Autism spectrum disorder is a lifelong developmental disorder that affects an estimated 2.2 percent—or nearly five and a half million—adults in the United States.
While research on the prevalence of substance use disorders in people with ASD has been scarce, there’s mounting evidence to suggest that this is more common than previously assumed.
Substance use disorders develop through a pattern of drug or alcohol misuse and can make stopping one’s use of drugs or alcohol feel impossible.
People with ASD may use these substances to overcome social anxiety, frustration, or self-medicate.
Addiction And Autism: How Common Is It?
Estimates on how common substance use disorders are in people with ASD vary, but a couple things are certain: it does happen, but there’s little documentation of it.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance misuse is less likely to be recognized in people with developmental disorders, for a few reasons.
- lack of education about developmental disorders among treatment providers
- believing people with autism lack the emotional, cognitive, or behavioral capacity to develop substance use issues
- lack of research available on substance misuse in this population
- overlap between symptoms of autism and intoxication
There’s a common misperception that people who have autism are less likely to develop substance use issues, which can reduce the likelihood of them receiving a proper diagnosis from a doctor.
According to some research, anywhere from 11 to 29 percent of people with ASD are estimated to develop a substance use disorder in their lifetime.
Addressing The Underrecognition Of Substance Misuse In People With Autism
In recent years, there have been increased efforts to raise awareness about drug and alcohol misuse in people with autism—particularly, what it can look like and best treatment practices.
Autism can cause a range of emotional, social, and behavioral challenges—the severity of which can occur along a spectrum.
These challenges can affect how well a person is able to communicate their thoughts, emotions, and needs—as well as how likely clinicians are to identify people with autism as being capable of having the same vulnerabilities to substance use as others.
Why People With Autism May Use Drugs Or Alcohol
Drugs and alcohol may be used to self-medicate the anxiety, depression, or frustration that can accompany the social and behavioral challenges associated with ASD.
People with autism have reported using drugs or alcohol to:
- reduce social anxiety
- feel more comfortable in social settings
- take the edge off
- forget their problems
- to feel “normal”
- get through the day
Self-medication is a behavior in which a person uses a substance to “treat” a problem without the guidance of a medical professional.
Although substance use can become a way to manage difficulties experienced by a person with autism, over the long term, this can further impair functioning.
People with ASD may also be less likely to identify the potential consequences of their behavior while intoxicated, which can lead to legal problems.
Effects Of Drugs And Alcohol On Autism Symptoms
Drinking for stress relief or to take the edge off is not a phenomenon unique to people with autism. However, it’s a behavior that’s less likely to be recognized in people with ASD.
Substance use can impair concentration, memory, reaction times, and reduce inhibition.
People with autism—who may already have difficulties in these areas—may feel the effects of drugs or alcohol more keenly, with steeper consequences.
Signs And Symptoms Of Addiction In People With Autism
Substance use disorders can be identified by a number of physical and behavioral signs. These signs can be somewhat different or trickier to identify in people with ASD.
Signs of substance misuse can include:
- drinking very often and in excessive amounts
- taking prescription medications in any way other than prescribed
- using illicit drugs (e.g. heroin, cocaine, methamphetamine)
- lying about how often one is drinking or using drugs
- unusual mood swings
- unexplainable changes in weight or appearance
- worsened symptoms of autism (e.g. increased anxiety)
- being unable to control drug or alcohol use
Addictive substances may mask symptoms of autism—such as slow response times—and vice versa. In addition, symptoms may vary depending on where a person is on the autism spectrum.
Who’s At Risk?
Autism occurs along a spectrum, and according to some research, some people can be at higher risk for developing a drug or alcohol use disorder than others.
Risk factors among people with autism include:
- having a higher level of social functioning
- living independently
- having a co-occurring mental illness
- higher intellectual ability
People with milder forms of autism—such as Asperger’s syndrome, or what was formerly identified as Asperger’s—are generally believed to be more likely to develop substance use disorders than people with more severe autism.
Treatment For Substance Abuse In People With Autism
About half of people who seek substance treatment drop out of treatment prematurely.
Among people with autism, this estimate may be even higher, as they are less likely to have co-occurring disorders recognized, diagnosed, and appropriately treated.
Research shows that traditional treatment models for substance misuse may need to be customized or adapted to better meet the needs of people with ASD.
Guiding principles for treatment include:
- Screening: Treatment centers are urged to develop screening procedures to identify autism among people who seek substance abuse treatment.
- Trauma-informed care: Providing treatment that is trauma-informed is considered a high priority for treating people with cognitive and behavioral disabilities.
