Autism and addiction affect many individuals and families in the U.S. and share some behavioral and biological parallels that have been driving increased medical interest.
In the past, they were mostly studied independently and considered mutually exclusive from one another. However, recent research has revealed findings that indicate otherwise.
What Is Autism-Spectrum Disorder?
The Centers for Disease Control and Prevention (CDC) defines autism as a developmental disability that impacts how people communicate, behave, and learn.
The Autistic Self Advocacy Network defines it as a disability that impacts how people experience the world.
Autistic people are born with autism and often begin to show signs in childhood and adolescence.
Some of these signs include:
- strong and focused interests
- strong preference for routine and familiarity
- heightened sensitivity to noise, lights, and other sensory information
- repetitive movements (stimming)
- repeating words and phrases (echolalia)
- discomfort with eye contact
- speech differences
- social difficulties
- struggles with non-verbal communication
Note that not every autistic person will experience the same signs. For example, an autistic person who can’t stand loud noises may have no issues with bright lights.
Likewise, someone could have a strong emotional reaction to a change in routine, but they may not have communication struggles.
Because many allistic (non-autistic) people misunderstand autistic communication, it can be difficult for them to spot signs of declining mental health in autistic friends and family members.
For example, some autistic people use echolalia as communication. An autistic person may, for instance, repeat specific phrases as a way to communicate anxiety.
However, because many allistic people see echolalia as repetition without purpose, they may not understand that their loved one is dealing with a mental health struggle.
Autism Support Needs
Because autism research often includes little input from autistic people themselves, much of the language surrounding autism has been rejected by autistic people.
Often, allistic people speak in terms of “functioning” and “severity levels.” For example, a “high functioning” autistic person, or a person with “level one autism” would have few communication difficulties.
However, autistic people are often defined as “high-functioning” or “low-functioning” depending on their ability to hide, or “mask,” their autistic qualities.
As a result of this language, the autism spectrum is viewed as a line ranging from least to most severe.
Autism, however, is a collection of traits that include varying support needs.
Among autistic people, it is common to need support in the following areas:
- sensory processing
- daily living tasks
- motor skills and coordination
- executive functions
If an autistic person has fewer support needs in one area, it does not necessarily mean that they will not need support in another area.
Likewise, if a person has high support needs in one area, it does not necessarily mean that they will need support in all areas.
New Research On The Link Between Autism And Addiction
Until recently, the comorbidity of autism and addiction was considered rare and unlikely. When studying the warning signs of drug use among children, researchers often only concerned themselves with allistic children.
Some autistic traits may indeed be protective factors against addiction.
For example, one risk factor for addiction is exposure to drugs and alcohol. Because many autistic people need extensive alone time, they may not often find themselves in environments that have drugs and alcohol.
Likewise, sensory processing difficulties may cause autistic people to avoid loud bars and clubs where drugs may be present.
However, new studies on the possible link between autism and addiction have revealed that the dopaminergic deregulation characteristic of autism is similar to what drives addictive behaviors.
Autistic people with above-average IQs have been found to be twice as likely to develop substance use disorders than allistic people with high IQs.
This risk factor is compounded for people who have attention deficit hyperactivity disorder (ADHD) in addition to autism, causing untreated symptoms to intensify.
Similarities Between Autism And Addiction
Although some autistic traits seem to have little in common with addiction-driven behaviors, there are some key behavioral similarities to consider.
Habitual And Impulsive Behaviors
Both autism and addiction are connected to the striatum, which is the part of the brain that regulates habits.
For autistic people, this connection may create a need for repetition and routine. For people with addictions, it may reinforce habits related to drugs and alcohol.
Certain genetic markers in the striatum may make autistic people susceptible to addiction.
Impulsivity is also common among both autistic people and people with addictions.
In autistic people, impulsive behaviors are often triggered by emotional distress, similar to behavioral changes and signs of drug addiction.
People affected by addiction develop compulsive responses to emotional triggers. As a result, they might have difficulty controlling obsessive thoughts about drugs and impulses to use.
These overlapping behaviors indicate similar neurological reactions with both conditions in the same regions of the brain, with similar responses to stressful stimuli.
Symptoms Of Anxiety
Anxiety is another common comorbidity of both autism and addiction. Up to 85% of autistic people deal with anxiety.
If anxiety symptoms go untreated, they might develop maladaptive and unsustainable coping strategies to alleviate their anxiety, such as substance use.
Both autistic and allistic people may develop a chemical dependence on drugs or alcohol to cope with untreated anxiety disorders, which progressively worsen.
How Autism Increases Risk Factors For Addiction
Researchers now believe that undiagnosed autistic people and autistic people with few social support needs are at significantly higher risk of developing substance use disorders.
The following issues related to ASD may increase a person’s risk of developing an addiction:
- childhood neglect, abuse, or trauma
- mental hyperactivity
- emotional hypersensitivity
- intellectual or cognitive disability
- social interaction deficits
- impulse-control disorder
Some autistic traits such as social anxiety and difficulty adapting to unfamiliar situations could increase the urge to use mood and mind-altering substances to manage stress.
Heroin addiction is becoming more prevalent among young undiagnosed autistic adults who struggle to cope with anxiety and hypersensitivity, and feel relief from the effects of heroin.
Heroin and other abused opioids have a sedative effect, spike dopamine levels (which increases a person’s sense of well-being), and de-escalate hyperactive mental activity.
Co-Occurrence Of Addiction And Autism
For people who mask autistic traits, co-occurrence with addiction may be more prevalent and also more difficult to diagnose until the addiction progresses.
Initially, people with autistic traits such as social anxiety may attempt to self-medicate with alcohol or certain drugs that give them a false sense of control and emotional regulation.
