Until recently, many researchers believed that substance abuse and addiction amongst autistic people was scarce. Stereotypes about autistic people being rule-driven, rigid, and socially avoidant, plus a narrative around autism that centers children, have contributed to the perception that autistic people are less vulnerable to addiction. It is true that autistic people are less likely to experiment with recreational drugs and alcohol; however, current studies suggest that autistic people more frequently turn to alcohol and drugs as a method of self-medication (Szalavitz, 2017).
Like most people, autistics don’t want to be alienated due to communication differences or social anxiety. Some autistic people may turn to drugs or drinking as they feel that this can help them fit in with the rest of the crowd or reduce social anxiety. However, this coping mechanism can be dangerous without realizing the risks that neurology can play into addiction.
Many autistics resort to substance use as a way of relieving anxiety and coping with insomnia, mutism, and sensory dysregulation. Social pressure may cause someone to experiment with drugs or alcohol as a way to fit in with peers.
Alcohol impacts everyone differently, especially when they are differently wired. Without any preparation or knowledge of how alcohol impacts a person’s neurodivergent brain, trying alcohol for the first time in a public place or on a date may be dangerous.
For autistic people, alcohol can mean a complete loss of self-control, as we find our thoughts are slowed down, our memories hazy and, worst of all, we can become trapped by strangers who are talking about football. However, even these hazards are nothing when they are compared to the fact that most ‘nights out’ will usually involve a bar full of loud noises, cramped spaces and other things to distress our senses.
From Autism & Alcohol: The Effects of Drinking on the Spectrum, by James Sinclair
Anxiety and Alienation
The issue of substance abuse affects autistic people of all ages, races, and genders. Matthew Tinsley, the author of the memoir, Asperger Syndrome and Alcohol: Drinking to Cope, reveals that from an early age, he would take his mother’s anxiety medication when he felt overwhelmed in group settings (Szalavitz, 2017).
The habit of substance use followed Tinsley into college, as he started to drink alcohol in dangerously large quantities to ease into social events. However, this unhealthy habit followed him to his 40s, where he realized that he was drinking “lethal amounts of alcohol” (Tinsley & Hendrickx, 2008).
Tinsley’s case is not unique, as this pattern is fairly common for both neurodivergent Autistics and ADHDers. In reality, resorting to drugs and alcohol in public settings can “take the edge off” and can help one avoid worrying about “autistic behaviours or sensory overload” (Hammond, 2020).
Tanea Patterson, mother of two who lives in New Zealand, experienced a similar case to Tinsley. She resorted to drugs as a way of dealing with social stress and sensory problems. As a teenager, Patterson had been bullied and alienated, prior to finding peers who used marijuana and were more accepting. Some autistic people report that drug culture helps them feel accepted, as being outside the status quo is expected from people under the influence– preventing them from standing out (Szalavitz, 2017).
Others find their way to addiction through prescribed medications. Even in the early childhood years, autistic kids can be prescribed powerful medications like stimulants for co-occurring ADHD, anti-depressants, anti-psychotics, mood stabilizers, and sleep aids (Gravitz, 2017).
Over time, a tolerance builds and dosages are increased. A study revealed that 64% of autistic children were on at least one psychiatric medication, 35% were on at least two, and 15% were on three or more (Spencer, 2017)
While medications are helpful and critically necessary at times, many autistic children are prescribed medications and are expected to cope before they are given access to sensory or academic accommodations. This can lead to patterns of addiction and seeking increasingly strong dosages to be able to cope.
Addiction And The Brain
Although both autism and substance abuse are separate entities and are independent of each other, there can be neurological factors that predispose autistics to addiction. This may be related to the tendency to prefer sameness or to form repetitive behaviours or habits.
Both autism and addiction are related to some of the same brain regions and involve some of the same genes. Because of these shared traits, autistic neurology and substance use tend to reinforce each other when they co-occur (Recovery Village, 2021). This information is prompting a new area of research that could eventually help aid treatment, prevention, and therapeutic supports for addiction that are tailored to autistic people.
