Autism is a mental condition that is a broad-spectrum disorder. It is mainly characterized by difficulty communicating, forming relationships and articulating abstract ideas. Autism may also be accompanied by sensory processing issues, such as discomfort in loud, busy places or wearing certain types of fabrics. These sensory issues may also be extended to touch by others and the types of foods one can tolerate eating. It is often referred to as Autism Spectrum Disorder (ASD). In the past, an autism diagnosis was often saved for those on the low-functioning end of the spectrum. These people may be nonverbal among other symptoms. It was thought that those with a diagnosis of autism were not susceptible to alcohol or drug addiction due to their disorder. That was due to their rigid routine structure and isolation from their typically developing peers. Since there has been a rise in high-functioning autism diagnoses, there are some changes to this perception. People with high-functioning autism can have a typical or high IQ. They can communicate, although perhaps with some difficulty in terms of social behavioral norms. They can also live independently and may have peers that are typically functioning. This means access to drugs and alcohol. According to an article in The Atlantic, “For much of the 20th century, most of those who received an autism diagnosis were on the severe end of the spectrum. In this largely nonverbal population, addiction seemed unlikely. But in 1994, when the ‘Diagnostic and Statistical Manual of Mental Disorders’ added Asperger syndrome as a category, the spectrum extended to people who had much more opportunity to access alcohol and other drugs. Still, for years, the assumption remained that addiction was one concern the autism community could safely ignore.”
Studies Point to a Link Between Addiction and Autism
A study out of Sweden shows an increased risk in substance abuse issues in those with autism spectrum disorders. “Yet, substance use-related problems have been observed among 19–30 % patients with ASD, at least in clinical settings. It has been suggested that the high rates of substance use-related problems may be attributed to comorbidity between ASD and attention deficit hyperactivity disorder (ADHD). Indeed, both ADHD and intellectual disability frequently co-occur with ASD and are linked to substance use-related problems. Since psychiatric disorder comorbidity is more likely to be noted in highly selected clinical populations, the setting might considerably influence rates of concurrent, documented substance use-related problems.” Some of this connection does have to do with co-occurring disorders as well as genetics. The study concluded, “In summary, this large population-based study suggests that individuals with ASD have higher risk of substance use-related problems than population controls; most likely because of a shared familial liability for these conditions. An important implication of our findings concerns diagnostics and treatment strategies in ASD. Increased risk of substance-related problems in ASD suggests attention and preventive measures regarding substance use disorder in this population. Since ASD frequently co-occurs with ADHD and intellectual disability and the trajectories of ASD into substance abuse may differ depending on concomitant conditions, the present results also highlight the need for comprehensive psychiatric examinations upon deciding on treatment strategies for substance use disorder.” One study from 2013 states, “Subjects with Asperger syndrome did score higher on introversive, inhibited, doleful, and borderline tendency prototypes than healthy controls, and scored lower on all sensation-seeking traits. Being male, a diagnosis of Asperger syndrome, and unruly, introversive, and sensation-seeking traits were all independently associated with the risk of drug abuse.” It looks like autism may be added to what is considered a common co-occurring disorder with substance abuse.”
What Are the Symptoms of High Functioning Autism or Asperger’s
High functioning autism can be hard to diagnose. This is one reason substance abuse in this population can be difficult to treat. Here are some common symptoms of high functioning autism:
- Easily becomes overwhelmed with excessive verbal direction.
- Calmed by external stimulation (e.g., soothing sounds or fidgeting).
- Difficulty with loud or sudden sounds.
- Emotions can pass very suddenly or are drawn out for an extended period.
- Intolerance to certain food textures, colors or the way they are presented on the plate (e.g., one food can’t touch another).
- May need to be left alone to release tension and frustration.
- Resists change in the environment (e.g., people, places, objects).
- Sensitivity or lack of sensitivity to sounds, textures, tastes, smells or light.
- Unusually high or low pain tolerance.
- Aversion to answering questions about themselves.
- Difficulty maintaining friendships.
- Trouble reading facial expressions and body language, understanding group interactions, and understanding the rules of conversation.
- Tough time understanding jokes, figures of speech or sarcasm.
- Difficulty sharing observations or experiences with others.
- Makes spontaneous comments which seem to have no connection to the current conversation.
- Makes honest, but inappropriate observations.
- Minimal acknowledgement of others.
- Overly trusting or unable to read people’s motivations.
- Prefers to be alone, aloof or overly-friendly.
- Resistance to being touched.
- Responds to social interactions, but may not initiate them.
- Seems unable to understand other people’s feelings.
