Until recently, the popular conception of autism didn’t include addiction.
Why not? First and foremost, individuals with autism tend to be more socially isolated, so people assumed that they wouldn’t succumb to peer pressure to try drugs.
As author and self-advocate Maia Szalavitz wrote in her 2017 Atlantic article The Hidden Link Between Autism and Addiction: “Because people with autism are often isolated from their peers, [the thinking was that] this could protect them from the peer pressure that can lead to youthful experimentation.”
In addition, some individuals with autism require a high degree of daily life support and lack the ability to access to addictive substances. The stereotypical view of a person with autism as “low functioning” led people to generalize, and until fairly recently, people with “high functioning” autism were often misdiagnosed.
However, new research shows that people with autism are actually more likely to struggle with addiction, not less. As it turns out, the social disconnection that individuals with autism experience isn’t a guard against addiction; on the contrary, it’s a risk factor.
In this post, we’ll clarify the relationship between addiction and autism spectrum disorders, and share some practical tips for people who have a dual diagnosis of both.
What are Autism Spectrum Disorders?
Autism Spectrum Disorders – commonly referred to as ASDs – are developmental conditions that affect both behavior and interpersonal communication.
According to the National Institute of Mental Health, autism is known as a “spectrum” disorder because of the significant degree of variation in symptomatology.
For example, some people with autism are highly verbal, loquacious speakers, while others with autism are entirely nonverbal and communicate through the use of assistive technology. Similarly, some people with autism struggle with daily care tasks such as toothbrushing and meal preparation, while others are highly independent.
That said, there are certain core criteria that must be met for an individual to receive an autism diagnosis. To paraphrase the current DSM-V, those criteria are:
- A significant degree of difficulty with personal interaction and interpersonal communication
- Repeated, seemingly compulsive behaviors; a narrow range of interests
- Symptoms which are pervasive, preventing the person from functioning independently in multiple areas of life
There’s a saying in the autism community: “If you’ve met one person with autism, you’ve met one person with autism.” It means something like: don’t generalize. Every person is unique, and you can’t interact with one person on the spectrum and assume that you know what everyone with autism is like.
What causes autism? Scientists and researchers don’t know exactly; the closest we’ve come is to say that it’s precipitated by a combination of genetic and environmental factors.
However, what we do know is that autism often occurs in combination with other conditions, such as ADHD. We also know that individuals with autism are more likely to struggle with substance abuse and addiction than neurotypicals.
According to a decades-long study of Swedish and Polish populations (1973-2009), over 3 percent of individuals with autism have been diagnosed with addictions, compared to less than 1 percent of neurotypicals. The study’s researchers stated:
“ASD … was related to a doubled risk of substance use-related problems. The risk of substance use-related problems was the highest among individuals with ASD and ADHD.”
Similarly, self-advocate Maia Szalavitz stated in our interview Tough Love and Addiction: Why It Doesn’t Work:
“Being on the [autism] spectrum, and having normal to high IQ, doubles your risk of addiction.”
What’s the Autism and Addiction Connection?
The neurological component
First, autism and addiction overlap in that they share neurological pathways. According to a 2016 study published in the journal Frontiers in Neuroscience, some of the same brain regions that contribute to ASDs are also connected with substance abuse.
As the authors note, “This growing literature on striatal dysfunction in ASDs has, rather surprisingly, implicated pathways and circuit elements known to play a role in drug addiction.”
The researchers go on to say that while both addiction and autism “are complicated disorders that likely involve many parts of the brain”, it’s also true that we’ve identified “a central role for the striatum and basal ganglia in both disorders”.
The mental health component
Furthermore, we now know that individuals with autism have symptoms that overlap with those of other mental health conditions, such as social anxiety disorder and bipolar disorder. As researchers noted in this 2016 Substance Abuse: Research and treatment paper:
“Patients with ASD have characteristics such as poor social functioning, repetitive behavior, anxiety, emotional lability, and eccentricities or fixed habits of behavior that can mimic symptoms of other [mental] illnesses …. These symptoms and co-occurring psychiatric diagnoses are also frequently found in patients with SUD [Substance Use Disorder].”
The social component
As mentioned earlier, the social disconnection and isolation that many adults with autism experience actually increases their risk of developing addiction. When individuals cannot form strong social bonds, they’ll often turn to substances to fill the void.
Johann Hari said it well in his TED talk Everything You Think You Know About Addiction Is Wrong:
“Human beings have a natural and innate need to bond, and when we’re happy and healthy, we’ll bond and connect with each other, but if you can’t do that … you will bond with something that will give you some sense of relief …. [It] might be cocaine, that might be cannabis, but you will bond and connect with something …. Disconnection is a major driver of addiction.”
In addition, some people with autism turn to drugs as a way to help them function socially. They’ll self-medicate to reduce their anxiety, or they’ll drink as a way to fit in.
Matthew Tinsley – who dealt with alcoholism and autism – was quoted in Maia Szalavitz’s Atlantic article: “Everyone else is drinking, it’s socially acceptable, and if you drink, you fit in because everyone else is doing it,” he says. “It took the edge off.”
And even if they are more socially isolated, individuals with autism tend toward addiction because of their penchant for repetitive behavior.
Self-advocate Ron Sandison quoted Dr. Duneesha De Alwis as saying: “People on the autism spectrum can be socially withdrawn, so drinking with peers is less likely. But if they do start drinking, even alone, they tend to repeat that behavior, which puts them at increased risk for alcohol dependence.”
Brief Recommendations for Treatment
Since the link between autism and addiction is a relatively recent discovery, there’s a dearth of research about the best treatment options for individuals with autism.
As the authors of the 2016 Substance Abuse Research and Treatment paper quoted above noted, “There is clearly a need for research on interventions that take account of the special needs of this patient group.”
However, we can learn from the experience of individuals with the dual diagnosis. In the aforementioned Atlantic article, Szalavitz quotes individuals with autism who didn’t fare well in traditional 12 Step programs. The large group component overwhelmed and frustrated them; they needed more customized, individualized therapy.
For individuals with this dual diagnosis, professional counseling is mandatory.
Closing: Autism, Addiction, and You
Part of the pain of both addiction and autism is the sense that other people don’t see the world the way you do. There’s a feeling of overwhelm and overload on every level: mental, emotional, and physical.
Having an ASD increases your likelihood of having a substance abuse disorder; it’s also likely that many people who wrestle with addiction have undiagnosed ASDs.
As Szalavitz noted poignantly in her interview:
“I was on a list of moms who had lost their kids [to addiction] and they were talking about, “Oh, they needed the tags cut out of their undershirts.” It was like, I could’ve been on an [autism parents] list. And [I thought], somebody really needs to study this.”
The good news is, we’re living in an era of increased autism awareness and improved addiction treatment too. If your 12 Step program isn’t working, you have other options. It may take time, but you can find a structured addiction recovery program that’s right for you.
Want to get started? Take a look at our side by side comparison of the Best Non 12 Step rehab programs in the country.
The saying is true: When you’ve met one person with autism, you’ve met one person with autism. The thing is, that’s also true for addiction recovery programs: When you’ve tried one addiction recovery program … you’ve tried one addiction recovery program. There are a great many treatments available today, and they vary tremendously in quality.
So if you’ve tried one program and found it ineffective, don’t give up. Instead, start researching programs that address the root cause of addiction … and remember that recovery really is possible.