- Structure: People with ASD can benefit from treatment programs that offer a high level of structure
- Support services: In addition to standard treatment services, assistance with transportation, housing, co-occurring mental illness, and legal problems may be needed.
- Personalized treatment: Personalizing effective forms of treatment may require adapting the format of some treatment services to better meet the needs of people with ASD.
Considerations For Treating People With Autism
The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a number of recommendations for the treatment of addiction in people with ASD.
Considerations for treatment include:
- conveying key ideas visually and repeating them often
- minimizing distractions such as noise
- allowing short breaks during group-based sessions
- incorporating role-playing
- focusing on concrete concepts (as opposed to abstract)
- adapting treatment based on input from loved ones (with the client’s consent) regarding the client’s preferred learning style and strengths
- developing training materials for treatment staff on how to work with people who have developmental disorders
Many drug and alcohol rehab programs emphasize a group-based aspect, as seen with 12-step groups and support groups like Alcoholics Anonymous.
For people with autism, however, the social nuances of these groups can present a challenge and may be more likely to become a source of distress rather than one of healing.
Healing from addiction doesn’t occur in isolation. Group-based treatments, such as support groups and psychoeducation, may be adapted to meet the needs of people with ASD.
Cognitive behavioral therapy (CBT) is a common form of behavioral therapy used to treat substance use disorders and may be helpful for people with ASD.
As with group therapy, this type of behavioral therapy may need to be adapted to account for cognitive, learning, or social difficulties. For instance, written or reading assignments may be adapted into verbal discussions.
Behavioral therapy can be useful for addressing a person’s attitude towards substance use and identifying supportive coping strategies that can serve as alternatives to drugs or drinking.
Medication, also known as pharmacological treatment, is commonly used for treating addiction to certain drugs, including alcohol.
Medication may be used during the detoxification process to treat withdrawal symptoms and can be provided throughout treatment to reduce drug cravings and treat co-occurring mental illness.
For opioid addiction, medication-assisted treatment—also known as medications for opioid use disorder—is associated with improved quality of life and reduced risk for relapse and overdose.
Addiction Treatment Programs For People With Autism
Addiction treatment is offered at multiple levels of care, based on the physical, psychological, and financial needs of the person who is seeking treatment.
Inpatient And Residential Treatment Programs
Inpatient treatment, also known as residential treatment, is the highest level of care for substance abuse. This type of program offers 24-hour supervision and support within a treatment facility.
These programs generally last 30 to 60 days. Long-term residential programs are offered by select treatment centers for people with a history of chronic addiction or other complex needs.
Common treatments offered include:
- medical detoxification
- individual therapy
- group counseling
- psychiatric services
- medical care
- family therapy
- relapse prevention
The high level of structure and support offered within these programs can be especially beneficial for people with mental health and developmental disorders in the early stages of the treatment process.
Outpatient Treatment For Addiction
Outpatient treatment is generally recommended for people who have recently completed an intensive treatment program to provide ongoing support in the recovery process.
Outpatient treatment programs such as partial hospitalization or intensive outpatient are step-down programs that offer the highest level of structure, followed by general outpatient.
For people with serious mental illness (SMI), assertive community treatment, or ACT, may also be helpful. This is a multidisciplinary, community-based treatment program that integrates social support services.
Recovering From Addiction With Autism
Recovering from drug addiction with a co-occurring mental health or developmental disorder comes with an additional set of challenges, but it’s not impossible.
Connecting people with autism to the support services they need to succeed in recovery is the most crucial component of the treatment process.
Recovery is more than just getting sober or completing a standard 30-day rehab program. This is a lifelong journey that begins with getting help and maintaining hope for a better future ahead.
Call our treatment specialist today to find a dual diagnosis rehab center near you.
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.
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- BioMedCentral Psychiatry—Everyday life consequences of substance use in adult patients with a substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD): a patient’s perspective
- Centers for Disease Control and Prevention (CDC)—Key Findings: CDC Releases First Estimates of the Number of Adults Living with Autism Spectrum Disorder in the United States
- Social Work Today—Substance Abuse in People With Intellectual and Developmental Disabilities
- Substance Abuse and Mental Health Services Administration (SAMHSA)—Substance Use Disorder for People with Physical and Cognitive Disabilities
- U.S. National Institute on Drug Abuse (NIDA)—What are the treatments for comorbid substance use disorder and mental health conditions?
- U.S. National Institute on Mental Health (NIMH)—Autism Spectrum Disorders
- U.S. National Library of Medicine—Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder