Nicotine addiction: the issue for Autistics that goes by the wayside

a cigarette with smoke coming off of it

I have written fairly extensively on the topic of addiction among Autistics. My focus has mainly been on the use of illicit and prescription substances, and alcohol, but there is one addiction that is extremely prevalent yet rarely discussed.

That addiction is nicotine.

Nicotine addiction is insidious. People focus on other substances because they have more obvious impacts in life and criminal status, but smoking and other forms of tobacco use affects far more people and kills at an inordinately high rate.

As an aside, using nicotine tablets, vaporizer pens, patches, or gum is markedly less dangerous than smoking or other forms of tobacco use. Further, no addiction is a moral failure.

So how many autistics are currently, or used to be a habitual nicotine user?

NeuroClastic recently surveyed nearly 400 Autistics on Twitter and found that 37% of them have a history of habitual nicotine use.

According to the WHO, there are 1.3 billion smokers in the world, which equates to nearly 17% of the global population. That means that (of our autistic respondents), the rate who smoke or have smoked is double compared to the overall population of the world. According to the NHS, 26.8% of adults aged 16+ were smokers (in the UK).

According to the CDC: “In 2019, nearly 14 of every 100 U.S. adults aged 18 years or older (14.0%) currently smoked cigarettes. This means an estimated 34.1 million adults in the United States currently smoke cigarettes. More than 16 million Americans live with a smoking-related disease.”

This represents a stark world in which Autistics are potentially dying of smoking related illness at a much higher rate than the world in general. Further, autistic people often have other health issues that could make smoking even more damaging, like connective tissue disorders that can cause lungs and the pharynx to lose elasticity faster.

So why might Autistics be so drawn to smoking?

The first and most obvious answer (in my opinion) is that smoking can be an oral stim. Autistics experience anxiety at a much higher rate than the general population, which leaves them feeling dysregulated. An oral stim such as smoking can help them to combat this feeling. It would be interesting to survey Autistic people who smoke or who used to smoke who also have been known to chew on pencils, straws, pens, or other objects to help them regulate themselves.

Autistics also experience mental health complications at a higher rate than the general population, probably because of the high rates of trauma that we are exposed to. It is known that mental health problems are a strong predictor for developing a habit of smoking.

This is because nicotine has a calming effect, but also because nicotine can help counter the sedative effects of many psychiatric medications. Nicotine can also help with relieving the pain and discomfort of some gastric issues that are common with autistic people.

Another reason that smoking is attractive to autistic people and may be harder to quit for autistics is that it provides an excuse to escape during social events. If an autistic person needed to take a break from a social situation without the excuse of smoking, and just went outside for fifteen minutes to enjoy some alone time to help themselves stay regulated, then returning would be met with questions:

Is everything okay?
Are you angry at me?
Was it something I said?
Where did you go?
Are you not having a good time?

While smoking may not be socially acceptable in every circle, people at least understand that when a smoker is feeling overwhelmed, they go and smoke. They do this to stay regulated and to reduce anxiety. The longer they wait, the higher their anxiety becomes.

Autistic people can feel this way in any social situation, but taking a break without the excuse of smoking is less socially acceptable than smoking a cigarette. A smoke break, for an autistic person, is often about escaping sensory overwhelm.

What’s more, an autistic person is likely to have found their way to smoking by running into other people who skirt the outside of social scenes– the outcasts and rule-breakers, if you will– by escaping social situations and running into the blunt-talking smokers swearing by the bushes and complaining about group think.

It’s reasonable to infer that smoking among the autistic population may play a role in our significantly-reduced life expectancy when compared to the general population.

Why might Autistics be struggling so much with nicotine addiction?

It is my opinion, that like any addiction cessation service, treatment is not designed with autistic neurotypes in mind. Smoking cessation is often designed to simply replace nicotine and taper down the dose used each day.

This approach does not consider or take into account some of the more nuanced reasons behind autistic smoking as mentioned above.

Smoking cessation needs to be tailored towards the autistic neurotype and informed by a knowledge of neurodiversity. The reasons that people continue to smoke– often to escape sensory and social overwhelm– need to be addressed.

Until this is done, Autistic people will still be struggling with nicotine addiction. We will suffer the related health consequences at an unacceptable rate, and our life expectancy will continue be lower than the general population.

