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.