By Patty Laushman
Addiction exists in many forms, from substance-related addictions like drug and alcohol addiction to behavioral addictions like eating, shopping, gambling, video games, and porn.
Although having autism doesn’t mean you automatically develop an addiction, research has shown that factors like social and communication differences, sensory sensitivities, and coexisting mental health conditions can make autistic individuals more vulnerable to developing one compared to the more neurotypical population. It's one more way in which they are more vulnerable living in a world that was not designed with their needs in mind.
Addiction is a complex issue, and the issue is even more complex for autistic individuals when their unique needs are not understood and accommodated. Understanding the intersection between autism and addiction is important to creating the foundation for effective treatment strategies sensitive to the needs of each autistic individual.
In this blog post, we will explore the link between autism and addiction, ways addiction treatment should be tailored to the individual based on their profile, and list interventions that can be part of the solution.
The Link Between Autism and Addiction
As previously stated, being autistic does not automatically mean an individual will develop an addiction, but trying to thrive in environments that were not designed with an individual's needs in mind can be downright traumatic and increase their vulnerability.
Understanding the link between autism and addiction is essential to developing maximally effective prevention and treatment strategies. Below are a list of factors that can increase an individual's susceptibility to developing an addiction.
Social Challenges
An autistic individual’s social and communication differences can lead them to extreme loneliness if they feel like they don't fit in anywhere and they can't figure out how to connect with other people deeply. This may drive an autistic individual to use substances as a form of self-medication or as a way to fit in with peers or numb their distress.
Sensory Sensitivities
Autistic individuals often grapple with heightened sensory sensitivities. These can lead to them using substances as a coping mechanism to manage overwhelming sensory input.
Coexisting Mental Health Issues
Many autistic individuals also live with co-occurring mental health disorders, such as anxiety, depression, or ADHD. The presence of these additional mental health conditions can exacerbate the risk of addiction as individuals may turn to substances to alleviate their psychological distress.
Lack of Coping Strategies
Because the world was not created with their needs in mind, life may be generally tougher for autistic individuals depending on the environments in which they live and work. Some autistic individuals may lack the level of adaptive coping strategies needed, which increases the likelihood of resorting to substance use when facing stress or emotional turmoil. Part of treatment may also involve figuring out how to reengineer their lives so their environments better fit their needs because we all deserve to live in supportive environments.
Tailoring Addiction Treatment to Autistic Individuals
The unique challenges autistic adults face can make them more prone to seek relief through substance use. And when these challenges are not directly addressed as part of their treatment plan, it can make that plan less effective.
Given the spectrum nature of autism, there is no one-size-fits-all approach to addiction treatment for autistic individuals. Treatment plans must be personalized to address the unique needs and challenges of each individual. Listed below are the components of such individualized treatment plans.
Accommodating Communication Differences
Many autistic individuals find group conversations to be intolerable for many reasons, so group therapy can be extra challenging.
Participating in conversations that involve multiple speakers can be difficult if the conversation shifts topics rapidly or includes non-literal language, such as idioms or sarcasm. Also, interpreting body language, tone of voice, and facial expressions may be challenging for them, making it hard to follow the social dynamics of group interactions. If their language processing speed is slow relative to the rest of the group, they may still be figuring out what to say while the conversation is moving on too rapidly. This can all result in cognitive overload and extreme frustration.
It is also common in group settings for addiction treatment for people to hug and otherwise touch each other in support, which may be anathema to autistic individuals with certain sensory sensitivities. Wanting to fit in, they may go along with it but experience the sensations as distressing.
Instead of participating and benefitting from the group discussion, they may spend their time simply coping with it. If this is the case, one-on-one therapy may be more effective.
In all cases, providers should use straightforward and literal language, avoiding idioms or metaphors. Visual supports, like treatment schedules, charts, or images, can also help convey information clearly.
Giving Them Space
Autistic individuals are often misunderstood by those around them who don’t understand their internal experiences. With social and communication differences, they also often struggle to make their needs known. And if they’ve been deeply masked for a long time in an effort to fit in or due to internalized ableism, they make even struggle to understand their own needs.
For all these reasons and more, having a roommate in a residential treatment setting can be counterproductive. They need to have a private space where they can have peace and calm and not deal with the triggers commonly associated with being around other people.
Incorporating Sensory-Friendly Environments and Tools
Autistic individuals should be treated in environments that minimize sensory overload, with considerations for lighting, sound, and space. For example, the fluorescent lights that often dominate treatment facilities or environmental noises can cause intense distress for individuals sensitive to them. An individual may do better if they are allowed to wear a baseball hat or other hat with a brim to blow overhead lights or wear tinted glasses inside.
They may also do better if given access to ear plugs that reduce the overall volume of sounds in the environment without reducing the fidelity so they can still hear the people around them and participate in discussions. One popular brand for this are the gentle, form-fitting Vibes. which minimize the sensation of pressure that accompanies many types of ear plugs.
Many autistic individuals are highly responsive to smells that others experience as just part of the background in a treatment setting, such as perfumes, body odors, and scents common to a medical setting. If this is a problem, wearing a surgical mask like the ones commonly worn during the pandemic can help, or in a worst-case scenario, an N-95 mask can block out most scents.