Addiction is known to be associated with changes in the striatum, a region of the brain that is involved in pleasure-seeking and habitual behavior. Before the evolution of drug addiction, drug-related brain activity occurred most commonly in the ventral area of the brain (Rothwell, 2016). At this stage, individuals resort to drugs because it offers a sense of comfort or joy. This area is also interconnected to impulsive behavior (Lüscher, Robbins, & Everitt, 2020).
As addiction becomes severe, some of the action moves towards the dorsal striatum, an area involved in converting behavior into more of a programmed pattern. This can create a compulsion that becomes difficult to constrain. Overall, in both cases, the striatum drives the persistent behavior. Consequently, behavioral patterns become greatly difficult to alter once they have become recurrent (Szalavitz, 2017).
Unfortunately, for autistic people who have developed habits of substance abuse, getting help may be challenging. In fact, most addiction treatment centers are poorly suited for autistic people as providers often know very little about autism (Gray-Hammond, 2020).
A prominently-practiced technique in addiction treatment centers involve addiction therapy, like the twelve-step program associated with Alcoholics Anonymous or Narcotics Anonymous. These exercises are largely regulated through group sessions, with rigorous rules that require members to participate and share their emotions with others.
David Gray-Hammond is a passionate advocate about addiction and getting more meaningful supports for autistic people. Even though these pre-packaged programs work for some, Gray-Hammond says they can be inappropriate for many autistics:
The first issue I had was the talk of a “higher power.” I fall on the side of agnosticism and atheism, relying on a higher powers felt absurd to me. The twelve-steps involved a lot of praying, and I couldn’t reconcile that with my own beliefs. In my opinion, this also reduces accessibility to the LGBT+ community, of whom many are autistic, because of religious trauma that they may have experienced.From “Limits of the traditional twelve-step program for autistic folk,” by David Gray-Hammond of Emergent Divergence
Chelsey Flood is autistic and sober now, but she recalls her time in twelve-step programs with grievances similar to Gray-Hammond’s (2021). She, too, struggled with praying and performing actions that were inauthentic. She also felt compelled to mask. She writes,
I ruminated over what I said and didn’t say. Unless they told me explicitly I could never tell if anyone liked me. I always defaulted to the belief they didn’t. Meetings were too bright and too busy. And I couldn’t stop smiling, (like I to Uncle Monty) no matter how I felt.-From “I drank because I was socially awkward, then I got sober and discovered I’m autistic,” by Chelsey Flood (2021), at The Society for the Study of Addiction.
Ross Cessna notes that being autistic in a group of non-autistic people, like those in addiction recovery, can be further isolating and set up a perpetual contrast between why he was using substances compared to others. He gives a thorough review of how so many of the steps to recovery were just gaslighting, noting, “I can’t live my life by other people’s map of reality” (2021).
While I didn’t know that I had autism until July of 2019, many signs show up in hindsight. So much of recovery relies upon telling other people how you honestly feel. As I got better clarity of myself, it was increasingly hard to find people who could relate to me and vice versa. The reason being most of the issues I was facing were symptoms of autism and not addiction. While they seemed similar enough on the surface, they weren’t when explored more deeply.-From “How Autism impacted my decision to leave 12 step Recovery,” by Matthew Cessna, Spiritual Phoenix Studios (2021).
Society stonewalls and gaslights autistic people unintentionally by having how “people” are as a default built into all social constructs without considering that autistic people exist and are different (Vance, 2019).
Because of this, non-autistic allies need to consult and include autistic people in structuring programs in ways that are specifically suited to meet the needs of autistic people.
Five Tips for Harm Reduction
Harm reduction refers to programs and practices that are implemented to help minimise detrimental health, social, and legal impacts associated with drug use (Harm Reduction International, 2021). Although it is not encouraged to start experimenting with recreational drugs, if you’re planning to try them, it is critical to know yourself and be as safe as possible. For neurodivergents, harm reduction begins with knowing and accommodating for oneself.