While smoking is far from the only addiction issue we as Autistics face, it is a significant barrier to health that we need to bring to prominence in our discussions. It is but one unhealthy coping mechanism that we often use to survive a society that is not built for us.

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11 Responses

  1. Excellent points made in the following; especially the one about needing a socially acceptable reason to go take a break, our society has a universal dysfunction with that thing,

    Another reason that smoking is attractive to autistic people and may be harder to quit for autistics is that it provides an excuse to escape during social events. If an autistic person needed to take a break from a social situation without the excuse of smoking, and just went outside for fifteen minutes to enjoy some alone time to help themselves stay regulated, then returning would be met with questions:

    Is everything okay?
    Are you angry at me?
    Was it something I said?
    Where did you go?
    Are you not having a good time?

    While smoking may not be socially acceptable in every circle, people at least understand that when a smoker is feeling overwhelmed, they go and smoke. They do this to stay regulated and to reduce anxiety. The longer they wait, the higher their anxiety becomes.

    Autistic people can feel this way in any social situation, but taking a break without the excuse of smoking is less socially acceptable than smoking a cigarette. A smoke break, for an autistic person, is often about escaping sensory overwhelm.

    What’s more, an autistic person is likely to have found their way to smoking by running into other people who skirt the outside of social scenes– the outcasts and rule-breakers, if you will– by escaping social situations and running into the blunt-talking smokers swearing by the bushes and complaining about group think.

    It’s reasonable to infer that smoking among the autistic population may play a role in our significantly-reduced life expectancy when compared to the general population.

    As for me, I’m an autistic who wasn’t drawn to smoking as the concept of sucking on a burning stick struck me as illogical. And another aspect of the thing is illustrated by a fellow who became a frequent customer of a hobby shop I worked at in 1980s; after he had a heart attack and had to quit smoking he discovered that all of a sudden he had money for those model trains which had previously been too expensive.

  2. That poll has a big problem with literal language. Any literal reader who has ever tried smoking is not going to tick I have never smoked! Because “smoked” can mean a singke action, its meaning is not confined to regular habit. So more words need adding to say that.
    It needs to be: I have never smoked regularly, or, I have never been a smoker.

  3. An alarming amount of this really resonated with my difficulty in quitting.

    The combination of smoking as both a passive social activity and a way to take a break from socializing is certainly a thing, though I suspect that’s an NT motivation for smoking too.

    It’s absolutely an oral stim, but in my case, it is *not* in conjunction with chewing-related oral stims. In fact, part of my struggle with quitting is in not being able to find a suitable non-chewing oral stim replacement, because gnawing on things not meant to be eaten comes with a boatload of sensory issues for me – especially hard or textured things. I tried different e-cigs and the like, but there was too much maintenance for me to maintain it as a replacement, and again we have the “hard things in my facehole” issue.

    Replacing it with food isn’t a functional option for me; I already struggle with eating, and framing food as a replacement for an addiction is a recipe for disaster for me. I rarely remember or am able to eat as it is, linking food with replacing cigarettes in the past has made that worse, and then we’re back to the maintainance need – having available healthy snacks prepared constantly.

    I’m *not* medicated, so smoking essentially amounts to my only chemical mitigation for anxiety, depressive episodes, etc. And I’m all too aware of how likely it is to kill me, which makes the conflict about it all sorts of fun. 🙄

