Can self-medication with substances mask untreated ADHD?

PostedNovember 25, 2025

UpdatedNovember 26, 2025

ByMy Patient Advice

Author: Victoria Rowe, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Many people with undiagnosed ADHD turn to alcohol or drugs to cope long before they realise what is really going on. According to NICE guidance on ADHD (NG87), self-medication is a recognised risk in untreated ADHD, and it can make the condition harder to spot, diagnose, and treat.

Why self-medication happens

When ADHD is not recognised or supported, daily life can feel overwhelming. Impulsivity, restlessness, emotional swings, and low motivation often drive people to seek relief through alcohol, cannabis, stimulants, or prescription drugs. As NHS guidance on ADHD notes, dopamine imbalance and poor emotional regulation can make these substances feel temporarily calming or focusing.

Research published in PubMed shows that people with untreated ADHD are two to three times more likely to misuse substances, with up to 43% developing a substance use disorder at some point in life (PubMed 2025). However, this “self-medication” can blur classic ADHD signs. Restlessness may appear as intoxication; low focus as burnout; and mood swings as depression, delaying diagnosis for years.

When masking leads to missed diagnosis

Studies in The Lancet Psychiatry and Frontiers in Psychiatry highlight that substance misuse can temporarily “mask” ADHD symptoms by numbing hyperactivity or emotional distress. Unfortunately, this often leads clinicians to treat addiction without identifying the underlying ADHD. Many people are not diagnosed until their substance use brings them into contact with health or justice systems (Frontiers in Psychiatry, 2025).

NICE and NHS guidance on screening and treatment

The NICE NG87 ADHD guideline advises clinicians to screen for substance misuse during ADHD assessment, and vice versa. Meanwhile, NICE NG135 and OHID’s substance misuse data highlight how often ADHD and addiction overlap in UK services.

The Royal College of Psychiatrists ADHD treatment by medication, therapy, or both helps reduce substance misuse and leads to better emotional stability and quality of life. For behavioural support alongside clinical care, services such as Theara Change provide evidence-based coaching to help manage ADHD symptoms and build healthier coping strategies.

Takeaway

Self-medication can temporarily hide ADHD, but it never heals it. According to NICE and NHS experts, early screening, accurate diagnosis, and joined-up ADHD and addiction care offer the best route to recovery and long-term wellbeing.

Victoria Rowe, MSc

Author

Victoria Rowe is a health psychologist with a Master’s in Health Psychology and a BS in Applied Psychology. She has experience as a school psychologist, conducting behavioural assessments, developing individualized education plans (IEPs), and supporting children’s mental health. Dr. Rowe has contributed to peer-reviewed research on mental health, including studies on anxiety disorders and the impact of COVID-19 on healthcare systems. Skilled in SPSS, Minitab, and academic writing, she is committed to advancing psychological knowledge and promoting well-being through evidence-based practice.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.