For a period of time, this may seem like an effective solution that provides temporary relief for someone who is trying to repress their emotional sensitivity to internal or external stimuli.
As tolerance to substances increases, it becomes more difficult to control drug and alcohol use, which can eventually start to exacerbate anxiety and depression.
Other Co-Occurring Mental Health Disorders
Undiagnosed or misdiagnosed autism is often due to co-occurrence with other mental health disorders, which obscures typical autistic traits and makes them harder to notice or identify.
Significant research has been conducted on the frequent co-occurrence of ADHD and ASD.
Studies have also emphasized the increased risk of substance use disorders with ADHD, but there has been a lack of information about the co-occurrence of all three.
New findings have emerged on the combination of autistic traits and ADHD symptoms co-occurring with substance use disorders involving alcohol, cannabis, and nicotine.
Depression And Bipolar Disorder
Depression and bipolar disorder are mood disorders that frequently co-occur with autism and can go unnoticed for a long time due to the overlapping symptoms.
The social and emotional challenges caused by autistic traits can be frustrating to individuals who have difficulty understanding or expressing how they feel, which fuels their depression.
Research shows that autistic masking can lead to autistic burnout, a condition that occurs when an autistic person has become physically and emotionally exhausted by the weight of hiding their traits and the lack of accommodations.
Many symptoms of autistic burnout mirror the symptoms of depression.
To deal with the effects of depressive or manic episodes, people often turn to alcohol or drugs to regulate their turbulent moods. Depression and alcohol misuse are especially codependent.
Social anxiety caused by autism can get internalized and turn into self-destructive tendencies. Eating disorders manifest for many psychological reasons, but anxiety is a major trigger.
Autistic people can feel overwhelmed by their anxiety and become obsessed with the need to feel in control, especially in unfamiliar, uncomfortable, or chaotic situations.
Eating disorders can turn into a means of internal control that provides a false sense of relief. It can also become a source of privacy and safety for people who feel exposed or vulnerable.
Barriers To Treating Addiction With Co-Occurring Autism
One of the barriers to treating people with co-occurring autism and addiction is the lack of empathetic understanding among less-experienced health professionals and treatment centers.
While there are facilities that specialize in addiction treatment for people with visual or auditory impairments and other physical disabilities, there are very limited options for autistic people.
Lack Of Professionals With Specialized Training
It can be difficult to find trained professionals who have experience in treating addiction in autistic adults and can provide specialized treatment.
The typical intervention and treatment methods for substance use disorders may be inadequate or ineffective for autistic people, such as conventional therapeutic approaches.
For example, most rehabs and traditional treatment programs emphasize the need to engage with peers, spend time in group therapy, participate in group activities, and avoid isolation.
Autistic people tend to struggle with social anxiety and often need time alone to decompress, so being forced to participate in large groups may not be effective.
For this reason, some autistic people may not be as successful in a traditional group-focused rehab setting.
Counselors need to be empathetic and cognizant of these traits. Autistic people may benefit more from individual therapy, a larger focus on family involvement, and other support.
Addiction Treatment Options For People With Autism
Cognitive behavioral therapy (CBT) is considered one of the more promising therapeutic approaches to treating addiction in autistic people.
Experts suggest that therapy should be adapted to autistic traits, and supplemented by psychoeducation, social training, and other means of support to manage associated difficulties.
While inpatient treatment centers might not always be able to accommodate the needs of autistic, outpatient treatment programs could be a better fit.
In outpatient programs, people can live in a familiar and comfortable home environment and attend treatment during the day. Sustaining a daily routine in treatment can help them feel safe.
They can also benefit from more individualized curriculums with more individual counseling than group therapy. Gradually, they could be introduced to small-sized groups for peer support.
Resources For Autistic People With Addiction
Dealing with autism-related stressors and addiction simultaneously is very challenging for people at any age or stage of their lives.
The following are helpful guides and resources for autistic people with addiction:
- Accessing Home and Community-Based Services: A Guide For Self Advocates: a handbook for autistic people resources, including healthcare resources
- Healthcare Transition Toolkit: A resource from the Autistic Self Advocacy Network (ASAN) helping autistic young adults find the right healthcare services.
- Interagency Autism Coordinating Committee: Find resources and guidance about issues related to COVID-19 for autistic people
- Online Intergroup Of Alcoholics Anonymous: A directory of online AA meetings, including some meetings for autistic and otherwise neurodivergent people
Resources For Family And Loved Ones
For family members and loved ones of autistic people with addictions, providing support can become easier with the right educational resources.
The following resources are available to provide guidance and support to families:
- Drinking, Drug Use, and Addiction in the Autism Community, by Elizabeth Kunreuther and Ann Palmer: a book that discusses the prevalence of drinking, drug abuse, and addiction among members of the autism community.
- National Autistic Society: Learn about educational resources and treatment options for autisic people who are also affected by addiction.
- The Autistic Advocate: This is an autistic-led organization that provides information for parents and professionals who want to learn more about autistic challenges.
- Start Here: A Guide For Parents Of Autistic Kids: This is a booklet about autism and resources written by autistic people.
Because autistic people have to navigate an allistic society, it can be difficult to cope with social stressors and similar challenges. Dealing with an addiction can heighten these challenges.
Fortunately, addiction can be treated, and treatment can be modified to provide accommodations for autistic people.
With access to the right resources and appropriate therapies, people can get the proper diagnoses and learn how to cope with their associated difficulties.
As research continues to reveal important findings about the co-occurrence of addiction and autism, we’ll have a better understanding of how to treat symptoms with a targeted and medically-informed approach.Article Sources
- Untreated Autism Spectrum Disorder Tied to Alcohol, Drug Abuse
- Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study