She began her film career in 1977 with a small part in Exorcist II: The Heretic. In 1993, Adams landed her first major film role as Simone in Richard Linklater's Dazed and Confused. The same year, she appeared in the Saturday Night Live spinoff film Coneheads as one of Connie Conehead's friends.

Two years later, Adams appeared in Mallrats, written and directed by Kevin Smith. The two started dating during the film's post-production, and their relationship provided the inspiration for Smith's next movie, 1997's Chasing Amy. Smith cast Adams in the lead role of Alyssa Jones, a lesbian who falls in love with a man played by Ben Affleck. Later, Smith would describe Chasing Amy as a "sort of penance/valentine" and a "thank-you homage" to Adams. In addition to her acting work on the film, Adams wrote and performed the song "Alive" for the movie's soundtrack.

Adams' performance in Chasing Amy earned her both the 1997 Chicago Film Critics Award and Las Vegas Film Critics Society Award for Most Promising Actress, and a Golden Globe nomination for Best Actress-Motion Picture Musical or Comedy. From there, Adams was originally slated to play the female lead of Bethany in Smith's next film, 1999's Dogma, but she dropped out of the project after the two broke off their romantic relationship. However, she would later make brief appearances in two other Smith projects: the 2001 film Jay and Silent Bob Strike Back, and the 2004 animated short Clerks: The Lost Scene, featured on the Clerks X DVD. In both of these appearances, Adams reprised her Chasing Amy role of Alyssa Jones.

Her post-Smith projects included playing a spunky veterinarian's assistant who falls in love with a single father (Vince Vaughn) in 1998's A Cool, Dry Place. The following year, Adams appeared in her first big-budget Hollywood release, playing Adam Sandler's love interest in the successful comedy Big Daddy. She then went on to appear in many smaller films, including Beautiful and In the Shadows.

In 2005, she had a guest role in an episode of TV show Veronica Mars. During 2006, Adams released her directorial debut, Come Early Morning, starring Ashley Judd, Jeffrey Donovan, Diane Ladd, Tim Blake Nelson and Laura Prepon. The film, shot on location in Little Rock and North Little Rock, was selected for the 2006 Sundance Film Festival.

On November 24, 2009, Interscope Records released Joey's directorial debut for a music video entitled "Belle of the Boulevard" by Dashboard Confessional.

Adams returned to TV in March 2010, on the Showtime series The United States of Tara. She appeared in at least three episodes as Pammy, a barmaid who falls for Buck, Tara's alpha-male alter ego.

Some speculation has been made that her high-pitched speaking voice has hampered her chances of Hollywood stardom, to which she has commented: "It's not a normal voice. It doesn't fit into people's preconceptions about what a woman's voice should sound like. My mom doesn't think I have an unusual voice, though. I'm sure it's helped me get some roles. But 'Chasing Amy' I almost didn't get. There was concern the voice would grate on some people, which some critics said it did." One film critic referred to her voice as a "sex-kitten-on-helium". Another said that whether viewers loved it or hated it, her voice had "the potential to hypnotize."

Adams was born in North Little Rock, Arkansas. Her father was a lumber yard owner. Adams grew up the youngest of three children in the Overbrook neighborhood in North Little Rock. She graduated from Northeast High School in 1986. She announced her intention to pursue acting after an exchange-student year in Australia. She moved to Hollywood in 1988, but now lives in Oxford, Mississippi.

As actress, except as noted: