Autism and addiction: Understanding the risks and getting the right support
For a long time, researchers assumed autistic people were unlikely to develop problems with alcohol or drugs. More recent research paints a different picture. Autistic people as a group may drink and use drugs less often than others. Those who do use substances, however, face particular risks, and some studies have found substance use problems in up to 36% of autistic participants.
Many autistic adults describe using alcohol or drugs to cope with anxiety or overwhelming situations, rather than for pleasure. Knowing why someone uses shapes how families and clinicians can best respond.
This article covers what research says about autism and substance use, and why some autistic people develop addiction. The article also explains how to recognise a problem and how treatment can adapt to autistic needs. The information is for autistic adults and for families looking for help.
A note on language: Many autistic people prefer identity-first language (“autistic person”) to person-first language (“person with autism”). This article mostly uses identity-first language, while recognising that preferences vary.
What the research shows about autism and substance use
Research on autism and addiction is still developing, and studies don’t all point the same way. Overall, the evidence shows that addiction does affect autistic people, and that some groups face a raised risk.
- Overall substance use may be lower. A UK study of more than 2,000 adults was published in The Lancet Psychiatry. Autistic participants were less likely than others to drink regularly or binge drink. Autistic men were also less likely to have ever used drugs.
- Substance use problems are still common. Across 26 studies, a systematic review found rates of substance use problems among autistic people of 1.3% to 36%. The wide range reflects differences in study design rather than a single true figure.
- Some groups face higher risk. In a Swedish study of almost 27,000 autistic people, autism alone doubled the risk of substance use problems. “Alone” here means without ADHD or intellectual disability. The risk was highest among autistic people who also had ADHD.
The Swedish study also found raised risks among the parents and siblings of autistic people. That finding suggests shared genetic or family factors play a part.
Why some autistic people develop addiction
Autistic people who develop substance use problems often have different reasons for using than their non-autistic peers.
Using substances to cope
The Lancet Psychiatry study asked participants why they used drugs. Among those who gave a reason, autistic participants were:
- Nearly nine times more likely to say they used substances to manage their behaviour
- Three times more likely to say they used them to manage mental health symptoms
For some autistic people, alcohol or drugs may dull the intensity of social situations or anxiety. That kind of use can feel functional at first, but it can turn into dependence over time.
Co-occurring mental health conditions
Co-occurring mental health conditions raise the risk further. The systematic review named co-occurring mental health issues and a family history of substance abuse among the main risk factors. Our articles on ADHD and addiction and anxiety and addiction cover those links in more detail. Vulnerability and social isolation
Autistic participants in the Lancet Psychiatry study were also more likely to report vulnerability linked to substance use. Examples included using drugs in childhood and being forced or tricked into taking drugs. The systematic review identified limited social support as another risk factor. Isolation can make substances more appealing, and fewer people are around to notice when use becomes a problem.
Signs of a substance use problem in an autistic person
The signs of a substance problem in an autistic person can resemble those in anyone else. Some, however, may be easy to miss or mistake for autistic traits. Families and clinicians can look out for:
- Drinking or using drugs before or after social situations, work, or other demanding events
- Relying on a substance to sleep or to calm down after becoming overwhelmed
- Pulling away from routines or interests the person used to value
- Changes in mood, sleep, or eating beyond the person’s usual patterns
- Needing more of a substance over time, or feeling unwell without it
Autistic people may communicate distress differently. A change in established routines can therefore be one of the clearest signs that something is wrong.
How addiction treatment can adapt to autistic needs
Most addiction treatment was designed with non-autistic people in mind, and research on adapted approaches is limited. The systematic review found only one exploratory study of an addiction intervention adapted for autistic people. Even so, clinicians can make practical adjustments that improve access to care.
Some aspects of standard rehab may be challenging for autistic people:
- Group therapy and shared living spaces
- Unfamiliar routines
- Noisy or brightly lit environments
At the same time, the clear daily structure of an inpatient programme may suit people who find unpredictability stressful.
When considering a treatment centre, autistic adults and their families can ask:
- Can the centre provide a written daily schedule in advance?
- Is there a calm space away from the group when activities become overwhelming?
- Can therapists adjust their communication style, for example by being more direct and literal?
- How does the centre handle sensory needs, such as noise and lighting?
- Will the psychiatric team assess and treat any co-occurring anxiety, depression, or ADHD?
Treatment at Houghton House
Houghton House is licensed as both a rehabilitation centre and a private psychiatric hospital. An in-house psychiatrist assesses every patient on admission. Our multidisciplinary team tailors treatment to each patient’s needs and includes:
- Psychiatrists and psychologists
- Occupational therapists
- Addiction counsellors
Where needed, treatment begins with three days in our medical detox unit. Patients then move into our rehab programme, which follows a full daily schedule. The programme runs for 30 days, extendable to 42 when clinically necessary. Treatment includes cognitive behavioural therapy (CBT), dialectical behaviour therapy (DBT), mindfulness, and counselling.
If you or your loved one is autistic, let our admissions team know during the first conversation. The team can discuss specific needs, and how the programme can accommodate them, before admission.
After discharge, our aftercare programme provides continued therapy and peer support. Aftercare helps people maintain the routines and coping skills they built during treatment.
How families can help
Families of autistic adults with substance use problems often feel caught between respecting independence and stepping in. A few approaches can help:
- Ask, without judgement, about the reasons behind the substance use
- Communicate clearly and directly about your concerns
- Help find treatment providers willing to adapt to autistic needs
- Get support for yourself as well
Our family support programme runs weekly meetings for anyone affected by a loved one’s addiction, whether or not that person is in treatment.
Medical aid cover for addiction treatment
Substance use disorders are prescribed minimum benefits (PMBs) in South Africa. All registered medical aids must therefore cover addiction treatment. Houghton House is also a licensed psychiatric hospital. Patients can claim for additional mental health services where a co-occurring condition qualifies under psychiatric PMBs.
Our admissions team checks your benefits and handles pre-authorisation for you. Visit our medical aid cover page, or contact our admissions team to find out what your scheme covers.
Frequently asked questions about autism and addiction
Are autistic people more likely to become addicted?
The research is mixed. Autistic people as a group may be less likely to drink regularly or use drugs. Those who do use substances, however, can face a raised risk of problems. A large Swedish study linked autism to double the risk of substance use problems, with the highest risk among people who also had ADHD.
Why do autistic people use drugs or alcohol?
Many autistic people who use substances do so to cope rather than for enjoyment. In one large study, autistic participants were much more likely than others to report using substances to manage their behaviour or mental health.
Can autistic people go to rehab?
Yes. Autistic people can benefit from addiction treatment, especially when the treatment centre is willing to adapt its approach. Discuss specific needs with the centre before admission.
Where can I get help for autism and addiction in South Africa?
Houghton House in Johannesburg treats addiction alongside co-occurring mental health conditions. Call our admissions team on +27 11 787 9142 for a free, no-obligation telephonic evaluation, or contact us online.
Sources
- Butwicka, A., Långström, N., Larsson, H., 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(1), 80–89. https://doi.org/10.1007/s10803-016-2914-2
- 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
- Weir, E., Allison, C., & Baron-Cohen, S. (2021). Understanding the substance use of autistic adolescents and adults: A mixed-methods approach. The Lancet Psychiatry, 8(8), 673–685. https://doi.org/10.1016/S2215-0366(21)00160-7
