The term autism describes a spectrum of developmental disorders that are most often identified in young children. People diagnosed with an autism spectrum disorder (ASD) will generally have a lower risk of substance abuse compared to people with other types of mental illness.
People with autism who struggle with addiction generally have more severe manifestations of substance abuse.
The Conceptualization of ASD
Before 2013, autism was included in a diagnostic category of mental illness referred to as pervasive developmental disorders. These disorders included Asperger’s disorder, autism, and other similar disorders that were commonly first diagnosed in very young children.
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In 2013, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) revised the classification of these disorders into autismspectrumdisorders. This means that all of these prior separate diagnostic categories were now placed together under one heading by the American Psychiatric Association (APA).
APA attempts to revise and update its classification system of mental illnesses based on research findings, and newer research into autism and related disorders indicated that the previous diagnostic categories represented a spectrum of different levels of dysfunction that were all related and would be better conceptualized as one specific disorder (ASD).
The ASD diagnosis can have a wide variability regarding the level of dysfunction any person may exhibit, such that some individuals may not appear to be significantly impaired, whereas others may be profoundly impaired.
What Are the Signs and Symptoms of ASD?
ASD is diagnosed according to strict behavioral criteria. There are no medical tests, blood tests, or imaging tests that can definitively diagnose ASD in any person. According to the DSM-5, the behavioral criteria used in the diagnosis of ASD include:
The diagnosis of ASD requires that the child/person displays impairment in their social functioning over numerous contexts that will include but are not limited to:
- Impairment in nonverbal norms of communication that are typically observed in the young individuals, such as making eye contact or responding with facial gestures
- Numerous impairments in social reciprocity or understanding or developing social relationships
People diagnosed with autism will often display very fixed interests, behaviors, or patterns of repetitive behavior that can include:
- Restricted/fixed interests that are often intense and abnormal preoccupations with unusual objects or situations
- An unusual need for a routine that can be observed in many different contexts
- Rigid patterns of thinking or acting
- Ritualistic or stereotyped uses of language, movement, or objects
- Extreme sensitivity to environmental conditions
The symptoms that are observed must occur early in development and must result in impairment in functioning over numerous areas. The symptoms cannot be better explained by some other condition or disorder, including a medical condition, some other form of mental illness, or another type of neurodevelopmental disorder.
Severity of Autism
ASD can lead to profound or mild impairment with everyday functioning. This means that some individuals who are diagnosed with autism may need around-the-clock care and supervision, whereas others may need substantially less help.
At the higher level of functioning, the individual will often still require some assistance and demonstrate some problems in social contexts that may often be viewed by outsiders as them being “quirky” or “odd.” Those with more profound impairments may have severe intellectual disabilities that necessitate very close supervision to protect them from harming themselves.
Whenever a person is diagnosed with any type of mental health disorder, the symptoms that are used to diagnose the disorder must occur over numerous areas of functioning. Autism is no different. Individuals diagnosed with this disorder, even if it is a high-functioning type, must demonstrate problems over many areas of functioning and not just in specific contexts.
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What Causes Autism?
There is no specific identified cause for autism. In the early conceptualization of the disorder, it was believed that the parents, particularly the mother, produced the disorder due to a very cold and detached style of parenting. However, this notion has long been discarded.
Instead, it is believed that autism has a very strong genetic component that leads to significant developmental issues in the brain. These abnormalities in brain development and structure are believed to produce the disorder.
There may also be some environmental contribution to the development of autism. Proposed causes like vaccinations, additives in food, and others have been soundly debunked by research studies.
ASD and Comorbid Substance Abuse
Comorbidity is a term used by clinicians to describe a situation where someone has co-occurring diagnoses at the same time. Many of the disorders listed in the DSM-5 have significant comorbidities with other types of mental health disorders.
ASD appears to have high comorbidity rates with intellectual dysfunction (significantly decreased IQ), attention deficit hyperactivity disorder, problems with language development, depression, and several other mental health disorders.
A person with a psychological disorder and a comorbid substance use disorder is often referred to as having a dual diagnosis.
Substance abuse and addiction are not considered to have significant comorbidity with those diagnosed with autism, according to APA. However, some studies have investigated the rates of substance use disorders in people diagnosed with ASD.
Research on ASD and Substance Abuse
One review published in 2016 found 18 research studies investigating the comorbidity of substance abuse and ASD and the effects of treatment on those with this dual diagnosis. No specific prevalence rate of substance abuse in people with ASD could be determined based on the research.
It was determined that in clinical settings, the condition represents a very small subgroup of people with ASD. Those with autism were more likely to have a more severe manifestation of substance abuse. There was even less research investigating the types of effective treatment interventions for people with co-occurring ASD and substance abuse issues.
