Addiction and Autism

What Is Autism Spectrum Disorder?

Autism is officially known as Autism Spectrum Disorder (ASD) and is considered a developmental disability. Individuals with ASD differ from the general population in how they learn, interact with others, and process the world around them. Autism affects nearly 1 in 54 children in the US.

ASD is a spectrum disorder, meaning a full spectrum of symptoms and severity occurs with this disorder. Previously, clinicians and the overall medical community included a few different developmental disorders under the umbrella of Autism, including:

• Asperger’s Syndrome*
• Pervasive developmental disorder, not otherwise specified (PDD-NOS)
• Autistic Disorder
• Childhood Disintegrative Disorder
• Rett’s Syndrome

Disclaimer: The term “Asperger’s Syndrome” was retired in 2013 by the DSM, and individuals diagnosed with Asperger’s now have a diagnosis of ASD (typically ASD Level 1). More importantly, most people also find the name disagreeable due to the recent uncovering of its namesake’s history and this namesake’s abhorrent, unethical practices.

However, in 2013 the DSM changed its classification of Autism Spectrum Disorder and what falls into that diagnosis. The DSM-5 now categorizes individuals with ASD based on the severity of their symptoms.

Individuals diagnosed with ASD are into one of three groups:

• Autism Level 1: Often considered high-functioning Autism; may have difficulty with social interaction; might struggle to switch between activities; can have a more challenging time staying organized and maintaining a schedule.
• Autism Level 2: Requires a higher level of support than Level 1, with significant impairments in communication (may even be non-verbal); generally inflexible when it comes to change, struggles significantly with adjusting focus; repetitive behaviors may be noticeable to the casual observer.
• Autism Level 3: Sometimes called “severe Autism,” significant support is usually required. Minimal communication skills, and will often be completely non-verbal; considerable difficulty coping with change, and disruptions to routine can be highly distressing; very noticeable repetitive behaviors.

Symptoms of Autism Spectrum Disorder

Autism usually appears in adolescents around age three, but autistic traits can present as early as 12 months old.

Some main symptoms of autism include:

• Intellectual disability (such as issues with abstract thinking, academic learning, problem-solving, planning, and so on)
• Difficulties with social interaction
• Difficulty communicating (some autistic individuals may be non-verbal altogether)
• Obsession with particular interests
• Great attention to detail
• Easily overstimulated (from light, sounds, crowds, etc.)
• Inconsistent or minimal eye contact
• Language regression (children under 3)
• Repetitive motor movements (sometimes referred to as “stimming”)

While intellectual impairment can be a common trait for autistic people, it is not always the case. Some autistic people have a very high IQ compared to the general population.

Many qualified individuals in the mental health field believe Albert Einstein was autistic, though he was never officially diagnosed. Similarly, renowned entrepreneur and brilliant innovator Elon Musk confirmed his ASD diagnosis in May 2021.

Autism As a “Superpower”

It’s worth noting that much of the Autism community—including those diagnosed with ASD and their loved ones—don’t like to consider Autism as a disorder. While ASD certainly creates unique challenges for those that have it, Autism also presents many strengths alongside its potential difficulties.

Several symptoms of Autism are also strengths in many ways. As an example, autistic individuals with great attention to detail (one of Autism’s main side effects) can excel in exercises that require someone’s intense focus.

For instance, Chess Grandmaster Bobby Fischer was a prodigy in the chess world, beginning his professional chess career at only eight years old. Many psychiatrists have pointed out that he displayed many characteristics of someone with ASD. His ability to hyperfocus likely lent itself to his masterful talent for beating opponent after opponent in a game as complex as chess.

Many other famous individuals have ASD (or are likely autistic) and have profoundly impacted our world using their unique skill sets.

Additional autistic traits that can be viewed as strengths:

• Strong short- and long-term memory skills
• Able to learn quickly with strong visual and auditory learning skills
• Often punctual
• Strong logical thinking skills; not easily overwhelmed or distracted by strong emotion
• Can excel in school, especially in logical subjects (math, science, engineering, etc.)
• Strong memorization skills
• Great attention to detail
• Honest and reliable
• Learning to read at an early age
• Reliable and dependable
• Excellent sense of direction
• Can concentrate/focus for long periods
• Strong compliance with rules
• Excellent at devising unique, alternate solutions to problems
• Views the world with an ongoing sense of wonder and awe

Sometimes the Autism community refers to Autism’s unique traits as “superpowers.” These individuals focus on the positive aspects of ASD rather than its challenges.

