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Autism, Substance Use and Recovery: A Comprehensive Guide

In recent years, proposed connections between autism and substance abuse have prompted considerable debate among researchers and healthcare professionals.

For decades, experts assumed that individuals on the autism spectrum were unlikely to experiment with drugs and alcohol, much less use them compulsively.

Yet recent studies suggest that people with autism spectrum disorder (ASD) face particular risks in relation to substances – and that their distinctive challenges have gone tragically ignored.

Moreover, individuals with ASD often require specialized care in substance abuse treatment. When providers fail to account for their individual needs, people with ASD may struggle to engage with the treatment process.

ASD and substance abuse treatment

Without the right therapeutic approach, their odds of success in recovery can be significantly diminished.

Clearly, the ties between ASD and substance use disorders are worthy of extensive exploration.

This guide will present the latest research pertaining to each condition, and illuminate the complex connections between them. Additionally, we’ll discuss how individuals with ASD can find effective care for substance abuse issues. Whether you’re a concerned family member or a professional in the field, this guide is your ultimate resource for understanding how autism and substance abuse intersect.

AUTISM SPECTRUM DISORDER: AN OVERVIEW

Autism spectrum disorder (ASD) is a complex and highly varied developmental disability.

While individuals with ASD report a diverse array of experiences and challenges, the disorder is characterized broadly by difficulties in interpersonal communication, social interaction, and behavioral functioning.

The cognitive abilities of individuals with ASD vary as much as their symptoms. Some are extremely gifted, while others struggle with certain forms of learning and problem-solving.

Additionally, the timing of diagnosis and treatment can differ significantly between cases. While symptoms of ASD typically appear before a child turns two, many individuals are diagnosed much later in life (including in adulthood in some cases).

Because ASD encompasses a wide range of challenges, no single symptom or behavior should be interpreted as representative of the disorder.

asd defined

However, individuals with ASD generally exhibit at least some of the following traits and tendencies.

SIGNS AND SYMPTOMS

CHALLENGES IN INTERACTION AND COMMUNICATION

asd challenges

RELATIVE TO NEUROTYPICAL INDIVIDUALS, PEOPLE WITH ASD TEND TO RELATE DIFFERENTLY TO OTHERS. WHEN INTERACTING WITH OTHER PEOPLE, THEIR BEHAVIORS MAY INCLUDE:

  • Looking away from others and limiting eye contact.
  • Failing to respond to verbal communication, or doing so inconsistently or slowly.
  • Struggling to maintain conversation with others in a “back-and-forth” dynamic.
  • Talking at length about subjects of personal interest without permitting others to respond.
  • Exhibiting body language or facial expressions that clash with their verbal statements.
  • Having trouble imagining or understanding other people’s points of view.
  • Being unable to predict others’ actions or comprehend their motives.
  • Failing to respond appropriately to clear social cues.

REPETITIVE INTERESTS AND BEHAVIORS

repetitive interests

PEOPLE WITH ASD OFTEN FOCUS INTENSELY ON SPECIFIC SUBJECTS OR ENGAGE REPEATEDLY IN PARTICULAR ACTIONS. EXAMPLES OF THIS TYPE OF BEHAVIOR INCLUDE:

  • Speaking specific words or phrases repeatedly, especially outside of appropriate contexts.
  • Fixating upon certain facts, topics or details.
  • Feeling significant emotional disturbances in response to slight disruptions to their routines.

SENSORY AND EMOTIONAL ISSUES

Individuals with ASD frequently report sensory sensitivity, including uncomfortably acute perceptions of light, noise, touch and temperature.

sensory emotional issues

Additionally, sleep problems are highly correlated with ASD.

Perhaps more importantly, people with ASD often struggle to identify and regulate their own moods and emotions. In reaction to daily challenges or in response to their other symptoms, people with ASD can become intensely upset.

In many cases, individuals with ASD struggle to employ coping strategies that neurotypical individuals practice intuitively.

AUTISM AND PREGNANCY

Maternal health is critical to both a healthy pregnancy and a safe delivery.

Substance abuse can impact virtually every aspect of a baby’s development, and it could potentially increase the likelihood of autism in the child.

THE CONNECTION BETWEEN DRUG AND ALCOHOL USE DURING PREGNANCY AND AUTISM

Drugs and alcohol cross the placenta and can impact a developing fetus. The Centers for Disease Control and Prevention (CDC) warns that alcohol use during pregnancy may cause harm to the unborn baby and lead to potential birth defects. Therefore, it should be avoided completely.

Autism is a brain disorder that is mostly considered to be caused by genetic factors, but environmental and other contributors likely play a role in its onset.
There are risk factors during pregnancy that could contribute to a greater likelihood that the baby will develop autism.

