Autistics, ADHD, & Addictions: A Broader View

Why we are at higher risk for substance use issues

I’m on a roll

I recently published a review of Dr. Maté’s new book, The Myth of Normal, in which I decry the fact that he completely ignores the Autistic and ADHD populations when discussing addictions.

In true ADHD fashion, this led me down a separate rabbit hole, exploring the underlying factors contributing to increased rates of addiction in Autistics and ADHDers.

The research focuses primarily on the neurological processes and executive functioning challenges which may contribute to addictions risk, such as impulsivity, dopamine “deficiency” (an inaccurate term), and genetics.

Although in the end, I personally would not recommend Dr. Maté’s new book, I did highlight a strength of his, which is his ability to look at the bigger picture when it comes to understanding and treating addictions and illnesses.

So I will write the section I felt was missing from his book here.

Prevalence

Largely due to an inaccurate stereotype of Autistics being “innocent” and unlikely to engage in risky sex, drug use, or alcohol use, there is inadequate research on the prevalence rates of substance use disorders (SUD) in Autistics.

One study suggests as many as 36% of Autistics may have a co-occurring issue with substance abuse, compared to a global estimate of just over 2%. In those with ADHD, the lifetime prevalence of addictions is estimated to be 12% for alcohol use disorders and 28% for drug use disorders.

Even countries with the highest rates of SUD have an estimated prevalence of between 5–6%, those being in Eastern Europe (Russia, Kazakhstan, Mongolia) and North America (USA and Canada).

Autistics may use alcohol or other drugs to mask social anxiety or to self-medicate against underlying psychological distress.

ADHDers are also more likely to self-medicate, either as a form of sensation-seeking due to reduced dopamine availability in the brain or in attempts to numb emotional pain.

Masking & self-medicating

Masking is attempting to suppress or hide traits which make us seem different. It’s also sometimes referred to as camouflaging, as we try to “blend in” with the neurotypical majority.

Masking can happen unconsciously, as we are gradually conditioned to follow certain social expectations in order to avoid criticism and rejection. It can also be a conscious decision, especially as we become more self-aware, when we mask as an act of self-preservation.

While masking is something we do to avoid negative social consequences, masking itself also has significant risks, especially when done over the long-term. Potential harms of masking include increased anxiety, fatigue, burnout, depression, isolation, feeling disconnected from oneself, and suicidal ideation.

Research has shown the primary reasons Autistics drink alcohol are to quell social anxiety and sensory processing challenges.

Autistics are also at higher risk for co-occurring anxiety, depression, bipolar and mood disorders, schizophrenia, suicidal behavior disorders, and ADHD.

No wonder we are more likely to self-medicate with mood-altering substances.

Social factors

Being different leads us to be treated differently, usually poorly, in comparison to our neurotypical (NT) peers.

Factors such as social rejection and isolation, abuse and mistreatment, lack of accommodation and support, and lack of understanding from others contribute to a lower quality of life (QOL) for many Autistics.

Recent research has cited social support and social connection as being the most important factors influencing QOL for Autistic adults.

A little experiment

Here’s a little unscientific experiment to see what types of messages Autistics receive about how others perceive us and messages allistics (non-Autistics) find online about what it means to be Autistic.

Open up your favourite search engine and type in any of the following search terms: Autism research, Autism red flags, Autism risks, Autism causes, Autism treatment, or (the worst one) Autism cures. See what comes up.

Now imagine you typed in something related to yourself or your child and all that came up were bad-news messages about how horrible life is with their disorder, how you must spend countless dollars and hours trying to “fix” them, and how you should be willing to try just about anything to prevent your baby from having this terrifying condition.

Explore the social media accounts of Autistic adults who have a lot of followers and check out the comments (I know, usually a bad idea). See what kind of abusive, ableist bullshit we put up with on a daily basis.

Worst of all (in my opinion), go into a “special ed” classroom or the classroom of an Autistic student who has an aide. See how they are treated and imagine yourself or your child in their position: having to perform certain behaviours to earn access to things they enjoy, sometimes even things which are basic human rights (like food or playing outside), having every mistake recorded to be sent home to their parents.

We’re not asking much

These are just the tip of the iceberg when it comes to the mistreatment and misunderstandings Autistics regularly endure. Our behaviours are constantly misinterpreted and misconstrued. We are frequently ignored, spoken down to, and treated as though we are “broken” or disordered.

We enter spaces created by and for NT people without consideration for anyone else (disabled people, Autistics, those with sensory issues, etc.), then are punished when we cannot succeed in these types of environments.

We’re expected to adapt, conform, and comply without regard for our own needs. We’re expected to make 100% of the effort to understand NTs and their unspoken social norms and expectations, while most of the NT majority makes little to no effort to understand, or even listen to, Autistics.

These, more than any biological or genetic factors, are what lead Autistics to greater rates of SUD.

© Jillian Enright, Neurodiversity MB

When you join medium, as a member you’ll have access to unlimited reads for only $5 per month. If you use my referral link, I’ll earn a small commission, and you’ll earn my undying gratitude.

If you’d prefer give a one-time tip, you can support my writing on Ko-Fi — also, it’s free to follow me on Facebook!

