ADHD and: Self-medicating

Some women with ADHD turn to self-medicating to cope with their symptoms. At first, it may seem to help. But over time, it can make ADHD harder to manage.

In this episode, Dr. Monica Johnson explains self-medicating and breaks down why some women with ADHD turn to it. Find out how self-medicating can be harmful and what healthier ways to cope might look like.

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(00:56) What does self-medicating look like?

(02:30) Ways self-medicating can be harmful 

(07:53) Healthier ways to cope with ADHD

Dr. J: You're juggling work, family, and a never-ending to-do list, but your mind feels like it's on overdrive. So, you grab a coffee or perhaps a glass of wine. Are these quick fixes actually helping, or are they masking the symptoms of ADHD? This is "ADHD and," where we talk about everyday life and ADHD. I'm your host, Dr. J. I'm a licensed psychologist who works with people with ADHD. Today, we're talking about ADHD and self-medicating.

ADHD in women often goes unnoticed, and by the time a diagnosis is given, chances are they're already managing the challenges in other ways. Let's discuss what self-medication is and how it may show up in women with ADHD.

Self-medication refers to the use of substances, so for example, things like alcohol, drugs, or caffeine, or behaviors, which is more like overeating, excessive gaming, or excessive shopping, to relieve psychological or physical distress without professional guidance.

ADHD is closely linked to dopaminergic dysfunction, which governs executive functioning, motivation, and self-regulation. People with ADHD often have lower baseline dopamine levels, which impairs motivation and reward sensitivity. Substances like nicotine, caffeine, cocaine, and amphetamine temporarily increase dopamine, which can improve focus or energy, making them particularly appealing for someone with ADHD.

One of the core features of ADHD is emotional dysregulation. So, this is intense, fast-moving emotions, and a difficulty of calming down once upset. Because ADHD is associated with impulsivity, people may not pause to weigh the long-term consequences before using a substance to feel better now. Behaviors like overeating, overspending on online shopping, excessive gaming or social media usage might also have similar consequences. While it might feel like a quick fix, what seems like a solution can create bigger problems down the road. Let's break down the dangers of self-medicating.

Number one is that it disrupts executive function even more. ADHD is already characterized by deficits in executive functioning skills, like planning, impulse control, organization, time management, and working memory. Substances like alcohol, cannabis, and sedatives further impair these functions. Alcohol and cannabis reduce activity in the prefrontal cortex. This is the same area that is already impaired in people with ADHD. Over time, chronic use can make it harder to follow through on tasks, meet goals, or manage impulsivity. For example, a person might drink to ease social anxiety before an event, but end up forgetting plans, acting impulsively, or saying things that they regret, which can worsen their social confidence over time.

Number two is that short-term relief equals long-term avoidance. Self-medication provides a temporary escape, but it prevents the person from developing healthier coping mechanisms. Instead of learning to regulate emotions, manage frustrations, or tackle overwhelming tasks, the brain begins to rely on a quick fix. This can create a cycle of avoidance, where the person becomes increasingly dependent on substances to feel normal. This reinforces negative reinforcement learning, whereas the person keeps using the substance not to feel good, but to avoid feeling bad.

To be clear, referencing the example that I mentioned earlier, if you struggle with social interactions, hi, welcome to the club. It's not fun. But if you're using substances to avoid the feeling of anxiety, you'll never learn how to cope with anxiety on your own or learn the skills that are required to obtain better outcomes in your social interactions. Which brings me to my next point.

Number three is that it worsens emotional dysregulation. While alcohol or cannabis may initially reduce anxiety or frustration, they often rebound with worse mood swings later. Alcohol is a depressant, and regular usage can worsen depression and irritability over time. Cannabis is linked to increased A-motivation, emotional numbing, and in some cases, cannabis-induced anxiety or paranoia. In research, people with ADHD and substance use tend to have higher rates of mood instability and emotional distress.

These emotions and situations that you're trying to delay, avoid, or entirely deny, they don't and won't disappear. So, once you start running, you have to keep running, and they always catch up with you eventually, except now they're bigger and stronger because of all that cardio.