  4. I grew up in a family of heavy smokers, and I loved the smell of tobacco so much I used to fetch the used package out of the wastebasket just to smell them. I’m 67 now, and by the mid-1960s the anti-smoking campaigns has started to come out, but almost needless to say, when I was fifteen, I started smoking-and it was love at first puff. Even though I’m in the U.S., I smoked Players Navy-Cut non-filters, and then switched to Camels when those got too hard or expensive to find. Though my (late) oldest brother smoked four-and-a-half packs a day, I only smoked three-and-a-half (as did my late older sister), and I was almost never without one in my mouth. It was warmth and comfort and kept me calm-and I loved it. By the time I was thirty-five, alcohol had become a problem as well, and I had to get sober (it’s been almost 32 years of continuous sobriety), got into therapy, and I stopped smoking as well. Everything about being a sober adult was so new I did okay, though I eventually they realized I needed to be medicated for anxiety and depression. I made it for seventeen years without a cigarette, but had “just one” during a particularly bad depressive episode, and I was back to two packs a day (40 cigarettes) in no time at all-it felt as though a missing body part had been restored. I would have smoked more, but it’s practically a capital crime to smoke in public in Seattle now. I had a heart episode in 2010 (tachycardia that went away once they ablated a nerve) and was was shamed into quitting again. The first time I quit was relatively easy, but the second time was three weeks of hell. It’s been ten years, and if you told me an asteroid was headed our way, I’d be on the way to the store to buy cigarettes before you could say boo. It calms me, and numbs me to the outside world (and I don’t actually enjoy having a better sense of taste and smell), and any unbearable task was made more bearable with a cigarette in my mouth.

    The genetics around nicotine addiction are pretty hard to track independently of other factors that might make one predisposed to smoking, but for me it is a genuine physical addiction and not “just a habit”, and for whatever reason, I’ve got a whole bunch of receptors that are STILL waiting for some nicotine. I’m not a biochemist, but from what I can understand of what I’ve read, nicotine acts on systems inside the body OTHER than just the dopamine receptors. My remaining sibling (eight years older) had a heart attack three years ago while playing tennis (fortunately he was playing a cardiologist), had a quadruple bypass-and went back to smoking.

    I very seldom think about or miss alcohol, but it’s one-day-at-a-time with nicotine-even after ten years. Cheers, emily

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114454/

  5. I support a person who I am sure is autistic, and he smokes heavily. He tells me it helps with his anxiety but I also think it enables him to stay outdoors with a takeout coffee rather than sit in a cafe and experience social anxiety. The thing that puzzles me is that he will only ever smoke half a cigarette, although he smokes 40 a day. I have asked him why and he avoids answering.
    Can anyone suggest why he only smokes half a cigarette at a time?
    (I say I’m sure he’s autistic because I see a lot of autistic traits in him. He has a diagnosis of schizophrenia and his psychiatrist and care manager won’t entertain considering an autism assessment. I am autistic and a senior mental health practitioner.)

    1. I started not to smoke full cigarettes because they made me feel sick, but I struggled to stop entirely because of the addiction side of it.

      Unfortunately (as I’m sure you know) cigarettes are a common vice amongst people diagnosed with psychotic conditions.

      For me, after smoking roughly half a cigarette, each puff thereafter would make me gag.

  6. The conclusion doesn’t match the data. The data actually says that 13% of autists are currently smokers, not 37%.
    I also agree that us autists are more likely to be exposed to smoking, and more drawn to the escape option, however;
    we are also less likely to appreciate the general concept, and an addiction does the opposite of provide stability.
    Furthermore, we autists tend to be more inclined to follow rules and expectations. Since smoking is frowned upon, most of us won’t start merely for that reason.

    I couldn’t tell you if autists are more or less likely to smoke, but this data is certainly inconclusive. If I had to venture a guess, I’d say less likely.

    1. I agree that us autists are more inclined to follow rules and expectations which is actually one reason I started smoking… It was far more socially acceptable to smoke when I was in high school than to regulate myself in less harmful ways. This is really unfortunate, but I didn’t feel like I had much of a choice. I HAD to regulate myself somehow and smoking was considered to be bad, but not weird, freakish, and worthy of extreme shunning from everyone around me… just some. Only in retrospect do I understand this better; I didn’t know that I was autistic until I was 35. When I started smoking in high school, the understanding of autism was crude at best. Believe me, if there was any question at all back then I would have wanted to be known as the smoking kid rather than the autistic kid. There was far more stigma about autism back then than there was about smoking. I was masking the best I could, but wouldn’t recognize it as such for a couple more decades.

  7. You built your argument on a wrong comparison.
    The stats you provide shows that the percentage of autistic currently smoking is actually 13%. Which is way less than the 17% worldwide and 26% in the UK. If you want to use the 37% figure, then please compare it to the percentage of people with a history of smoking.
    So you are comparing the wrong thing, and the stats you provided actually show that it is less an issue that in the average population… which is the opposite of what you’re trying to say.

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