Substance Abuse and ASD: Ties, Treatment, and How to Address the Problem
Posted on 08/24/18 in Transition to Adulthood by Milestones
Recent studies indicate that adults with autism spectrum disorder (ASD) have significantly higher risk of developing a substance use diagnosis (SUD) than the general population (Butwicka, et al, 2017). With its sensory complications, social deficits, rigid behaviors and rule-following, autism was thought to offer protection for developing a SUD. However, in the 2008 book, Asperger Syndrome and Alcohol: Drinking to Cope? the authors Tinsley and Hendricks suggest that being undiagnosed or misdiagnosed might lead someone with ASD to use alcohol or drugs to self-medicate. Though this is true for some, addiction is prevalent among a generation that was diagnosed young, offered early interventions and mainstreamed.
Integrating children with autism into mainstream classrooms can raise expectations that students with ASD will seamlessly blend in and adapt to public schools, colleges and typical work settings. Socializing after school or work, managing stress, meeting deadlines and fitting in are examples of the many challenges adolescents and adults with autism face. People with an autism spectrum diagnosis are experimenting and finding relief.
Certainly, people with autism drink to cope. After transitioning from a predictable home life to a less structured college environment, one individual with co-occurring ASD and SUD shared how he found solace in the local bars after class.
“I got in trouble with alcohol not within years or even months but within a matter of weeks when I first started drinking. Once I started I didn’t want to stop because the effect was boy this is different and I sure as hell wanted different. I felt so isolated up there [college] and apart and different from everybody.”
Self-medication is one explanation for why people with ASD might turn to substances. There may also be a genetic connection as studies show that individuals with substance use or autism spectrum diagnosis may both be prone to reward system/cerebral dopamine dysfunction.
But clearly there is a behavioral connection. As self-advocate and person in recovery, Maia Szalavitz wrote in her book The Unbroken Brain, “It seems that the same regions that gave me my intense curiosity, obsessive focus, and ability to learn and memorize quickly also made me vulnerable to discovering potential bad habits and then rapidly getting locked into them” (2016, p63).
Obsessive focus, a desire for routine and repetitive behaviors of ASD share similarities with substance use disorder.
Just as many parents/caregivers worry their children with ASD may be addicted to video games, one mother confessed online she was concerned that her son had developed a special interest in marijuana and worried over the tenuous distinction between perseveration and addiction.
How do we address SUD in the ASD community? First, we cannot assume traits of autism are a protective factor from developing an SUD. One job coach from the autism community confessed that “drugs weren’t on our radar” and was genuinely surprised when clients regularly failed their employers’ drug tests. Prevention is key. Educate-this is true for all children not just those with ASD-start when they are in middle school. Explain why drugs and alcohol are popular, emphasize that initially drugs or alcohol may feel like a relief but after a period of time, dependence can occur. Share if substance use disorder is in the family and the impact it may have had. As they get older, be honest, offer the pros as well as the cons.
Do not assume that if a rule-bound teen/young adult reports they do not or will not drink/use drugs that they won’t. Rule-following may be a protective factor for individuals with autism for developing a SUD but we have to remember the rules change significantly in adolescence and early adulthood. Be prepared. Many adolescents with ASD may find that drugs or alcohol offer relief for sensory sensitivities and social challenges, they may also find using offers social capital. As author and clinician Tony Attwood writes “Being part of the drug or gaming culture can provide purpose and structure for the day. There is a sense of achievement in seeking and finding drugs, and an opportunity to leave one’s accommodation and to meet people.”
When it comes to treatment for SUD, play to an individual’s strengths. This may mean offering concrete, visual reduction or avoidance strategies. Sometimes reducing use may be a better strategy than total abstinence. Collaboration is key. Customize and adapt treatments such as creating social narratives, schedules, tracking logs, apps and alternative rewards. Work on long-term and short-term goals and assess together how substance use may be an obstacle for achieving positive outcomes.
Last, it’s important to remember there is no cure for SUD, just maintenance. Return to use doesn’t mean failure, it’s part of the diagnosis. It’s important to advocate to reduce stigma; no one “chooses” addiction just as no one chooses autism. It is imperative to remain nonjudgmental, offer support, and have patience.
Elizabeth Kunreuther, LCSW, LCASA, is a Clinical Instructor for UNC WakeBrook’s Addictions and Detoxification Unit. Before getting her MSW, Elizabeth was the Family Intake Coordinator for UNC’s TEACCH Autism Program and the Family Recruitment Coordinator for the Carolina Institute for Developmental Disabilities’ Autism Research Registry. Elizabeth co-authored the book, Drinking, Drug Use and Addiction in the Autism Community.
Ann Palmer, BA, is a parent of an adult son with autism and a professional having worked with families for over 24 years. She was the Parent Support Coordinator at the UNC TEACCH Autism Program, the Director of Advocacy and Chapters at the Autism Society of North Carolina, and is currently on faculty at the Carolina Institute for Developmental Disabilities (CIDD) at the University of North Carolina in Chapel Hill. She is the author of four books published by Jessica Kingsley Publishers: Realizing the College Dream with Autism or Asperger Syndrome: a Parent’s Guide to Student Success, Parenting Across the Autism Spectrum: Unexpected Lessons We’ve Learned(co-authored with Maureen Morrell), A Friend’s and Relative’s Guide to Supporting the Family with Autism: How Can I Help?, and Drinking, Drug Use and Addiction in the Autism Community, co-authored with Elizabeth Kunreuther.