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Autism and Alcohol

Autism and Alcohol

Table of Contents

Is There a Link Between Autism and Alcohol Addiction?

Depression, anxiety, and post-traumatic stress disorder; these are the mental health concerns that doctors usually associate with being at increased risk for substance abuse. But, is there a link between autism and alcohol? Traditionally, doctors didn’t think that many people with an autism spectrum disorder (ASD) would also have a substance abuse problem.1

In more recent times, that line of thinking has changed. Doctors have identified that rates of substance use disorder in a person with an autism spectrum disorder are higher than previously thought.1

There are a few concerns with this information. First of all, there isn’t a lot of science-based research on how people with autism spectrum disorders respond to traditional substance use disorder (SUD) treatments.1 Second, this makes treating SUD’s in a person with an autism more challenging because many of the interventions doctors would usually use may not work as well.

Is Asperger's Syndrome Different than Autism?

Asperger’s syndrome is a medical condition that doctors consider a part of the autism spectrum. But, Asperger’s has different symptoms that help a person differentiate between it and other types of autism.

Asperger syndrome typically presents symptoms like:

Issues with social interactions

Stronger verbal skills

Distinctive strengths, such as focus, persistence, and ability to recognize patterns

However, living with Asperger’s may also present unique challenges that may include hypersensitivity to light, sound, or taste; difficulty with responding at appropriate times in conversation; problems with non-verbal conversation skills, and clumsiness. Some of these challenges lead to a struggle with autism and alcohol.2

Autism and Alcohol Use Disorders

Traditionally, doctors have thought that those on the spectrum have lower rates of alcohol addiction than those who do not.3 The doctors didn’t believe there was a link between autism and alcohol. However, it’s important to remember that there are different levels of autism spectrum disorders. As a result, some may be better able to conceal their alcohol-consuming behaviors than others. Or, they may use alcohol or other medications (such as those to relieve anxiety) as a means to cover up some of their symptoms.3

Are Substance Use Disorders a Symptom of Autism?

Substance use disorders aren’t usually a symptom of autism. Those with autism are more likely to experience other symptoms, which include:

poor social functioningeccentric behavior
anxietyfixed habits
repetitive behaviors 

Sometimes, symptoms can resemble other conditions, such as bipolar disorder, attention deficit hyperactivity disorder, and social anxiety disorder. It can be difficult to sort these conditions from the issues caused by autism and alcohol.4

Do People with ASD Have More Issues with Substance Use Disorders?

Doctors know that an estimated 29.5 million people in the United States struggle with substance abuse, according to an article in the journal Substance Abuse: Research and Treatment.1 Of those, an estimated 23 percent have attention deficit hyperactivity disorder (ADHD).1

However, doctors don’t know exactly how many people with autism also struggle with substance use disorders. They do have some estimates that may range anywhere from 0.7% all the way up to 36%.1 One study suggested the range is anywhere from 11% to 29% percent over a person’s lifetime.5

The more sociable, intelligent, or confident a person with an ASD is, the more they might struggle with their autism and alcohol use.1 Those who are very socially withdrawn are less likely to experience an alcohol issue. Those who are less social will show a weaker link between their autism and alcohol addiction.

Is Alcohol a Coping Mechanism for the Anxiety of Social Situations?

For a long time, doctors believed that having an ASD was actually protective against alcohol addiction because many people who abuse alcohol do so to interact with the outside world, including building social networks.1

Their engagement in social behaviors may make it easier to “fit in” when they are drinking. They may even appear more “normal” in behavior to the outside world, which they may think allows them to maintain better relationships and even succeed more in their careers.3 However, this can make diagnosing and treating autism and alcohol use disorder more difficult.

Are Children with ASD at Higher Risk of Abusing Drugs and Alcohol?

Doctors don’t usually think of substance abuse as a symptom of autism, so there isn’t a strong link between autism and alcohol. According to an article in the journal BMC Psychiatry, a study of 122 teenagers with high-functioning autism spectrum disorders found they had a lower risk of developing a substance use disorder compared to teenagers who were not on the spectrum.

