“I Thought I Was Just Thick”: ADHD, Cannabis, and What a First Session Can Reveal

One of the most important things a first counselling session can do is not solve anything.

Its job is to create the conditions in which a person feels safe enough to be honest — with you, and perhaps more critically, with themselves.

In a recent initial session, delivered within a Motivational Interviewing and psychoeducation framework, a client I’ll call G. said something that has stayed with me. Describing his school years, he told me he had been made to feel “thick” — despite being someone with clear and demonstrable practical intelligence. He holds a tree-surgery ticket. He has a sharp mechanical aptitude. He is articulate, self-reflective, and perceptive in conversation. And yet for years, he internalised the message that he wasn’t capable.

That moment — and the exploration that followed — opened up something significant about the relationship between unrecognised neurodivergence and long-term substance use.

When the Brain Finds Its Own Solutions

G. self-reports ADHD, with possible autism and a lived experience of dyslexia. At the time of our session, this had not been formally assessed — but the profile was consistent: impulsivity, sensitivity to stimulation, rapid emotional shifts, a tendency to seek out intensity, and a brain that struggles to find the brakes when boredom or discomfort arrive.

Cannabis had been a daily feature of his life for years. Alcohol episodically, and heavily. There had been a period of cocaine use, though he had moved away from that. When I asked him what these substances did for him — not what they cost him, but what they gave him — his answers were thoughtful and immediate.

He wasn’t using to rebel. He wasn’t using out of carelessness. He was, in the language of the formulation I was beginning to develop, self-medicating a nervous system that had never been adequately understood or supported.

For a young person who has never been told their brain works differently, discovering that a substance makes them feel functional is not a failure of character. It’s a logical response to an unmet need.

This is not an uncommon presentation. Research consistently shows that people with ADHD are two to three times more likely to develop a substance use disorder than the neurotypical population. Cannabis in particular has a complex relationship with ADHD — it can temporarily dampen hyperarousal, reduce the sensation of mental noise, and provide the “off switch” that the ADHD brain so often lacks.

The Cost of Not Knowing

What struck me most in working with G. was how much of his story had been shaped by the absence of a framework. Without a word for how his brain worked, he had constructed explanations from the available materials: he was difficult, impulsive, a troublemaker. He wasn’t academic, not because of neurology, but because he simply wasn’t clever enough. His family of origin had normalised substance use — there was no map that pointed elsewhere.

The crisis point came, as it often does, not from the substances themselves but from the weight of simultaneous pressures converging: relationships fracturing, children’s welfare at stake, housing instability, a body that had been run hard for too long. It was a year or so before our session that things had reached their lowest, and the support available at that moment had not been adequate to the need.

What brings someone like G. into a counselling room, when he finally arrives, is rarely a single trigger. It is the accumulation — and somewhere beneath it, a sense that there is still something worth salvaging. He came with that. I could hear it in how he spoke about his children, in the pride he took in some small wins over the weekend, in his willingness to be honest about the weekend’s failures in the same breath.

Psychoeducation as an Act of Repair

One of the things I find most powerful in early sessions with clients who present with likely neurodivergence is the moment when psychoeducation lands. Not as a lecture, but as a mirror.

When a client hears, perhaps for the first time, that the impulsivity and the emotional flooding and the difficulty with boredom are features of a particular neurological profile — not moral shortcomings — something visibly shifts. There is often a quality of relief that moves through the room. Sometimes it looks like anger: why didn’t anyone tell me this? Sometimes it looks like grief. Sometimes it comes out as a kind of dark humour — a reframing of years of difficulty through a lens that finally makes sense.

With G., we used plain language to explore what ADHD dysregulation actually looks like in the body — the amygdala’s role in threat-detection, the way the vagal system governs arousal and calm, the neuroscience behind why high-risk or high-stimulation environments can feel more manageable than quiet ones. This is not about overwhelming a client with jargon. It’s about giving someone a vocabulary for their own experience. That vocabulary is, itself, therapeutic.

It also reframes the cannabis use. Instead of “addiction” as a label that carries shame, we can explore: what need was this meeting, and what are some other ways that need might be met? That’s a very different conversation. It’s the conversation MI is designed to open.

Ambivalence in the Right Direction

G. was not ambivalent about wanting things to be different. He was clear about that. Where the ambivalence lived was in the how — the fear that stopping cannabis entirely might leave him unable to regulate in the short term, the social fabric that use was woven into, the question of whether the version of himself he was reaching towards was actually achievable.

These are not obstacles to change. They are the substance of change. In MI, we are not trying to eliminate ambivalence — we are trying to help the client hear their own change talk more clearly, to explore the discrepancy between where they are and what they value, and to strengthen their confidence that movement is possible.

By the end of the session, G. and I had the beginnings of a shared working frame: a nine-month horizon, a central goal around his family, and a clearer map of what the work ahead might involve — including the possibility of a formal ADHD assessment as part of that journey.

A Note on the Counsellor’s Role

Working with clients like G. requires the counsellor to resist a particular temptation: the urge to push. When someone is intelligent, motivated, and clearly capable of insight, it can feel like the right thing to do is accelerate — to move quickly through the formulation, to offer solutions, to lay out a path.

MI asks us to slow down. The client’s pace is the right pace. The insights that stick are the ones the client arrives at themselves, with you alongside them. The counsellor’s job in that first session is not to impress anyone with the formulation — it is to create enough safety and curiosity that the client wants to come back for the second one.

G. did.

All identifying details have been fully removed. This post is a reflective piece for professional and public audiences and does not constitute clinical advice.

Paul Burrows is a Drug & Alcohol Counsellor practising Motivational Interviewing and Psychoeducation-based approaches in community settings.