I tell them that first. Every time someone starts with "I know I probably shouldn't bring this up, but..." or "I don't want to be difficult, but I think maybe..."
You're not being difficult. You're describing what's actually happening, and that matters.
Nobody ever said that to me.
I spent years being made to feel like I was the problem for having more than one thing going on at once. Thirteen psychiatrists refused my referral before one said yes. No explanation. Just silence that became its own answer.
When I finally got in the room with number fourteen, I sat there realizing for the first time that all these things I thought were just "me being broken" actually had a name. Every question about my actions, my behavior, my mannerisms in relation to ADHD got a yes. I didn't know there was a condition that explained why I do the things I do.
I just thought that was me.
The $480 Gate
The psychiatrist prescribed medication. Gave me the script. But the system built in a monthly gate to keep accessing it.
$480 every month just to see him and get the prescription reissued. I was on a low income. At some point you realize you simply can't afford to keep being treated.
He never sent the formal diagnosis back to my GP. The bit of paper that would've let any doctor take over. When I went chasing it, I learned he'd gone on indefinite leave. Files on his computer. No way to reach him. End of story.
So I pushed. I read up on my rights as a patient. I quoted the legislation. I named the regulator I'd be going to next. Got one reply back, then nothing.
Later, in rehab, a doctor floated the idea of a non-stimulant option. For a moment I thought, finally, someone's actually listening. Then that doctor went on leave too. The plan got refused. More than once I was told straight out to stop talking about my ADHD.
No discussion. No medication. Just drop it.
What Self-Medication Actually Means
Before I got proper ADHD treatment, I was using crystal meth as my medicine. I didn't know I was treating undiagnosed and untreated ADHD. I just knew my brain was screaming at me.
The meth would quiet things down for a bit. Then I'd crash harder and need more just to feel baseline.
With actual ADHD medication, I could focus without that screaming. I could sit still. Finish a thought. Not feel like I was constantly trying to outrun my own mind.
The meth was like trying to fix a broken leg with alcohol. Sure, you don't feel the pain for a while. But you're making everything worse. The ADHD meds actually addressed what was broken instead of just numbing me to it.
Research shows that 70% of young adults with both substance use disorder and ADHD report they used substances as a form of self-medication rather than to get high. What systems call "addiction" is often desperate problem-solving for a brain that won't cooperate.
I lived with that screaming for 36 years before getting my first diagnosis. Then I had to get diagnosed again at 40 because the system quietly fell apart around me.
Liability Dressed Up as Caution
When you're working with people through NDIS, you start recognizing the pattern. It's when they start apologizing for asking.
They've learned that advocating for themselves is somehow being a problem.
I see it most when someone mentions they think they might have ADHD or autism or something else going on underneath the addiction or mental health stuff everyone's already focused on. The way they bring it up—tentative, like they're expecting to be told no before they even finish the sentence.
They've already been through the system that treats complexity like it's inconvenient instead of just the actual reality of how people work.
The worst part is watching them shrink when they talk about it. Like they're taking up too much space by existing with more than one thing wrong at once.
I lived that. I know exactly what that does to you over time.
Clinical guidelines say you can treat ADHD safely even with substance use history. International guidelines explicitly state that ADHD diagnosis and treatment should be initiated "as soon as possible" in individuals with substance use disorder, with simultaneous and integrated treatment for both conditions preferred.
But practitioners override the evidence with fear-based gatekeeping.
They're more afraid of being the one who prescribed stimulants to someone with an addiction history and having it go wrong than they are of leaving someone untreated and watching them keep self-medicating with something far more dangerous.
It's easier to say no and feel like you protected yourself than to actually do the harder work of monitoring someone properly.
There's this assumption baked in that people with addiction histories can't be trusted. Not just with the medication, but with their own experience of their symptoms. The moment you admit you've used, suddenly everything you say about your brain becomes suspect.
You're not a reliable narrator of your own life anymore.
The guidelines say treat it, monitor it, adjust as needed. But the practitioner is thinking about the review board, the complaint, the headline if something goes sideways. So they default to no, call it "clinical judgment," and the person in front of them just becomes another file they didn't have to take a risk on.
It's not evidence-based. It's fear-based.
And the person pays the price for that fear with years of their life.
The Actual Cost
The system's rejection becomes your internal voice.
You start thinking maybe they're right. Maybe I am just an addict looking for a fix. Maybe I can't be trusted. Maybe this is just who I am and I need to accept it.
You keep using because the underlying thing driving you to use never gets addressed. You go to rehab, you get clean, you white-knuckle it for a while. Then your brain is still screaming at you and you don't have any other tools, so you go back to the only thing that ever worked, even though it's destroying you.