Psychiatric Comorbidity and Autism

It’s not uncommon for an individual with ASD to receive a dual diagnosis that includes a mental disorder. An estimated 84% of autistic people also deal with some type of anxiety problem. There also seems to be a high prevalence of autistic individuals with OCD.

The most common mental health conditions that appear alongside an Autism diagnosis are:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Depression
• Generalized Anxiety Disorder
• Bipolar Disorder
• Social Anxiety Disorder
• Obsessive-Compulsive Disorder (OCD)
• Schizophrenia
• Eating Disorders (e.g., Binge-Eating Disorder, Anorexia, Bulimia, and Pica)

Treatment for Autism will include a type of therapy or counseling to help people with ASD manage some of their symptoms to function better in their daily lives. Therapy can be even more helpful for autistic individuals with psychiatric comorbidity as counseling can provide them with critical support for both disorders.

Cognitive Behavioral Therapy (CBT), for instance, is a method of psychiatry that focuses on identifying problematic or disruptive thoughts and behaviors, then working with a therapist to reframe these negative habits into healthier coping mechanisms and behaviors.

Statistical Data About Comorbidity With Autism

The organization Autism Speaks reports the following data about some of the common mental health conditions that occur alongside Autism:

• Eating problems affect roughly 70% of autistic children
• Between 30% to 60% of autistic people also have ADHD
• An estimated 42% of autistic people also deal with an anxiety disorder, particularly social anxiety
• Depression affects 7% of autistic children and 26% of autistic adults
• OCD is more common in autistic teens and adults compared to the general population

What is Addiction?

Addiction is a degenerative disease classified as an obsession with a substance or activity despite negatively impacting that individual’s life. Individuals struggling with chronic alcohol abuse or drug addiction typically have what is known as substance use disorder (SUD) and are unable to control their drug or alcohol use.

However, inappropriate alcohol and/or drug use are not the only habits that can lead to an addiction. The National Institute of Health explains that behavioral addictions can be just as detrimental as substance addiction and may create significant negative consequences for the individual.

Some common behavioral addictions include:

• Pornography
• Gambling
• Food
• Shopping
• Exercise
• Sex
• Video Games
• Internet and/or Social Media
• Plastic Surgery

Behavioral addictions occur when a person becomes obsessed with the feelings they get from participating in a specific behavior, such as shopping or playing online video games, to the detriment of their well-being.

Behavioral addiction is more than a hobby that a person frequently indulges in; behavioral addictions disrupt people’s lives, causing harm to their health, jobs, relationships, and so on.

Understanding Autism Alongside Addiction

There are a few theories about how Autism and addiction might be connected. Individuals with an Autism diagnosis have a higher risk of developing substance use disorder. The prevalence of substance issues in the Autism community may seem alarming, but having Autism doesn’t necessarily mean that developing an addiction is a given.

What Is the Connection Between Addiction and Autism?

Autistic individuals are more likely to develop substance use disorder or a behavioral addiction. There are a few theories about why addiction is somewhat common in the Autism community, including:

• Brain wiring
• Predisposition to repetitive behavior
• ASD symptoms such as hyper-fixation and obsessive tendencies
• Desire to lessen the severity of some ASD symptoms
• Wanting to “fit in” socially
• Difficulty with self-regulation
• Self-medicating with substances as a coping mechanism

Addiction Trends in the Autism Community

The following data illustrates some key trends regarding substance abuse within the Autism community.

• Individuals with ASD are twice as likely to develop an addiction problem than their non-autistic peers.
• Nearly 7% of individuals seeking substance abuse treatment also had an AUD diagnosis.
• An estimated 1 in 5 teens and young adults receiving substance abuse treatment may have undiagnosed symptoms of ASD.
• Research from the University of Cambridge revealed that alcohol abuse is somewhat lower in autistic individuals compared to the general public; however, autistic individuals were almost nine times more likely to engage in recreational drug use than non-autistic people.
• Autistic adults are three times more likely to self-medicate with drugs and/or alcohol for symptoms of depression and anxiety.

Common Addictions Among Autistic People

Unfortunately, addiction is somewhat common among autistic individuals: studies indicate that people with ASD are two to three times more likely to develop an addiction at some point in their lives.