  • Maternal diet
  • Stress
  • Genetic factors
  • Medications taken during pregnancy
  • Nutrition

Illicit drugs and alcohol work by interacting with neurotransmitters in the brain, essentially changing brain chemistry. It is unclear if this can also present a risk for a developing brain in the womb.

It is known that exposure to drugs and alcohol at a young age — before the brain is fully developed in the mid-20s — can increase the odds for developing a problem with alcohol and/or drug use later in life. The reward center of the brain can be compromised by drug and alcohol use before it is fully formed.

No amount of recreational drug use is safe, especially during pregnancy. It can increase the odds for miscarriage as well as developmental and birth defects in the baby.

MEDICATIONS AND AUTISM

Certain drugs, like antidepressants, anticonvulsants, asthma medications, and acetaminophen, have all been potentially linked to a possible doubled rate of autism in babies whose mothers took these medications during pregnancy. It is not entirely clear if a predisposition for autism already existed due to conditions causing the need for these drugs, just that women taking them during pregnancy have an increased risk for autism in the fetus.

Autism development in an unborn baby is not only related to genes of the parents, but also to health of the mother during pregnancy. In fact, the health of a pregnant woman may be more of an indicator of potential issues in the baby after birth than medication use. Some medications are needed to keep a mother healthy, and the supervising physician will weigh the risks and benefits of medications for particular situations.

PREGNANCY COMPLICATIONS, SUPPLEMENTS, AND AUTISM RISKS

Eating a healthy and balanced diet, getting regular exercise, and reducing stress can all improve a mother’s health. They can also promote a healthy delivery with fewer complications.

Studies have shown that taking supplements during pregnancy, such as folic acid, and eating a diet rich in omega-3s can lower the odds that a baby will develop autism. When taken during pregnancy, folic acid can reduce the risk of autism by as much as 40 percent, and omega-3s may reduce the risk by 50 percent. Other supplements taken during pregnancy, including prenatal vitamins and iron, may decrease the potential for autism in an unborn child.

Other factors during pregnancy can contribute to an increased rate of autism for babies, including induced labor, preeclampsia, maternal diabetes, a compromised immune system, infections in the mother, and poor health in general.

Staying as healthy as possible during pregnancy and avoiding potential stressors can help to minimize the odds for a baby developing autism. This includes avoiding recreational drug and alcohol use during pregnancy.

A SHIFT TOWARD A SPECTRUM

In 2013, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This updated manual transformed the diagnosis of autism, consolidating several related conditions under the unified category of “autism spectrum disorder.”

PREVIOUS VERSIONS OF THE DSM HAD RECOGNIZED FOUR DISTINCT DISORDERS:

  • Austistic disorder
  • Asperger syndrome
  • Childhood disintegrative disorder
  • Pervasive developmental disorder – not otherwise specified

In light of the overlap between these conditions and the sheer diversity of autistic symptoms, the APA adopted a spectrum model to assess individual patients.

Accordingly, the “autism spectrum” now encompasses several kinds of symptoms and varying degrees of ability and impairment.

Asperger’s syndrome is regarded as a “high-functioning” variant of ASD, and many individuals prefer to identify using that term. Individuals with Aspergers frequently attain a significant degree of autonomy, especially if their challenges are identified and addressed at a young age. As we’ll discuss later, however, self-sufficiency in work or school settings may actually facilitate exposure to drugs and alcohol.

PREVALENCE

According to the CDC, roughly 1 in 59 children in America has a diagnosis of ASD. This number represents a marked increase in estimated prevalence, as awareness of the disorder grows nationwide and screening becomes more accessible.

CDC

CDC estimates also present compelling demographic contrasts.

Male children were approximately four times more likely to be diagnosed with ASD than their female peers.

Additionally, white children were significantly more likely to be diagnosed than minority children, though this gap likely reflects inequalities in access to screening.

Notably, no reliable estimates currently exist for the number of American adults with ASD. As a result, it is difficult for medical and public policy experts to assess the needs of this community and develop services accordingly.

If you or someone you love might be interested in an ASD evaluation, it’s easy to find resources in your area.

Just visit this resource guide from Autism Speaks, a leading research and advocacy organization. Under the “Evaluation & Diagnosis” heading, you’ll find links to qualified professionals ready to help.

AUTISM SPECTRUM DISORDERS AND SUBSTANCE ABUSE: UNCOVERING A CONNECTION

For decades, experts believed that substance use disorders were less common among those with ASD than the general population. Though little hard data supported this conviction, the underlying rationale was simple.

Because individuals with ASD are often closely supervised by family members or caregivers, they’re rarely able to experiment with drugs and alcohol.

Moreover, many researchers assumed that young people with ASD would be immune to peer pressure. Because so many find it difficult to perceive social dynamics, the urge to “fit in” by doing drugs might not apply.

Another common assumption concerned the sensory sensitivity and rigid behaviors that define the disorder. Why would someone with these symptoms seek out the heightened sensations or a loss of control that drugs typically produce?