Related Articles

References

Anker, E., Haavik, J., Heir, T. (2020). Alcohol and drug use disorders in adult attention-deficit/hyperactivity disorder: Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation. World journal of psychiatry, 10(9), 202–211. https://doi.org/10.5498/wjp.v10.i9.202

Bradley, L., Shaw, R., Baron-Cohen, S., Cassidy, S. (2021). Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood 3(4), 320–329. http://doi.org/10.1089/aut.2020.0071

Bowri, M., Hull, L., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., Mandy, W. (2021). Demographic and psychological predictors of alcohol use and misuse in autistic adults. Autism : the international journal of research and practice, 25(5), 1469–1480. https://doi.org/10.1177/1362361321992668

Brosnan, M., & Adams, S. (2020). The Expectancies and Motivations for Heavy Episodic Drinking of Alcohol in Autistic Adults. Autism in Adulthood 2(4), 317–324. https://doi.org/10.1089/aut.2020.0008

Butwicka, A., Långström, N., Larsson, Lundström, S., Serlachius, E., Almqvist, C., Frisén, L., Lichtenstein, P. (2017). Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. Journal of Autism and Developmental Disorders 47, 80–89. https://doi.org/10.1007/s10803-016-2914-2

Charlton, R. A., McQuaid, G. A., Wallace, G. L. (2023). Social support and links to quality of life among middle-aged and older autistic adults. Autism, 27(1), 92–104. https://doi.org/10.1177/13623613221081917

De Alwis, D., Agrawal, A., Reiersen, A. M., Constantino, J. N., Henders, A., Martin, N. G., & Lynskey, M. T. (2014). ADHD symptoms, autistic traits, and substance use and misuse in adult Australian twins. Journal of studies on alcohol and drugs, 75(2), 211–221. https://doi.org/10.15288/jsad.2014.75.211

Haasbroek, H., & Morojele, N. A. (2022). Systematic Literature Review on the Relationship Between Autism Spectrum Disorder and Substance Use Among Adults and Adolescents. Review Journal of Autism and Developmental Disorders 9, 1–20. https://doi.org/10.1007/s40489-021-00242-1

Hollocks, M., Lerh, J., Magiati, I., Meiser-Stedman, R., Brugha, T. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4), 559–572. https://doi.org/10.1017/S0033291718002283

Hossain, M., Khan, N., Sultana, A., Ma, P., McKyer, P.L.J., Ahmed, H.U., Purohit, N. (2020). Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Research 287, 112922. https://doi.org/10.1016/j.psychres.2020.112922

Huang, J., Yang, F., Chien, W. (2021). Risk of Substance Use Disorder and Its Associations With Comorbidities and Psychotropic Agents in Patients With Autism. JAMA Pediatrics, 175(2), e205371. https://doi.org/10.1001/jamapediatrics.2020.5371

Hull, L., Levy, L., Lai, M.C., Petrides, K.V., Baron-Cohen, S., Allison, C., Smith, P., Mandy, W. (2021). Is social camouflaging associated with anxiety and depression in autistic adults?. Molecular Autism 12, 13. https://doi.org/10.1186/s13229-021-00421-1

Mason, D., McConachie, H., Garland, D., Petrou, A., Rodgers, J., Parr, J. R. (2018). Predictors of quality of life for autistic adults. Autism research : official journal of the International Society for Autism Research, 11(8), 1138–1147. https://doi.org/10.1002/aur.1965

McKowen, J., Woodward, D., Yule, A.M., DiSalvo, M., Rao V., Greenbaum, J., Joshi, G., Wilens, T. E. (2022). Characterizing autistic traits in treatment-seeking young adults with substance use disorders. Americal Journal on Addictions 31, 108- 114. https://doi.org/10.1111/ajad.13247

Miller, D., Rees, J., Pearson, A. (2021). “Masking Is Life”: Experiences of Masking in Autistic and Nonautistic Adults. Autism in Adulthood, 3(4), 330–338. http://doi.org/10.1089/aut.2020.0083

Pehlivanidis, A., Papanikolaou, K., Mantas, V., Mantas, V., Kalantzi, E., Korobili, K., Xenaki, L.A., Vassiliou, G., Papageorgiou, C. (2020). Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC Psychiatry 20, 423. https://doi.org/10.1186/s12888-020-02828-1

Ressel, M., Thompson, B., Poulin, M.-H., Normand, C. L., Fisher, M. H., Couture, G., Iarocci, G. (2020). Systematic review of risk and protective factors associated with substance use and abuse in individuals with autism spectrum disorders. Autism, 24(4), 899–918. https://doi.org/10.1177/1362361320910963

Rothman, E. F., Graham Holmes, L., Brooks, D., Krauss, S., & Caplan, R. (2023). Reasons for alcohol use and non-use by underage U.S. autistic youth: A qualitative study. Autism, 27(1), 213–225. https://doi.org/10.1177/13623613221091319

Wang, G-J., Volkow, N.D., Wigal, T., Kollins, S.H., Newcorn, J.H., Telang F… Swanson, J.M., et al. (2013). Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder. PLoS ONE 8(5): e63023. https://doi.org/10.1371/journal.pone.0063023

Wilens, T.E., Adamson, J., Sgambati, S., Whitley, J., Santry, A., Monuteaux, M.C., Biederman, J. (2007). Do Individuals with ADHD Self-Medicate with Cigarettes and Substances of Abuse? Results from a Controlled Family Study of ADHD. The American Journal on Addictions, 16, 14–23. https://doi.org/10.1080/10550490601082742