The exact link between ASD and addiction is unknown. Still, theories suggest that there may be a correlation between the brain region affected by Autism and brain receptors influenced by substance abuse. In addition, some symptoms of Autism (such as obsessive tendencies) can lend themselves to making autistic people susceptible to developing behavioral addictions.

There is also strong evidence to suggest that autistic people turn to substances as a form of self-medication. They drink alcohol or abuse drugs to help lower their social inhibitions and/or decrease some of the adverse side effects of their condition, such as anxiety.

Substance Addiction

The most frequently-reported substances abused by autistic individuals include:

• Alcohol
• Nicotine
• Marijuana
• Prescription Opioids
• LSD
• Magic Mushrooms
• Heroin
• Cocaine
• Amphetamines (e.g., Crystal Meth)

Behavioral Addiction

The most common behavioral addiction among those with ASD include:

• Internet addiction
• Videogame addiction
• Gambling addiction
• Shopping addiction

Addiction Risk Factors for Autistic Individuals

There are many reasons why autistic people are more vulnerable to developing an addiction than people in the general population.

As indicated in research by the National Institute on Drug Abuse:

“The high frequency of anxiety and other psychiatric disorders among individuals with ASD has been proposed as a principal reason for their alcohol or illegal drug use.

Other reasons for drug or alcohol use include a reduction in social inhibition, the ability to forget problems and/or to attain peace of mind, to get through the day, or to overcome frustration.”

Repetitive or Obsessive Behaviors

The need for a strict routine and the tendency toward repetitive behaviors are common traits of autistic individuals. Autistic people tend to hyperfocus on tasks and activities, such as video games. Unfortunately, these traits can contribute to developing a behavioral addiction.

Notably, there is a significant crossover between people diagnosed with ASD and Obsessive-Compulsive Disorder (OCD). People who struggle with obsessive and/or compulsive tendencies can become deeply attached to specific activities and habits, potentially becoming addicted to these hobbies.

Impulsivity

Autistic people, especially those with a dual diagnosis of ADHD, often struggle with impulse control. Impulsivity can lead to risky behaviors, including experimenting with illicit substances. Many drugs are highly addictive and can lead to addiction even after the first use.

Autistic people can often struggle with self-regulation, making them more vulnerable to becoming addicted to drugs or alcohol.

Mental Focus

Some substances can make a person gain a better ability to focus. Drugs like cocaine, amphetamines, and even prescription stimulants like Adderall or Ritalin can be “helpful” in allowing a person to eliminate distractions and “zone in” to a specific task.

While the ability to focus is often considered a common symptom of Autism, an autistic person may find that certain environments make it challenging to do so—like a hectic workplace or busy college library. Abusing prescription stimulants or using illicit drugs may offer them what they think is a solution to their inability to focus when their environment feels disruptive.

Overstimulation

Alcohol and some drugs can reduce sensory overload, which can seem appealing to autistic individuals that have to deal with overstimulation. They may seek these substances as a way to make the world feel less intense than it does when they are sober.

Masking

Drugs and alcohol can often reduce social inhibitions. For autistic individuals, social anxiety is one of the most common concerns they report. By using drugs or drinking alcohol, they may feel less anxious in social situations. They may also want to hide or “mask” some of their symptoms, such as social awkwardness or uncertainty around others.

In addition, some autistic people may consume drugs or alcohol because the people around them are doing it. They may feel socially pressured to fit in. Socializing can sometimes be a struggle for autistic individuals, so they may see drinking or doing drugs as a way to be part of a particular peer group because that’s what the group does.

Negative Emotions

Many autistic individuals struggle with their symptoms to varying degrees. Autism has its strengths, but some symptoms can also be very challenging. An autistic person may turn to drugs or alcohol to alleviate their negative emotions and “just get through the day.”

Depression and anxiety commonly occur alongside Autism diagnoses. People dealing with anxiety or depression, whether they have Autism or not, may turn to drugs and alcohol as a form of self-medication to lessen these feelings.

Co-Occurring Mental Illness

It is not uncommon for autistic individuals to also experience psychiatric comorbidity, which is the presence of other mental health disorders alongside their Autism diagnosis. Autistic people who are also struggling with mental illness may feel tempted to self-medicate using alcohol and/or drugs to cope with their mental disorder on top of the difficulties that Autism can cause for them.