In the last few years, however, new research has called these assumptions into question. In many cases, it seems, people with ASD are far more vulnerable to substance use disorders than previously imagined.

EVOLVING UNDERSTANDING: RECENT RESEARCH

In 2017, Swedish researchers published a landmark study of nearly 27,000 individuals diagnosed with ASD. According to their results, people with ASD were twice as likely to develop substance use disorders as those without a mental health diagnosis.

This finding startled experts in both autism and addiction, many of whom had dismissed a connection between these disorders.

But the Swedish study actually echoed earlier research, such as a 2014 study from Washington University School of Medicine in St. Louis. In that study, researchers found a significant correlation between alcohol problems and autistic traits.

That same year, a report in the Journal of Alcoholism and Drug Dependence found that the rate of ASD diagnoses among patients with substance use disorders was substantially higher than in the general population.

These findings also resonated with the anecdotal experiences of mental health professionals, who observed substance abuse issues among their clients with ASD.

2x SUD

In light of this emerging scholarship, experts have begun to probe the links between ASD and substance use disorders. Accordingly, they’ve uncovered several reasons people with ASD turn to substances and eventually become dependent.

COPING AND COMPULSION: WHY INDIVIDUALS WITH ASD SEEK SUBSTANCES

REGULATING EMOTIONS

Autism is highly associated with emotional challenges, ranging from severe depression to disabling anxiety.

As we noted when discussing ASD symptoms, slight disruptions to daily routines can precipitate sudden shifts in mood.

In using substances, individuals with ASD may seek to diminish the intensity of their negative emotions, especially if they lack other effective coping skills. Notably, this motive is common among those without ASD as well.

Individuals with mood disorders regularly seek chemical relief for their symptoms.

NAVIGATING SOCIAL SITUATIONS

In new or uncomfortable social settings, many individuals turn to alcohol. There’s a reason it’s known as a “social lubricant.”

For individuals with ASD, however, social interactions can seem especially dauntingAlcohol and other drugs can ease the difficulty relating to others, and lessen a sense of social alienation.

This temptation is especially relevant for college students with ASD, where a pervasive drinking culture can give rise to real problems.

As one former college student with ASD recalled to The Atlantic, “Everyone else is drinking, it’s socially acceptable, and if you drink, you fit in because everyone else is doing it.”

Unfortunately, this phenomenon is an unforeseen byproduct of a positive development. As people with high-functioning ASD gain greater access to institutions like work and college, they’re more likely to be exposed to drugs and alcohol.  

DEALING WITH SENSORY ISSUES

As we mentioned earlier, many experts felt people with ASD would avoid substances because of sensory sensitivity, in which case taking drugs or alcohol could exacerbate their discomfort.

But some individuals with ASD actually use drugs to dull their hypersensitive senses, drowning out frustrating stimuli.

Indeed, one opioid user with ASD reported drugs “wound down my senses to a more bearable level.”

hypersensitive senses

COPING WITH CO-OCCURRING DISORDERS

ASD is associated with increased risk for a range of mental health conditions, including schizophrenia, bipolar disorder and obsessive compulsive disorder.

These disorders are in turn associated with elevated substance abuse risk. In fact, roughly one in four people with a serious mental illness also have a substance use disorder.

serious SUD

Self-medication is a driving force behind these connections. Often, people with serious mental health challenges use substances to reduce or tolerate their symptoms.

For individuals with ASD, substance use disorders and another mental illness, alcohol and drugs may represent valued coping mechanisms.

A NEUROLOGICAL LINK?

In a rapidly developing field of study, some neuroscientists suggest that ASD and substance use disorders may involve similar regions of the brain.

According to these hypotheses, irregular function in the basal ganglia and striatum could contribute to both disorders. This might explain why people with ASD demonstrate repetitive patterns of speech and behavior, just as persons with addictions compulsively use drugs.

More research is necessary to determine if people with ASD are additionally vulnerable to substance abuse on this basis.

SIGNS THAT SOMEONE WITH ASD IS ABUSING SUBSTANCES

In many cases, friends and family detect a loved one’s substance abuse by observing emotional and psychological changes, such as depressed or anxious emotional states.

In other situations, occupational challenges or poor school performance can indicate a problem. Even the user’s interpersonal relationships may become strained.

Yet for individuals with ASD, these warning signs may be difficult to distinguish from the typical symptoms of their disorder.

However, physical indicators of substance use may be helpful in detecting substance use disorders among individuals with ASD. These signs could include:

Additionally, some researchers suggest people with ASD present a “normal” facade when drinking alcohol, further complicating detection and assessment.

Given these challenges, it is difficult to suggest definite behavioral signs than an individual with ASD is using substances problematically.

