Substances as Self-Medication for Overwhelming Emotions
Many people struggling with alcohol or addiction are not simply seeking pleasure, excitement or escape. In 2017 Edward Khantzian, a substance abuse specialist, advanced the hypothesis that substances are often used as a form of self-medication—an attempt to regulate overwhelming internal states that the person themselves may not be fully aware of.
In over 20 years of working as a BACP (British Association for Counselling and Psychotherapy)-accredited psychotherapist, I have often encountered individuals whose addictive behaviour was closely connected not only to trauma, but also to previously unrecognised Attention Deficit Hyperactivity Disorder (ADHD).
For some people, the use of nicotine, alcohol, drugs or other addictive behaviours is an attempt to quieten an overactive brain that has felt dysregulated for most of their lives.
I provide trauma therapy in Manchester and online using approaches that work directly with how the brain processes and stores traumatic experience, and coaching for those with ADHD whose lives are unmanageable.
The Link Between Childhood Experiences and Addiction
In a landmark study, Vincent Felitti demonstrated a powerful connection between adverse childhood experiences and mental and physical health problems in adult years.
The study found that people exposed to abuse, neglect, mental illness or family dysfunction in childhood were significantly more likely to experience:
- Alcohol dependency
- Drug misuse and/or other addictions
- Depression and anxiety
- Self-harm and impulsive behaviours
- Serious long-term health problems
Importantly, many people with ADHD also grow up subjected to repeated emotional stress:
- Feeling different or “not normal”
- Chronic criticism
- Rejection or social exclusion
- Academic underachievement despite intelligence
- Emotional dysregulation and shame
Over time, these bewildering experiences can become deeply psychologically painful.
ADHD and the Need to Regulate the Nervous System
Undiagnosed ADHD is often misunderstood. It is not simply a problem with attention. For many adults, it may involve:
- Chronic mental restlessness
- Difficulty regulating emotions
- Racing thoughts
- Sleep problems
- Anxiety and overwhelm
- A constant search for stimulation or relief
Edward Hallowell in his book Driven to Distraction describes many adults with ADHD as feeling chronically “switched on”, overstimulated or in a constant internal state of high mental activity.
Alcohol, cannabis or cocaine can temporarily slow this state down.
Some individuals discover that:
- Alcohol quietens mental noise
- Cannabis slows racing thoughts
- Stimulants increase focus and motivation
- Opiates numb emotional pain
Societally, this aberration is seen as criminal and self-destructive. Psychologically and neurologically, however, it’s often a simple attempt to achieve regulation.
This is why simply telling someone to stop drinking or using substances can fail if the underlying condition remains unidentified.
ADHD, Trauma and Addiction Often Overlap
In practice, trauma and ADHD frequently interact.
Someone with undiagnosed ADHD may:
- Experience repeated failures or rejection in childhood
- Develop low self-esteem and chronic shame
- Become more vulnerable to anxiety or depression
- Use substances to manage emotional overload
Likewise, a person with trauma may develop symptoms that resemble ADHD:
- Poor concentration
- Hypervigilance
- Emotional impulsivity
- Restlessness
This overlap means careful assessment is important. Many adults reaching addiction services have never had their neurodevelopmental difficulties recognised.
Why Willpower Alone Rarely Works
Treatment for addictive behaviours is often based on the Prochaska and DiClemente “Stages of Change” model, which assumes people stop drinking and/or using when they become sufficiently motivated or aware of the consequences.
Unfortunately, reality is usually more complicated.
If alcohol or drugs are functioning as:
- emotional anaesthetic,
- nervous system regulation,
- relief from hyperactivity,
- or escape from unresolved trauma,
then removing the substance without addressing these drivers can leave the person overwhelmed by the very distress the addiction was managing.
This is one reason relapse can occur even in highly motivated individuals.
The “Dry Drunk” Phenomenon
The “Big Book” of Alcoholics Anonymous describes a person who has stopped drinking but continues to experience the same emotional and psychological difficulties that fuelled the addiction. Such a person later came to be referred to in the Fellowship as a “dry drunk”.
Clinically, this often reflects unresolved trauma, untreated ADHD or both.
The coping mechanism disappears, but:
- emotional dysregulation,
- agitation,
- shame,
- anxiety,
- and intrusive thoughts
remain unchanged.
Long-term recovery generally requires more than abstinence. It requires identifying and resolving the underlying drivers of distress.
A Trauma-Informed and Neurodiversity-Informed Approach
Effective therapy needs to ask not simply:
“How do we stop doing this?”
but also:
“What function is the addiction serving?”
A trauma-informed and neurodiversity-informed approach may involve:
- understanding childhood experiences,
- recognising undiagnosed ADHD,
- reducing shame,
- improving nervous system regulation,
- and processing unresolved trauma safely.
This is a very different experience from approaches based solely on education and behaviour control.
EMDR and Trauma Resolution
One therapy that can be particularly valuable is Eye Movement Desensitisation and Reprocessing (EMDR).
EMDR helps the brain process unresolved traumatic memories so they lose their emotional intensity and triggering power. As this happens, many people find:
- reduced emotional overwhelm,
- fewer trauma triggers,
- improved self-regulation,
- and less need to rely on alcohol or substances to cope.
Where ADHD is present, therapy may also involve helping the person understand how their nervous system works, why they’ve struggled and how years of self-criticism may have compounded their difficulties.
Recovery Through Understanding, Not Shame
Many people with addiction problems have spent years believing they’re weak, flawed or lacking discipline.
Often this is not true.
In many cases:
- the addiction developed as a survival strategy,
- the nervous system has been chronically dysregulated,
- trauma has remained unresolved,
- or ADHD has never been recognised.
When these underlying factors are addressed properly, meaningful and lasting change becomes far more achievable.
Seeking Support
I provide confidential therapy for individuals experiencing alcohol dependency, addiction, trauma, anxiety and emotional dysregulation, including those who may suspect undiagnosed ADHD.
In my 20 years’ experience as a BACP accredited psychotherapist, I’ve been providing therapy which integrates trauma-informed psychotherapy with other models designed to support emotional regulation and neurological change, including (among others) Eye Movement Desensitisation and Reprocessing (EMDR).
For many people, recovery begins not with shame, blame or an effort of will, but with finally understanding why the addiction developed in the first place.
Book a free 15-minute consultation if you’re interested in working with me.
Important: This article is not intended to replace medical, psychiatric or in-patient detoxification treatment. Anyone concerned about alcohol dependency, substance misuse or mental ill-health should seek appropriate professional support.