There may be a few reasons why those with ASD are not necessarily at increased risk for substance abuse. One, fewer “sensation-seeking” behaviors tend to appear in people with ASD.3 Sensation-seeking is one of the leading indicators of addiction. But, some with autism may still seek thrills which would be an indicator that they struggle with both autism and alcohol. People with autism who are more introverted will be less likely to engage in social behaviors, including drinking.

Peer Pressure

Those on the spectrum tend to have traits that include impaired social skills and social rigidity. They may have a hard time interacting with and relating to others. As a result, they may be less likely to “give in” to peer pressures to drink.

On the other hand, those with ASD may feel tremendous pressure, anxiety, and even depression about their ability to fit in. As a result, they may give in to peer pressure as a means to feel or act more like those around them.3

Peer pressure can push a person with autism away from alcohol or lead them to struggle with their autism and alcohol use disorder. The spectrum is so wide there are no one-fit answers.

Complicating Factors Unique to ASD

Those on the spectrum often have difficulty relating to the outside world.1 They may feel excluded and not know how to include themselves and relate to others. As a result, attempting to “self-medicate” with alcohol or drugs as a means to deal with anxiety, depression, and isolation may occur.

Another complicating factor is that a person with autism may immediately respond to a plea to stop drinking despite any consequences.1 Therefore, when someone tells them that they need to stop drinking, they may suddenly stop without treatment and develop alcohol withdrawal syndrome which can be painful or even deadly. They may need professional rehabilitation to overcome substance use while minimizing symptoms of withdrawal.

Treating Someone on the Autism Spectrum for Substance Use Disorder

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy involves educating a person on a topic, such as alcohol addiction, and the thoughts and behaviors that may keep a person addicted to the substance. Then, behaviors are learned that can support sobriety and keep them away from substance abuse.

Unfortunately, there isn’t a lot of research based on the best treatments for someone struggling with autism and alcohol addiction. Cognitive-behavioral therapy or CBT usually works very well in helping those with ASD and any disorders they may have, including treating their autism and alcohol addiction at the same time.1

According to an article in the Journal of Substance Abuse, those on the spectrum who also suffer from an addiction to drugs or alcohol often require more individualized therapy and therapy that lasts much longer than a person who doesn’t have an autism spectrum disorder.

CBT May Need to be Slightly Altered

When it comes to treating a person with autism and alcohol addiction, therapists may slightly alter their approaches to better serve the needs of the individual. An example might be to maintain routines and activities during treatment. This can help a person with an ASD that often thrives on predictability. Ideally, the same therapist should be kept throughout treatment to achieve the greatest effectiveness.

Some of the ways a therapist may change treatment to better suit the needs of a person with an ASD include the following:1

Provide written plans, outlines, and even "homework" for a person in recovery to get the structure they need

Let a person with ASD know upfront about how long they can expect to be in treatment as ending treatment can be very challenging or make them feel rejected

Collaborate with family as quickly as possible

Work to help not only with treating autism and alcohol addiction, but also in helping find resources after ending treatment, such as housing assistance, employment, or job training

Finding emotional support or social contacts outside of the rehabilitation center

12-Step Groups May Hurt More Than They Help

Researchers also know that some typical substance abuse treatments can create extreme anxiety and even fear in a person with ASD.4 For example, participation in 12-step programs or other larger self-help groups can increase the likelihood a person may drop out of substance abuse treatment.4 Also, outpatient treatment may be better for someone with ASD compared to a residential setting where a person is out of their comfort zone.

Conclusions

Those with an autism spectrum disorder may not have an increased risk for alcohol addiction — or it’s possible there just isn’t enough research out there to know one way or the other. However, doctors do know that those with autism and alcohol addiction may not respond to traditional substance abuse treatments the same as a person who isn’t on the spectrum. If you or someone you love has autism and alcohol addiction, seek treatment from a therapist or program that specializes in treating both conditions for long-term healing.

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