Number four is that it disrupts sleep. People with ADHD often struggle with inconsistent sleep patterns, and substances make this worse. Alcohol might help someone fall asleep quickly, but it disrupts REM sleep and may lead to early waking. I tell my patients all the time, falling asleep and passing out are two totally different things. Cannabis can also alter sleep structure, leading to reduced sleep quality. Poor sleep worsens in attention, irritability, and memory problems, which are all core challenges for people with ADHD.

Chronic sleep disruption sets off a chain reaction. Worse mood, worse focus, and more reliant on substances and unhealthy habits like mindless scrolling and overeating to get through the day.

Number five might seem obvious. It increases the risk for addiction. Because people with ADHD are more prone to impulsivity, novelty-seeking, and emotion-driven decisions, they're at a higher risk of developing substance use disorders. Up to 50% of adults with untreated ADHD will have a co-occurring substance use disorder at some point in their lives. The earlier the substance use begins, the higher the risk of chronic addiction and relapse, especially without ADHD treatment.

Number six is that it masks the need for proper treatment. When people self-medicate, they may delay seeking appropriate treatment. This includes things like getting an ADHD diagnosis, evidence-based treatment like stimulant medication and CBT, lifestyle strategies like time management skills, sleep hygiene, or mindfulness. This delays actual symptom management and often allows co-occurring disorders like anxiety or depression to worsen. Research shows that proper treatment for ADHD can significantly reduce the risk of substance misuse, especially when started early.

It's easy to fall into the trap of self-medicating when you're trying to manage the challenges of ADHD, but there are healthier, more effective ways to regain control. Instead of relying on substances, research suggests these strategies, which are more sustainable.

Get a full evaluation to clarify ADHD and any co-occurring conditions. This is something that might take time. If you are reliant on insurance and can't afford out-of-pocket services, you may need to get on a waiting list. Get on that waiting list now. Clarification and diagnosis is important because there's so much overlap between conditions, and there's much comorbidity that can be present.

Consider evidence-based treatments like stimulant medications and ADHD-specific CBT. These are proven to work. With that, I would include practicing emotion regulation techniques. This would be mindfulness and or DBT skills, which have been shown to have great effectiveness. You can get access to CBT, DBT, and mindfulness techniques prior to getting the diagnosis. So, don't wait. My practice offers virtual mindfulness and DBT skills training classes in most U.S. States. We take insurance and we provide a sliding scale as low as $20 for those who need it.

Next is to improve sleep hygiene to strengthen focus and mood. Yes, I know this is difficult, and sleep is the foundation of everything. Getting on a routine where you get the appropriate amount of hours of sleep that you need is key. If you're meeting with a psychologist like myself, they can usually help you out with strategies to improve in this area. You can also find a lot of basic sleep hygiene information online.

And lastly, mind your meals and movement. A healthy diet and exercise has been proven to help with basically everything, including ADHD. And quite honestly, for my ADHD girlies, diet, sleep, and exercise, especially as you age, will become more and more vital to how you feel on the day to day.

While none of these things is an instant fix, I have seen people make significant gains in a few months of effective treatment and implementing routines. And once they're locked in and consistent, there's a marked improvement in daily living that is sustainable. Ignore people who promise quick and easy fixes. An easy fix won't be quick, and a quick fix won't last. Remember that.

You can't get much easier than eating vegetables and going on daily walks, but these types of habits require a few months before you notice a difference. You can continue to self-medicate, which is quick, but the dopamine hit from buying another Amazon find or smoking weed will only last a couple of hours, and the consequences can be huge. This is not to say that easy fixes are easy, like they have their own challenges. The definition of easy here relates more to simplicity, ease of access, et cetera.

If you're struggling with these core habits, it's OK. No one becomes a master of anything without a lot of trial and error. Let go of the shoulds, like this shouldn't be this hard or I should have figured this out sooner. All that matters in this moment is what you decide to do today for the person that you want to be tomorrow. One breath, one step, and one day at a time.

That's it for this session of "ADHD and." If you enjoyed today's episode, please check out our episode on ADHD and caffeine, where I explain how caffeine can impact ADHD symptoms. Remember to let me know what questions you have in the comments. I really enjoy hearing from all of you, and I'd also love it if you'd subscribe for more.

This show is brought to you by Understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences, like ADHD and dyslexia. Learn more at Understood.org.

"ADHD and" is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Samiah Adams is our production manager. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and music composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.