Addiction Support for Parents of Autistic Children

If you’re a parent of someone who is autistic, you are likely already well-versed in your child’s unique behaviors resulting from their ASD. Unfortunately, recognizing addiction in your autistic child may be challenging, as some ASD symptoms—such as hyper-fixation or difficulty with self-regulation—may be hard to discern from a true behavioral addiction. Unusual behaviors that indicate a substance abuse problem may also be more challenging to identify.

Here are some signs to look for that may indicate your child may be dealing with addiction:

• Pinned or dilated pupils
• Sudden changes in weight (gain or loss)
• Finding empty alcohol bottles or drug paraphernalia (such as a pipe or a bong)
• Bruises or wounds, particularly around the arms
• Burns on fingers or lips
• Neglecting personal hygiene
• Increased or unusual mood swings
• Missing school or work
• Sudden changes in regular habits
• Changes in sleep patterns (significant increase or decrease)
• New or increased secrecy, lying about whereabouts
• Losing interest in favorite hobbies
• Sudden financial problems
• Spending time with a group of friends known for drug activity or excess drinking
• Increased irritability or even hostility when interrupted during a particular activity (such as videogames)

The key to many of these warning signs is that you’ll notice unusual changes in your child’s typical behavior and/or physical appearance, particularly in teens or young adults.

Will My Autistic Child Develop an Addiction?

Statistically speaking, autistic individuals have a higher risk of developing substance use disorder or a behavioral addiction at some point in their lives. However, that doesn’t automatically mean your child will deal with addiction.

One of the best ways to prevent addiction is to talk with your child about it. Helping them understand what puts them at risk for addiction, as well as the damaging impact addiction can have on them, will go a long way.

Talking to Your Autistic Child About Addiction

Talking with your child about addiction is a meaningful conversation to have. As a parent, you’re the best person to gauge when it’s time to broach the subject. You’ll also probably know how to talk about it with special accommodations for your child’s understanding or any social struggles they might have as part of their ASD.

Generally speaking, the earlier you can talk to your child about addiction, the better. Prevention, as they say, is better than a cure.

Here are some tips for having the “addiction talk” with your autistic child:

• It’s a conversation, not a lecture. Nobody is receptive when scolded, so turning this conversation into a discussion gives your children the chance to ask questions or express concerns. This approach shows you as someone who can turn to addiction in the future.
• Use logic. Since many autistic individuals are very logically-minded, using logic to help your child understand the risks of substance abuse and other addictions can be helpful. You may also want to point out the increased risk that autistic individuals have of developing an addiction. They should be mindful of this, particularly if they are young but old enough to drink alcohol.
• Choose the right time. Starting a conversation about addiction (either substance abuse or behavioral addiction) isn’t going to be effective during or on the heels of an argument. It’s also not a good idea to interrupt them while they’re focused on another task, as sudden disruptions can be distressing and could cause them to go into the conversation distracted or feel resentful.

Addiction Treatment for Autistic People

Getting treatment for addiction can be difficult in itself, but for an autistic person, unique challenges may come up during the process. The level of difficulty an autistic person may experience may be related to the severity of their ASD symptoms.

Some challenges of addiction treatment for autistic individuals may include:

• Group therapy sessions. Group therapy is standard during addiction treatment, but this format may feel overwhelming—especially for individuals that struggle with social anxiety. Autistic individuals may also have trouble connecting with their peers or understanding specific social cues during group sessions, which can lead to feeling isolated or uncomfortable.
• Disruption to routine. Addiction treatment provides a new routine for recovering addicts, but for someone that’s autistic, this change in their daily schedule may be jarring and unpleasant.
• New environment. Similar to disrupting a person’s routine, a new environment may also be an unwelcome change. Addiction treatment is offered through inpatient and outpatient treatment programs; an inpatient or residential program may be especially challenging for someone with ASD as they will have to live in a new environment for 30+ days.

Additionally, treatment facility environments may not always be Autism-friendly. Stimuli, such as bright lights or lots of people talking, might be hard for an autistic person to cope with, for instance.

