaviours to manage how they feel.
The apparent increase in ADHD does not necessarily mean the condition has suddenly become more common. Greater public awareness, reduced stigma and better recognition of ADHD beyond childhood are enabling people to identify patterns that may have been present throughout their lives. Clients previously described as lazy, disorganised, oversensitive or simply anxious may now be considering whether a neurodevelopmental difference offers a more accurate and compassionate explanation.
Anxiety is often what initially brings someone into the counselling room. A client might describe racing thoughts, poor sleep, perfectionism, panic or a persistent fear of failure. Beneath this can lie years of missed deadlines, forgotten appointments, impulsive decisions, difficulty completing tasks and feeling unable to meet everyday expectations.
ADHD and anxiety can create a difficult cycle. Problems with attention, planning, working memory and emotional regulation lead to uncertainty and stress. Anxiety then disrupts concentration and sleep, making organisation even harder. Many clients compensate through overworking, excessive checking, people-pleasing or completing tasks during last-minute bursts of intense activity. Although these strategies may preserve outward functioning, they can also produce exhaustion, shame and low self-worth.
Those with less visible hyperactivity may have appeared quiet, dreamy or academically capable while struggling internally. Some learned to mask their difficulties through perfectionism and rigid routines. Life transitions—including university, parenthood, menopause, promotion, bereavement or relationship breakdown—can expose difficulties when established coping systems are no longer enough.
For some people, alcohol or drugs provide temporary relief from internal restlessness, intrusive thoughts, social anxiety or difficulty sleeping. Stimulant substances may be used to increase focus or energy, while sedating substances may slow thoughts or soften emotional intensity. Gambling and shopping can offer stimulation, escape or the immediate reward that routine tasks fail to provide. Other clients may become preoccupied with gaming, food, sex, work or online activity. What begins as an attempt to regulate mood or attention can gradually become a source of financial, physical, relational and psychological harm.
Impulsivity may play a part, but it is rarely the whole story. A behaviour can serve several functions at once: relieving boredom, creating excitement, avoiding distress or briefly restoring a sense of control. Afterwards, regret and practical consequences increase anxiety, which can trigger further self-medication. Understanding this cycle helps us separate the person from the behaviour without overlooking responsibility or risk.
I find it helpful to approach these behaviours with curiosity rather than judgement. Labelling them simply as recklessness or poor self-control risks reinforcing the shame clients may already carry. Asking what the behaviour provides—calm, stimulation, confidence, escape or connection—can help reveal the need beneath it. This does not minimise harmful consequences, but it creates a more compassionate starting point for change.
Counsellors do not need to diagnose ADHD, but we can explore developmental history, patterns across different settings, functional impact, sleep, trauma, mood, substance use and family experiences. We should also remain alert to overlapping or alternative explanations, including depression, autism, obsessive-compulsive difficulties, bipolar disorder, learning differences and physical health conditions. Screening tools can support discussion, although they do not replace a comprehensive assessment. Where appropriate, we can discuss referral options during what may be a lengthy process.
Therapeutic work may include psychoeducation, identifying triggers, developing alternative ways to regulate emotion and creating external supports. Breaking tasks into manageable steps, using reminders, planning for vulnerable times and reducing environmental demands may help. Conventional anxiety strategies sometimes need adapting if they rely heavily on sustained attention, memory or consistent routines. Plans should be specific, personalised and easy to restart after disruption.
Harm reduction can provide a realistic bridge to change. Exploring spending limits, self-exclusion from gambling, safer social support or specialist substance services may be more achievable than demanding immediate perfection. Where dependency, withdrawal, significant financial harm, safeguarding concerns or serious risk is present, specialist assessment and multidisciplinary collaboration are essential.
For me, the growing visibility of ADHD is an invitation to look beneath the presenting symptom. Anxiety and self-medication may not be separate problems, but interconnected responses to an overwhelmed nervous system and years of trying to cope without adequate understanding. When clients recognise this, they can begin replacing self-blame with compassion, take responsibility without being defined by shame, and develop safer ways of meeting the needs those behaviours were trying to address.
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