Autism & addiction

In the past, it was assumed that people with autism had a much lower chance of developing an addiction disorder. However, since autism is characterized by dopaminergic deregulations, they are at high risk for developing addictive behaviors.^[1]Addiction and Autism Spectrum Disorder (van Wijngaarden-Cremers & van der Gaag, 2014)

In fact, recent research suggests that autistic individuals are nearly twice as likely to develop a substance use disorder (SUD).^[2]Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study (Butwicka et al., 2017)

ASD without diagnosed comorbidity of attention deficit hyperactivity disorder (ADHD) or intellectual disability, was related to a doubled risk of substance use-related problems.

The majority of autistic people with intellectual disability do not use substances; however, autistic people without intellectual disability have a much higher rate of substance abuse.

Overall, an autism diagnosis doubles the risk of addiction, the researchers found. Elevated risk is concentrated among those with an IQ of 100 or above. But across the spectrum, ADHD is a great multiplier of risk: Among those with autism and intellectual disability, having ADHD increases the risk of addiction fourfold; among those with an IQ in the typical range or above, ADHD increases the risk eightfold.

Parents and siblings of autistic people also have a higher risk of addiction, suggesting a genetic link.^[3]The Hidden Link Between Autism and Addiction (Szalavitz, 2017) | The Atlantic

Habitual behaviour

Addiction is known to be linked to changes in a central part of the brain known as the striatum, which is involved in persistent or habitual behaviour.

In both autistic people as well as in people with addiction in general, this part of the brain gets stuck in a repetitive pattern. Genetic links—NLGN3 and CNTNAP4, which are both candidate genes for autism^[4]Pinpointing common deficits (Yates, 2014) | Nature^[5]Variations analysis of NLGN3 and NLGN4X gene in Chinese autism patients (Xu et al., 2014)—are active in the striatum.

Addiction in autistic people can be induced by early stress, thus affecting the proper functioning of the cortico-striatal dopaminergic regulation systems (and also the HPA axis).^[6]Autism and substance use comorbidity: Screening, identification and treatment Author links open overlay panel (van Wijngaarden-Cremers, 2016) Less dopamine means more behaviors where dopamine is sought after, and since dopamine is produced among other things by sex, food, and drugs, this also makes autistic people prone to addiction.

Social challenges

Neurochemical alterations may also lie between the connection. Specifically, oxytocin is low in autistic people,^[7]Plasma oxytocin levels in autistic children (Modahl et al., 1998) and addicts often report being unable to socialize without drugs or alcohol.

During adolescence autistic people often find themselves having difficulty socializing and fitting in and as a result, alcohol and drugs can act like a social lubricant. In addition, the marginalized teen may find a way of fitting into the high school culture via engaging in drug use.

With the advent of early interventions and mainstreaming, more autistic adults not only have to navigate the same stresses most adults face—school, financial concerns, relationship issues, work stressors,” Kunreuther said.

“But they have to contend with higher rates of co-occurring depression and anxiety, not to mention coping with the sensory and social issues that also accompany an autism diagnosis. It’s no surprise that individuals with ASD might turn to alcohol and drugs for relief. Yet, we found little evidence that the autism community saw substance abuse as relevant or as an issue at all.”

Other reasons cited by autistic people are a slowing of their racing thoughts; and drugs like ecstasy (MDMA) can help them feel connected.^[8]New book explores drinking, drug abuse, and addiction in the autism community (2017) | Medical Xpress For information on the use of ecstasy/MDMA for autistic people, have a look at:

MDMA-assisted therapy for autistic people

Anxiety

About 85% of autistic people suffer from anxiety. Drugs and alcohol allow the person to decrease their anxiety. In addition, the use of drugs or alcohol anesthetizes the person from previous traumas, sexual, physical, financial abuse etc.

Matthew Tinsley, now 55, had always looked to alcohol and prescription drugs to reduce his anxiety. Tinsley is author of Asperger Syndrome and Alcohol: Drinking to Cope, one of the few books on this subject. (He has been sober since 2004.) From an early age, he would take his mother’s anxiety medications when he felt overwhelmed. “I found being amongst groups of people very stressful,” he says.

In college, he discovered that alcohol also helped ease socializing. “Everyone else is drinking, it’s socially acceptable, and if you drink, you fit in because everyone else is doing it,” he says. “It took the edge off.”

By the time he was in his 40s, Tinsley adds, he was drinking “lethal” amounts of alcohol: three liters of gin every day. This led to cirrhosis, and he entered rehab in 2004.

As in Stoner’s case, his autism diagnosis in 2005 came as a relief. Once he realized there was an explanation for his sensory and social difficulties, he began to be kinder to himself and found healthier ways of coping.^[9]The Hidden Link Between Autism and Addiction (Szalavitz, 2017) | The Atlantic

Matthew Tinsley and his therapist/co-author Sarah Hendrickx suggest he turned to alcohol to self-medicate undiagnosed Asperger’s syndrome.^[10]People With Autism Aren’t Protected From Opioid Addiction. They Might Be at Higher Risk. (Kunreuther, 2018) | Slate So this was Matthew’s way to alleviate his anxiety around undiagnosed autism.

Motor cognition

Something that may have contributed to Matthew Tinsley’s need to self-medicate using alcohol is motor cognition, which is the notion that cognition is embodied in action, and thus that the motor system contributes to our mental processing, including those involved in social interaction.^[11]Weaving the fabric of social interaction: Articulating developmental psychology and cognitive neuroscience in the domain of motor cognition (Sommerville & Decety, 2006)

Anomalies in motor cognition may have cascade effects on social functioning in autistic individuals, which is definitely what Tinsley experienced. But on the flipside, motor cognition may help explain the pathophysiology of drug-seeking and drug-taking behaviors in the most severe phase of drug addiction.^[12]The motor way: Clinical implications of understanding and shaping actions with the motor system in autism and drug addiction (Casartelli & Chiamulera, 2015)

Impulsivity

Another reason why autistic people are prone to addiction is the fact that impulsivity is very common in autism.^[13]Clonidine treatment of hyperactive and impulsive children with autistic disorder (Jaselskis, 1992)

Also, autistic people tend to engage in repetitive behaviour or stimming to alleviate—or some cases increase—sensory stimulation.^[14]What is stimming? | Medical News Today^[15]When the world becomes ‘too real’: a Bayesian explanation of autistic perception (Pellicano & Burr, 2012)^[16]The musicality of stimming: Promoting neurodiversity in the ethnomusicology of autism (Bakan, 2014) Addictive substances can do the same.

More information

A recent book released on October 19 2017, called Drinking, Drug Use, and Addiction in the Autism Community by Ann Palmer (author), Elizabeth Kunreuther (author), and Tony Attwood (foreword) may help people shed more light on the topic if they are interested.