Many autistic individuals may feel more comfortable and safer with added pressure such as that from a weight lap pad or being wrapped in a soft blanket. Wherever accommodations like this can be encouraged, the individual is likely to be more present and receptive to the treatment program.
Accommodating a Need for Predictability
In order to feel safe, most autistic individuals need to have a sense that they know what's coming, so it's really important for providers to explain the routine or schedule in advance and even provide reminders about what is next. A written schedule is even better.
Involving Family and Caregivers
Family members and caregivers are a major source of support for autistic individuals going through treatment. If they are not already aware, educating the individual's support system about the unique challenges and needs of autistic individuals with addiction is critically important for creating a supportive home environment during and after substance use treatment.
Addiction Interventions
When addressing addiction in autistic individuals, employing specific interventions that consider their unique characteristics is important. These interventions should be adaptable, evidence-based, and sensitive to the individual’s sensory and communication needs.
Neurodiversity-Informed Mental Health Therapy
Mental health therapy with a neurodiversity-informed and -affirming therapist is critical to healing anxiety, depression, and other mental health conditions that often co-occur with autism and addiction. The specific modality will depend on the individual, and it may be an iterative process to identify what works. If there is trauma involved, the individual will definitely want to work with a therapist highly skilled in trauma therapy. Some types of therapies that have helped clients of Thrive Autism Coaching include CBT, DBT, ACT, EMDR, and somatic therapy.
Occupational Therapy
Occupational therapy can assist autistic individuals in developing skills necessary for daily living and independence, supporting the individual’s sense of self-determination and ultimately their recovery. Occupational therapists can also work with autistic individuals to help them cope with sensory sensitivities, which may contribute to substance abuse as a coping mechanism.
Autism Life Coaching
With a focus on setting practical goals for creating the self-determined life they want, an autism life coach like those at Thrive Autism Coaching can be an important member of an individual's recovery team. Goals are often set around relationships or improving executive functioning and daily living skills, and then the coach works with the individual to create a step-by-step plan for achieving their goals and encouraging them throughout the process.
We may work to improve social and communication skills in a way that honors their individual preferences so they can build more supportive relationships and become less isolated. We may work to help them identify ways in which the environments they operate in are not meeting their needs and figure out how to make adjustments. We may also work on strengthening or figuring out accommodations for executive functioning skills challenges that are getting in the way of their quality of life.
If you'd like to explore this option, we offer a complimentary consultation to discuss the situation and determine if coaching may be a good fit for this phase of your journey. You can schedule that call from this webpage.
Support Systems
Family, friends, and caregivers play a critical role in the recovery of autistic individuals facing addiction. These support networks provide the necessary emotional, social, and practical support that enhances the effectiveness of treatment interventions.
The support from loved ones can offer stability and reassurance, which are both helpful for individuals dealing with addiction. Family and friends should be actively involved in the treatment process. They can help providers understand their loved one's autism profile and create a supportive environment for recovery.
If Your Loved One is Refusing Treatment
If your loved one is struggling with addiction and refusing treatment, you may be interested in Community Reinforcement and Family Training (CRAFT), an evidence-based approach that friends, families, and caregivers can use to influence an individual's substance use by staying involved in an ongoing, positive way while respecting their own boundaries. It's an alternative to ultimatums that end up harming your relationship and often don't achieve the desired result. CRAFT was created by Dr. Robert Meyers and expanded upon by the psychologists at the CMC: Foundation for Change.
Conclusion
In conclusion, understanding the intersection of autism and addiction is vital for creating effective treatment strategies. Each autistic individual is unique, influenced by their social, sensory, and mental health needs. By understanding an individual's autism profile and tailoring treatment plans that accommodate and address their specific challenges, addiction treatment can be more accessible and effective.
From accommodating communication differences to creating sensory-friendly environments, every detail counts. Family involvement and other support systems are also crucial, offering reassurance and important, practical resources throughout the recovery journey. With the right strategies, it’s possible to create a path to recovery that meets the unique needs of each individual and enables them to live their best life.
References
Butwicka, Agnieszka, Niklas Långström, Henrik Larsson, Sebastian Lundström, Eva Serlachius, Catarina Almqvist, Louise Frisén, and Paul Lichtenstein. 2017. “Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study.” Journal of Autism and Developmental Disorders 47 (1): 80–89. https://doi.org/10.1007/s10803-016-2914-2.
Haasbroek, Helandri, and Neo Morojele. 2022. “A 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): 1–20. https://doi.org/10.1007/s40489-021-00242-1.
Kervin, Ryan, Chelsea Berger, Sun Jae Moon, Harrison Hill, Dongchan Park, and Jung Won Kim. 2021. “Behavioral Addiction and Autism Spectrum Disorder: A Systematic Review.” Research in Developmental Disabilities 117 (October):104033. https://doi.org/10.1016/j.ridd.2021.104033.
Lalanne, Laurence, Luisa Weiner, Benoit Trojak, Fabrice Berna, and Gilles Bertschy. 2015. “Substance-Use Disorder in High-Functioning Autism: Clinical and Neurocognitive Insights from Two Case Reports.” BMC Psychiatry 15 (1): 149. https://doi.org/10.1186/s12888-015-0541-7.