• New people. The counselors, clinicians, and other healthcare providers that make up the staff at the treatment center will be entirely new to the autistic person. In addition, the autistic individual receiving treatment will also be accompanied by other recovering addicts—such as during group therapy and/or in their general living areas (at inpatient rehab programs). For someone with ASD, meeting new people can be stressful, intimidating, and overall difficult.
• Inconsistent accommodation. Unfortunately, not all treatment centers are as well-equipped as they should be in terms of accommodating the unique needs of autistic individuals. While many autistic people make strides in this area, the overall treatment and recovery community still has a long way to go before all treatment facilities offer the necessary level of care needed to accommodate people with disabilities—including ASD.

Thankfully, individuals can choose from a myriad of addiction treatment options. Treatment programs can tailor their approach to suit an individual’s needs, which includes ASD-centered accommodations.

Finding the right treatment program (one that can adequately accommodate a person’s ASD symptoms and needs) may take some extra effort. However, treatment facilities across the US are constantly improving their accommodations for individuals with co-occurring disabilities and disorders, including Autism.

Addiction Treatment Programs for Autistic Individuals

Whether you are looking for addiction treatment for yourself or someone under your care, there are many options. The program you select will often be influenced by the recovering addict’s level of addiction and any special needs or accommodations required due to their ASD.

Inpatient Rehab for Autistic Individuals

When people think of addiction treatment, they usually picture inpatient rehab. However, inpatient treatment is only one type of addiction program. Inpatient rehab occurs at a residential facility where the recovering addict will live for 30-90 days.

During their stay, patients will have a strict daily schedule that includes group and individual therapy plus additional activities to support their recovery. The extra activities may vary based on each treatment center but can consist of education programs, nutrition counseling, 12-step meetings, outdoor activities (such as hiking or horseback riding), and more.

Inpatient rehab is considered the highest level of addiction treatment and is ideal for individuals with severe addiction or previous rehab visits. The high level of structure benefits recovering addicts and can also be helpful for autistic individuals since routine and structure are often highly valued by people with ASD.

Outpatient Services for Autistic Individuals

Outpatient rehab comes in a few different levels of care. A Partial Hospitalization Program (PHP) has treatment services similar to what an inpatient center offers but does not require the patient to stay overnight. For autistic people, a PHP may provide much-needed structure and stability. It also allows them to receive a high level of care without forcing them to live in a new environment that could otherwise feel very distressing.

An IOP, or Intensive Outpatient Program, is less intensive than a PHP. Treatment through an IOP usually occurs a few days a week and includes group therapy, individual therapy, and additional support programs. Someone that is autistic may benefit from this less intense level of treatment because it would be the least disruptive to their regular daily lives.

Medical Detox for Autistic Individuals

Detoxing from drugs or alcohol happens when the body stops receiving a substance. During the detox process, people will often experience symptoms of withdrawal. However, in some cases, withdrawal can have life-threatening side effects when it takes place without medical intervention. Alcohol and benzodiazepines are substances with the most dangerous withdrawal process.

On the other hand, medical detox is a safer alternative to detoxing alone. Not only will healthcare staff monitor the recovering addict’s vitals and provide emergency care if necessary, but they can also provide prescription medication to alleviate withdrawal symptoms and help prevent relapse.

Medical detox can be provided at an inpatient center for severe cases, while most individuals can safely go through medical detox at an outpatient level.

Therapy and Counseling

Therapy is not only an essential part of most rehab programs but also a critical practice during an individual’s long-term recovery plan.

Cognitive Behavioral Therapy (CBT) is among the most popular therapy for recovering addicts. CBT helps patients reframe negative thought patterns and develop positive attributes, such as higher self-esteem and healthy coping mechanisms.

Family therapy can also be highly beneficial for both autistic teens and autistic adults getting treatment for addiction because it can provide recovering addicts with a much-needed support system. Family members engaging in therapy alongside their recovering loved one will be able to learn more about addiction and how to provide the support their loved one needs in the future.

In addition, family therapy can also help loved ones gain a better understanding of Autism and what they can do to be more accommodating of their loved one’s needs as an autistic person.

Get Addiction Support for Someone Who Is Autistic

Many addiction treatment options are available, whether you seek support for yourself or a loved one. You should speak with your doctor about your concerns and request a substance abuse assessment. This assessment can help you determine the level of your addiction and the right degree of treatment that will be best for you.

You can also inquire about Autism-specific accommodations with any treatment center in your area by contacting the facility with your questions. Find out what treatment options are available in your area by calling SAMHSA’s helpline at 1-800-662-4357 or visiting their online program locator tool.