Up until recent years, it’s been widely assumed that substance abuse cases among people with autism spectrum disorder (ASD) are rare.
But much of this data and assumption has been based on outdated ideas that the majority of autistic cases are severe (meaning, largely non-verbal with limited mobility).
As we know now, autism is a spectrum, and not all individuals on the spectrum have severe, immobilizing autism.
Despite previous assumptions, people with autism have access to drugs and alcohol, and some might use substances in social settings to ease anxieties.
Current studies suggest a greater connection between substance abuse and autism than before, as this notion was generally dismissed as very unlikely.
Disclaimer: In this article, we’ve opted for person-first language, “person with autism”, as opposed to identity-first language, “autistic person”. It’s our aim to use language that is inclusive and respectful for the individuals and families in this community.
What Research Says About Substance Abuse And Autism
A 2016 study examining co-occurring ASD and substance use disorder (SUD) found several similarities between the behaviors of people with ASD and those with addictions.
For example, one of the core traits of autism is restricted, repetitive behaviors. For a person with autism, this might look like ritualistic behaviors or obsession over specific interests.
We see this same trait in individuals who abuse substances. It’s the same type of repetitive, obsessive behaviors that drive people to continue using substances despite the consequences.
Other shared characteristics between people with ASD and SUD include:
- poor social functioning
- emotional lability
- fixed habits of behavior
- co-occurring mental health disorders
Many people with ASD and/or SUD are diagnosed with co-occurring disorders of:
- schizophrenia spectrum disorders
- bipolar disorder
- attention deficit hyperactivity disorder (ADHD)
- avoidant personality disorder (AVPD)
- social anxiety disorder
- mood disorder
Substance Abuse Is Likely Underdiagnosed
In clinical settings, people with ASD are not often screened for SUD, despite SUD screenings being a common procedure in most psychiatric settings.
Interventions, screenings, assessments, and community-based efforts largely ignore the ASD population, suggesting a misrepresentation of the reality of substance abuse for this population.
Clinicians should be aware of the possibility of substance abuse among people with ASD and take better precautions to assess signs of drug and alcohol use.
Risk Factors For Substance Abuse Among Those With Autism
A person with autism has many of the same risk factors of substance abuse that the general population has.
- genetics, or addiction in the family
- economic factors, such as difficulties obtaining and keeping jobs
- social factors, such as isolation
- stress or anxiety
- difficulty adapting to major life changes
In addition to these risks of abusing substances, someone with ASD has increased risk factors associated with intellectual ability and experience with other mental challenges.
Though research is still limited at this time, experts believe that substance abuse may be more prevalent in those with high-functioning ASD.
This is because of a few different reasons, one of the primary explanations being social engagement.
A person with high-functioning autism will likely engage socially much more than others on the spectrum who find it more difficult to relate with people, make friends, and go to public places.
This puts a person with ASD at a higher risk of coming in contact with substances as they’re spending time with more people and going to social settings that may involve substances.
Understanding The Consequences Of Substance Use
Someone on the autism spectrum may also experience challenges in comprehending the consequences of substance abuse.
Children with autism may not get the same level of education in school on drug and alcohol use, and can enter into adult life without the same understanding of substances as their peers.
When a person with ASD uses drugs or alcohol, they might not have fully anticipated the results of those actions.
After using substances, a person with ASD is particularly vulnerable as they might struggle to know when to stop, have further difficulties with social behaviors, and more.
Other Mental Disorders
People with autism are often at higher risks of developing co-occurring disorders, such as anxiety, ADHD, and many others.
According to research published on the National Center for Biotechnology Information (NCBI):
- About 20% of people on the autism spectrum have been diagnosed with anxiety.
- About 28% to 44% of adults diagnosed with ASD also meet the criteria for ADHD.
Other mental issues that people with autism face (such as suicidal tendencies and bipolar disorder) are largely associated with an increased risk of substance misuse.
Experts have concluded that people with autism might use substances as a way to cope with these co-occurring conditions, in addition to the social and cognitive difficulties with ASD.
Self-medicating with substances may happen in isolation or in social situations as a way to calm social anxiety and fear.
Treating Substance Abuse In A Person With Autism
Each of the issues discussed previously suggests a need for proper drug and alcohol abuse education and treatment that specialized for people on the autism spectrum.
However, this level of care and consideration is not always implemented at drug rehab centers, resulting in barriers to treatment for those with autism.
Barriers To Treatment
Much of modern, evidence-based addiction treatment is centered on group involvement, which tends to exclude individuals with autism.
The following treatment strategies can be difficult for those with ASD:
- group therapy
- Alcoholics Anonymous (AA) meetings
- 12-step groups
- educational classes
- residential treatment and community-based facilities
- other self-help groups
Each of the above treatments can increase anxiety, anger, and feelings of social isolation among people with autism in treatment.
Some treatment providers may misunderstand a person’s withdrawal from these activities as a lack of motivation or desire to recover, when it’s just an indication that social activities are not optimal for that person’s recovery.
This, in turn, can lead to burnout and a feeling of failure and rejection for those with autism. This burden of stress and disappointment contributes to high treatment drop-out rates.
This is why it’s increasingly important that rehab centers provide individualized treatment that meets the needs of specialized groups, as recovery is not one-size-fits-all.
Dual Diagnosis Treatment
To provide the best level of care for individuals with autism, dual diagnosis treatment is very important.
When treating a dual diagnosis, counselors and treatment specialists can tailor the rehab program to consider the needs of a client who has both ASD and SUD.
In this setting, support from family and friends is integral to the success of an ASD client.
Treating a dual diagnosis of ASD and SUD may also involve incorporating strategies commonly recommended for people with ASD.
- incorporating familiar routines
- improving self-efficacy
- setting realistic goals
- teaching social skills
- vocational training
Cognitive Behavioral Therapy (CBT)
The most commonly recommended behavioral therapy for clients with ASD in substance abuse treatment is cognitive behavioral therapy.
CBT is a method that involves awareness of negative or inaccurate thoughts so a person can better overcome those thoughts and situations.
Researchers have found that CBT can best be adjusted to the needs of ASD clients in treatment, providing the strongest pathway to recovery when compared to other therapies.
This method of treatment can help an ASD client by:
- improving awareness of existing issues and challenges with thoughts and behaviors
- teaching new methods of coping with stressful situations, negative thoughts, or mental disorders
- improving self-confidence
Resources For Those With Autism Seeking Help
If you or someone you love have ASD and SUD, there are resources that can help kickstart the journey to recovery.
Review the list of resources below to learn more about substance abuse, addiction, and their intersection with autism.
Federal and national organizations with resources on substance abuse and mental health:
- National Alliance on Mental Illness (NAMI): Find resources on mental illness, substance abuse, and advocacy.
- National Institute on Drug Abuse (NIDA): You can learn more about how drugs affect the brain, research, and clinical resources.
- Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator: Search for treatment centers in your area.
Books, podcasts, and resources:
- Drinking, Drug Use, and Addiction in the Autism Community, by Elizabeth Kunreuther: This book discusses the connection between autism and addiction.
- Mental Health America, Take a Mental Health Test: You can use this as a tool to gauge your mental health and substance use.
- Radio Health Journal podcast, “Autism And Substance Abuse”: This podcast episode explores how one person used alcohol to cope with autism.
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- National Center for Biotechnology — Autism Spectrum Disorder and Co-occurring Substance Use Disorder – A Systematic Review
- National Center for Biotechnology — Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study
- Springer Link — Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study
- U.S. National Library of Medicine: PubMed — High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: a preliminary study of 44 outpatients