3 February 2022

Substance abuse linked to autism traits

Addiction Clinical Neurology

One in five young people with substance use disorder had clinically elevated and undiagnosed autistic traits.


One in five young people seeking treatment for a substance use disorder has undiagnosed autistic traits, a study published in the American Journal of Addictions suggests. 

The US study involved almost 70 young adults (average age 18.7 years) who were attending a Boston outpatient clinic for substance use disorder for the first time.  

Researchers asked the patients’ parents to complete a questionnaire about the presence of various behaviour traits that have been linked with autism spectrum disorder (ASD). The questionnaire measured an individual’s social awareness, social cognition, social communication, social motivation, and restricted interests and repetitive behaviours. 

Researchers found 20% had elevated scores on the social responsiveness scale, which not only shows the presence of ASD symptoms but can also reliably identify the severity of social impairment among individuals along the autism spectrum and can distinguish autism from other disorders. 

The researchers found that adolescents with higher scores on the social responsiveness scale had a nearly eightfold higher likelihood of stimulant use disorder, and a fivefold higher risk for opioid use disorder.

The authors claim this study shows the high prevalence and significant morbidity of ASD symptoms in a young population with substance use disorder, and highlights the need for more research. 

Lead author Dr James McKowen, of the Addiction Recovery Management Service at Massachusetts General Hospital said the results highlighted the importance of assessing patients in a substance use disorder treatment setting for autistic traits. 

“For clinicians, the big takeaway point from this study is that we need to get better at screening and certainly training in the presence of autism spectrum disorder, because many clinicians treat substance use disorder but don’t have specialty developmental training, particularly for issues around autism,” he said. 

Professor Adam Guastella, at the University of Sydney’s Brain and Mind Centre and the Children’s Hospital Westmead Clinical School, said that while young adults on the spectrum generally showed lower rates of alcohol misuse, they were more likely to misuse drugs. 

“There is a smaller group who transition into using drugs as a coping mechanism,” he told TMR. “There’s no doubt autistic young adults need more supports.” 

While the study could not conclude that the participants definitely had undiagnosed ASD, it highlighted the need for more research, more awareness and more support for young adults on the spectrum, said Professor Guastella. 

He said the pathways and supports were focussed on children and early intervention, but the “adult services are just nowhere near the same”, describing it as a “services cliff” for high school students transitioning to adulthood. 

Instead, there was an urgent need for a national strategy across the spectrum of neurodevelopmental disorders, including ASD and ADHD, that included “serious investment” into research and hubs that provide good clinical advice and pathways to continue supporting young people into adulthood, he added. 

“When you provide the right support you can get extraordinary outcomes,” he said. 

“The travesty here is that people have enormous potential, but the supports just aren’t there.” 

The American Journal on Addictions, online December 2021