A 2017 study published in the Journal of Autism and Developmental Disorders investigated rates of substance abuse in people with ASD and their non-ASD relatives.
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The findings indicated that being diagnosed with an ASD was associated with an increased risk for substance abuse, particularly if the person had a comorbid diagnosis of some other disorder like ADHD or an intellectual disability, but the prevalence of substance abuse in individuals with ASD remained low.
The relatives of people with autism who were not diagnosed with the disorder demonstrated increased risk for substance abuse if they had characteristics that were similar to those with ASD but were not significant enough for a formal diagnosis.
The researchers suggested that any increased risk for substance abuse in individuals with ASD was probably due to genetic factors.
A previous study in 2014 found a similar association of an increased risk for substance abuse in people who did not have a diagnosis of ASD but did display some ASD-like traits.
What Does the Research Mean?
Based on the research, it can be concluded that as a group, people with autism may be at an increased risk to develop problems with substance abuse, with more high-functioning individuals and those with other comorbid conditions being at an elevated risk compared to those without comorbid conditions or those who are lower functioning.
A diagnosis of autism is associated with a decreased risk for substance abuse problems compared to other types of mental health disorders, but if an individual with autism abuses drugs or alcohol, they are likely to have a more severe issue with substance abuse. The primary substance of abuse for these individuals would be alcohol, but other drugs of abuse may also be used depending on the situation.
There are no formal identified treatment protocols designed to specifically address comorbid autism and substance use disorders, partially because of the significant variability in the level of dysfunction that occurs in individuals diagnosed with ASD.
The treatment of a substance use disorder in any person with ASD should be personalized according to the level of dysfunction displayed by that person along with other variables, including the substance of abuse, the person’s level of disability, and their living situation.
Because all individuals with ASD display some issues with social functioning and social interactions, treatment should focus on behavioral interventions. It should include therapy that is appropriate for the person’s level of functioning.
If you know someone with autism who may have a substance abuse issue, you should have them fully assessed by experienced clinicians. Then, if it is deemed that treatment is needed, the following components of treatment should be considered:
Medications to address cravings and withdrawal symptoms from alcohol or other drugs may be used. The use of medications alone is typically not considered to be sufficient for recovery from any substance use disorder. Other interventions should also be included.
These might often focus on contingency management type programs where rewards are provided when the person engages in positive behaviors such as abstinence.
The use of various types of therapy for substance abuse could be considered depending on the person’s level of functioning. Some individuals with ASD may benefit from mindfulness training, and the use of group therapy may be beneficial for some individuals.
The use of peer support, such as 12-step groups, will be dependent on the person’s ability to interact with others.
The use of various types of alternative and complementary treatments might be particularly beneficial with this particular group. The use of animal-assisted therapies, music therapy, art therapy, and similar offerings could be very useful in addressing substance abuse in individuals with autism and decreasing relapses in these individuals.
(June 2013) SHANK3 haploinsufficiency: A “common” but underdiagnosed highly penetrant monogenic cause of autism spectrum disorders. Molecular Autism. Retrieved April 2019 from from https://molecularautism.biomedcentral.com/articles/10.1186/2040-2392-4-17
(January 2018) Comorbidity: Substance Use Disorders and Other Mental Illnesses. National Institute on Drug Abuse. Retrieved April 2019 from from https://www.drugabuse.gov/publications/drugfacts/comorbidity-substance-use-disorders-other-mental-illnesses
(August 2016) Autism spectrum disorder and co-occurring substance use disorder–a systematic review. Substance Abuse: Research and Treatment. Retrieved April 2019 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990150/
(January 2017) Increased risk for substance use-related problems in autism spectrum disorders: a population-based cohort study. Journal of Autism and Developmental Disorders. Retrieved April 2019 from from https://link.springer.com/article/10.1007/s10803-016-2914-2
(March 2014) ADHD symptoms, autistic traits, and substance use and misuse in adult Australian twins. Journal of Studies on Alcohol and Drugs. Retrieved April 2019 from from https://www.ncbi.nlm.nih.gov/pubmed/24650814
(September 2013) Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Research in Developmental Disabilities. Retrieved April 2019 from from https://groups.psychology.org.au/Assets/Files/Spek%20et%20al%202013.pdf
(November 2013) Animal-assisted intervention for autism spectrum disorder: A systematic literature review. Journal of Autism and Developmental Disorders. Retrieved April 2019 from from https://www.vet.purdue.edu/chab/ohaire/files/documents/JADD_2013_OHaire.pdf
(2014) Music therapy for people with autism spectrum disorder. Cochrane Database of Systematic Reviews. Retrieved April 2019 from from https://core.ac.uk/download/pdf/60565645.pdf
(January 2009) Art therapy and autism: Overview and recommendations. Art Therapy. Retrieved April 2019 from from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.925.1615&rep=rep1&type=pdf