The cycle just keeps repeating because everyone's treating the symptom and ignoring the cause.
I lost years to that. Relationships, jobs, any sense of stability. All of it gone because I was trying to fix something I didn't have the right tools for.
And the whole time, the answer existed. It was in the guidelines. It was in the research. It was sitting right there.
But I couldn't access it because someone decided their comfort level with risk mattered more than my actual life.
Research confirms this pattern. Patients with substance use disorder and underlying ADHD have more complex addiction patterns, more poly-substance use, earlier age of onset, higher likelihood of suicidal behaviors, more hospitalizations, and lower treatment adherence compared with those without ADHD.
The system's refusal to treat both conditions creates the very failures it claims to prevent.
The erosion of believing you deserve help at all happens slowly. Once that's gone, you stop asking. You just accept that this is how it's going to be until it kills you.
What Kept Me Asking
I think it was spite, honestly.
And the fact that I'd seen enough people die accepting the system's version of who they were. I watched people I cared about just give up, believe they were too broken to fix, and I saw where that ended.
I wasn't going to let that be my story.
I got angry. Really angry. Because the more I read, the more I realized the help existed and I was being denied it for reasons that had nothing to do with my wellbeing and everything to do with someone else's comfort.
That shifted something. It stopped being about me being broken and started being about them being wrong.
When the reason is "we don't trust you" instead of "this won't work," that's not clinical. That's personal.
I wasn't going to let someone else's bias be the thing that killed me.
I think part of me knew that if I stopped asking, I'd prove them right. That I wasn't worth the effort. That I couldn't be helped. That I was just another lost cause.
I refused to become the story they'd already written about me.
What Their "No" Actually Does
When you deny someone ADHD treatment because you're worried about misuse, you're not protecting them.
You're guaranteeing they'll keep self-medicating with street drugs that have no monitoring, no dosing consistency, and no safety net at all.
Your caution becomes their death sentence.
The evidence supports this. Treatment of ADHD with stimulant medication was associated with an 85% reduction in risk of substance use disorders in youth with ADHD. Proper treatment doesn't create addiction risk. It eliminates the need for self-medication.
Person-centered care would mean actually listening when someone tells you what's happening in their brain instead of deciding their addiction history makes them unreliable.
It would mean following the clinical guidelines that say you can treat ADHD safely even with substance use history, and then doing the actual work of monitoring instead of just saying no and calling it clinical judgment.
It would look like asking "what support do you need to make this work safely?" instead of "I don't trust you with this."
Regular check-ins. Pill counts if needed. Whatever structure makes it safe. But actually providing the treatment instead of withholding it.
Because the research is clear: treating the underlying ADHD often reduces the pull toward substances. Ignoring it guarantees the cycle continues.
The infrastructure exists. The medications exist. The guidelines exist.
What's missing is practitioners willing to do the harder thing. To actually treat the whole person in front of them instead of just the parts they're comfortable with.
What I Tell Them Now
When someone comes to me with that apologetic "I don't want to be difficult, but..." I tell them what the system never told me.
You're not being difficult. You're describing what's actually happening, and that matters.
I tell them to keep their own records. Every appointment. Every time they ask for something and get told no. Every symptom they notice.
When you're in the system, especially with an addiction history, people will act like you're unreliable. Your own documentation becomes your proof that you're not making this up. That there's a pattern. That you've been asking for help and getting shut down.
I tell them that advocating for yourself isn't being a pain in the ass. It's survival.
The system is designed to make you give up. It wears you down with waitlists and referrals that go nowhere and practitioners who disappear with your files.
If you stop asking, they win, and you lose years of your life to something that could've been treated.
But mostly, I just make sure they know they're not alone in this.
What they're experiencing—the dismissal, the runaround, the feeling like they're too complicated to help—that's not them being broken.
That's the system failing them.
And they deserve better than that. They deserve someone who actually listens and doesn't make them apologize for needing help.
Last week I sat down in front of a psychiatrist who actually heard me. I'll be honest, it brings me to tears even writing this. Forty years, and finally someone looked at me and said there's a reason you are the way you are, there's something we can do about it, and you don't have to do this on your own.
It's early days on my treatment plan, but for the first time in a long time, I feel like I'm finally meeting the real me.
Five years working as a disability support worker has taught me one thing above almost everything else.
You never, ever want to become the barrier to someone's care.
Because knowing the help is right there and choosing not to give it isn't clinical caution.
It's a barrier wearing a lanyard.
Tony Bailey is in recovery, studying counselling at Torrens University, and hosts the podcast Fall From Grace.