- Talks excessively about one or two topics.
- Tends to get too close when speaking to someone (i.e., lack of personal space).
- Unaware of/disinterested in what is going on around them.
- Difficulty making eye contact.
For adults who missed diagnosis as children, the National Autistic Society states “The characteristics of autism vary from one person to another, but in order for a diagnosis to be made, a person will usually be assessed as having had persistent difficulties with social communication and social interaction and restricted and repetitive patterns of behaviors, activities or interests (this includes sensory behavior), since early childhood, to the extent that these ‘limit and impair everyday functioning’.”
Co-occurring Disorders and the Connection to Substance Abuse
According to the National Alliance for Mental Illness (NAMI), “About a third of all people experiencing mental illnesses and about half of people living with severe mental illnesses also experience substance abuse. These statistics are mirrored in the substance abuse community, where about a third alcohol abusers and more than half of all drug abusers report experiencing a mental illness. Men are more likely to develop a co-occurring disorder than women.” The risk is even higher if the individual is from a lower socioeconomic status, is a military veteran, or is someone with another general medical illness. Mental illness and addiction co-existing does not mean that one necessarily causes the other. The causality is unclear for many reasons. First, drug addiction can cause you to experience one or many symptoms of a mental illness. Second, mental illness can trigger drug abuse as a way of self-medicating. Third, other factors such as genetics and a history of trauma can cause a dual diagnosis. Common co-occurring disorders include:
- Anxiety
- ADHD
- Bipolar disorder
- Depression
- Eating disorders
- Obsessive compulsive disorder
- Post-traumatic stress disorder
- Trauma
The Need to Self-medicate is Common in Co-occurring Disorders
According to Autism Speaks, “Compared with classic autism, children with Asperger Syndrome/high functioning autism (HFA) have IQs that fall in the normal or even superior range. To many, they may seem just like other children but not quite: children with AS are socially awkward in a manner that’s not easily understood. This explains why healthcare providers may miss seeing Asperger Syndrome/HFA symptoms in their young patients, or may misdiagnose it completely. The late onset of complex social skills, such as peer interaction, also explains why some parents don’t seek help until much later compared to those whose kids display a more profound or more obvious set of symptoms from a very young age.” To fit in with their peers, they may feel tempted to use substances to hide their social anxiety or fear. Under the guise or “high” of a drug, their autism symptoms may go unnoticed by friends and schoolmates.
The Challenge of Treating Co-occurring Disorders
Addiction removes the structure someone with autism often needs. Drinking or using drugs may relieve anxiety or sensory overload in the short term, but if the cycle of addiction begins, it’s difficult to overcome. There are many options for those with dual diagnoses to overcome their substance abuse: Cognitive Behavioral Therapy (CBT) – CBT focuses on decreasing dysfunctional actions and thoughts. This is an effective approach for those with disorders such as depression and anxiety. The goal is to break the cycle of negative thoughts while transforming them into positive thoughts. It also tries to find effective stress coping mechanisms other than substance abuse. CBT is works to address immediate problems in the short term. CBT can be done while in detox or in addition to many other types of therapy. Group Therapy – Group therapy can be specifically targeted for people who suffer from a variety of dual diagnosis. Members are educated on their types of diagnosis. Groups are encouraged to work and think together to motivate and provide support. Everyone in the group benefits from the relationships they develop as well as the sense of self-worth and optimism that comes from working through a common challenge with others. Medications – Although abusing substances is not safe, treating a dual diagnosis with physician-prescribed medications can be. For mood disorders, these are can be medications such as antidepressants, anxiolytics and antipsychotics. Other prescribed drugs for co-occurring disorders are selective serotonin reuptake inhibitors (SSRIs). These are drugs such as Prozac, Celexa and Zoloft that can regulate chemical imbalances by increasing the hormone serotonin in the brain. They are used to treat mood disorders because of their mild side effects compared to other medications. Individual Psychotherapy – Psychotherapy is also known as individual therapy or counseling. This is when a therapist and patient work together to make changes to improve their quality of life. This is a safe place for doctor and patient to discuss private matters and impediments during the recovery process. Topics are not limited to addiction or the dual diagnosis – the therapist will also work with patients on things like self-esteem, empathy and happiness so that the overall well-being of the patient is addressed. A good therapist will help someone with autism to create specific goals for your recovery, overall health and co-occurring condition. Treatment that addresses those with high functioning autism does exist, and it is often treated very similarly to anyone with a dual diagnosis. The important thing to note is that recovery from substance abuse for those with an autism diagnoses are available.