Because everyone– but especially autistic people– react differently to drugs and alcohol, it is important to have a trusted person with you who is sober and who can be trusted to respect your privacy, boundaries, and dignity. Make sure you try in a private setting and experimenting with lower quantities to avoid potential overdoses and minimize the impact of negative reactions.
Lastly, always remember that autistic people can be predisposed to forming habits that can lead to addiction. Try to space out the time between using substances and accommodate for your sensory and emotional health so you feel less reliant on substances to have a good time. It’s always okay to arrive late to parties or leave early, or skip invitations altogether when you’re overwhelmed.
Managing your sensory and emotional health can help you to be less vulnerable to addiction. Having access to a great neurodiversity-affirming therapist or community supports can help you manage emotional health and stress so you’re less likely to develop dependence.
If you already have developed an addiction, remember that it’s not shameful or a moral failure. While finding help that is tailored to the autistic experience can be hard, connecting with the autistic community can be helpful to find resources and support in your area.
Autism and substance abuse. (2021, July 12). The Recovery Village Drug and Alcohol Rehab. https://www.therecoveryvillage.com/mental-health/autism/substance-abuse/
Cessna, M. (2021). How Autism impacted my decision to leave 12 step Recovery. Spiritual Phoenix Studios. https://spiritualphoenixstudios.com/blog/how-autism-impacted-my-decision-to-leave-12-step-recovery
Flood, C. (2021). I drank because I was socially awkward, then I got sober and discovered I’m autistic. The Society for the Study of Addiction. https://www.addiction-ssa.org/i-drank-because-i-was-socially-awkward-then-i-got-sober-and-discovered-im-autistic/
Gravitz, L. (2017). Autism’s Drug Problem. Spectrum. https://www.spectrumnews.org/features/deep-dive/autisms-drug-problem/amp/
Gray-Hammond, D. (2021, February 7). ‘Fitting in’ and other issues with being an autistic addict in recovery. NeuroClastic. https://neuroclastic.com/fitting-in-and-other-issues-with-being-an-autistic-addict-in-recovery/.
Gray-Hammond, D. (2020). Autism & Addiction: The deadly issue no one is talking about. NeuroClastic. https://neuroclastic.com/wp-content/uploads/2021/01/Autism-and-Addiction.pdf
Lüscher, C., Robbins, T.W. & Everitt, B.J. (2020). The transition to compulsion in addiction. Nature Review Neuroscience. 21, 247–263. https://doi.org/10.1038/s41583-020-0289-z
Rothwell, P. (2016). Autism Spectrum Disorders and Drug Addiction: Common Pathways, Common Molecules, Distinct Disorders? Frontiers in Neuroscience. https://www.frontiersin.org/articles/10.3389/fnins.2016.00020/full
Sinclair, J. (2020). Autism & Alcohol: The Effects of Drinking on the Spectrum. Autistic & Unapologetic. https://autisticandunapologetic.com/2020/10/24/autism-alcohol-the-effects-of-drinking-on-the-spectrum/
Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., Azocar, F., & Jain, A. (2013). Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders. Pediatrics. 132 (5): 833–840.
Szalavitz, M. (2017, March 2). The hidden link between autism and addiction. The Atlantic.
Milestones Autism Resources (2018, August 24). Substance abuse and ASD: Ties, treatment, and how to address the problem. https://www.milestones.org/resources/blog/2018/08/24/substance-abuse-and-asd-ties-treatment-and-how-to-address-the-problem
Tinsley, M., & Hendrickx, S. (2008). Asperger’s Syndrome and Alcohol: Drinking to Cope? Jessica Kingsley Publishers. https://www.amazon.com/Asperger-Syndrome-Alcohol-Drinking-Cope/dp/1843106094
Vance, T. (2019). 50 Ways Society Gaslights and Stonewalls Autistic People. NeuroClastic. https://neuroclastic.com/ways-society-gaslights-autistics/
Harm Reduction International. (n.d.). What is Harm Reduction? https://www.hri.global/what-is-harm-reduction
- The Unexplored Link Between Autism and Substance Abuse - November 24, 2021