  • Changes in appetite.
  • Changes in weight.
  • Slurred speech.
  • Tremors or impaired coordination.
  • Unusual odors on body or clothing.
  • Bloodshot eyes.
  • Enlarged or shrunken pupils.
  • Runny nose.
  • Sleep disruptions.
physical indicators

It is important to note any of these signs, such as sleep issues, are common in individuals with ASD. Before leaping to conclusions, consider whether the individual in question has experienced similar changes in the past.

If you do believe a loved one with ASD is using drugs or alcohol – or need help making a determination – we suggest enlisting the help of the individual’s primary care physician or psychiatrist. These professionals are likely better equipped to assess signs of substance use and even administer drug testing.

Assessing drug use in individuals with ASD can be extremely difficult, so don’t hesitate to ask for help.

GETTING HELP: FINDING TREATMENT FOR SOMEONE WITH ASD

For any family, navigating the treatment landscape can seem overwhelming.

With so many types of programs, therapeutic modalities and payment options available, getting help for a loved one can get complicated.

For those seeking treatment for someone with ASD, selecting the best facility can be particularly challenging. Research consistently shows that the healthcare industry often fails adults with autism, leading to negative experiences and poor health outcomes.

When a loved one with ASD is abusing substances, how can you choose a treatment provider prepared to meet their needs?

SEEK EXPERIENCED STAFF

Many facilities claim to specialize in dual-diagnosis care, reflecting an industry-wide shift towards comprehensive mental health care. But even if a treatment center regularly serves clients with serious mental illnesses, they may not be adequately acquainted with the needs of people with ASD.

Furthermore, treatment providers may possess an abstract understanding of the autism spectrum, yet fail to understand the disorder’s practical implications.

For example, will the person with ASD respond to minor aspects of the residential settings, such as sharing a room with another client? Will the adjustment to the clinical schedule prove overwhelming? Can the kitchen team accommodate the patient’s aversion to specific foods?

If the treatment team has real experience with patients with ASD, they’ll be able to anticipate and answer these questions. They may even be able to share solutions they’ve implemented previously, while still respecting the privacy of past patients.

Don’t be afraid to ask pointed, direct questions about the clinical staff’s expertise and experience with ASD and substance use disorders.

No matter how challenging your loved one’s symptoms may be, every patient is entitled to qualified team of care providers.

INSIST ON INDIVIDUALIZED TREATMENT

Every person struggling with a substance use disorder deserves treatment tailored to his or her individual needs. When facilities insist on a one-size-fits-all approach to clinical and medical services, both urgent concerns and opportunities for progress can go woefully overlooked.

For people with ASD in particular, the importance of appropriate, individualized care cannot be overstated.

Indeed, depending upon the patient’s particular challenges, essential components of a treatment program may need to significantly adjusted.

specialized treatment

Consider group therapy, the central therapeutic modality of most inpatient treatment centers. In most instances, clients are strongly encouraged or required to attend therapy groups and participate in them actively.

For clients with ASD, however, this approach might be painfully counterproductive.

While client needs differ significantly, it is generally best to allow individuals on the autism spectrum to engage with others at their own pace and in settings in which they feel comfortable.

Similarly, people with ASD often need time alone to process their experiences, relax and withdraw from social stimuli.

In other clients, this behavior might be interpreted as harmful or as an indication of underlying depression.

Additionally, the treatment of people with ASD should entail evidence-based therapeutic modalities proven effective for this population. Cognitive Behavioral Therapy has been shown to help clients with both ASD and substance use disorders, so it is a particularly useful approach.

Most importantly, the facility should perform a comprehensive assessment of the patient’s aptitudes, challenges and symptoms during the intake stage. The results of that process should inform subsequent treatment planning, aligning the treatment center’s resources with the individual’s personal strengths and obstacles.

If the facility you’re considering cannot accommodate these aspects of individualized care for people with ASD, you may be better served elsewhere.

KNOW THE NEXT STEPS

Within the broader category of substance abuse treatment, there are multiple levels of care reflecting different client needs.

Ideally, clients progress through high-intensity treatment to lower-intensity services over time, transitioning between services when clinically appropriate.

For all individuals with substance use disorders, continuity of care is immensely important. If a client leaves inpatient care with no resources in place, the sharp adjustment can prove disastrous. But this concern is especially relevant for individuals with ASD, who may find disruptions to routine particularly unnerving.

When inquiring about a treatment center’s services, probe how the clinical staff prepares clients for success once inpatient care concludes.

Do they offer intensive outpatient services, so that clients can remain engaged in therapy once their rehab stay is over? Is sober housing available, so that clients can benefit from communal support and accountability?

As you consider these options, ask how the treatment provider can insure that transitions between levels of care go smoothly.

A patient with ASD can find it difficult to adjust to one program, let alone several in succession. Accordingly, a seamless handoff between services could vastly improve their experience.

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