Autism and Alcohol Use

How are Autism and Alcohol Connected?

Autism and alcohol misuse may seem unrelated. Drinking is typically a social activity, and because of this, very few people with autism engage in social or binge drinking.

However, if they start drinking, it can easily become a habit, leading to frequent drinking. Some people with autism drink excessively, though not as much as others. 

Those with autism have a high risk of developing an alcohol use disorder (AUD). They may also have a higher tendency to use nicotine and cannabis.^6,7

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What is Autism?

Autism refers to several developmental disorders that affect 1 in 54 children. It is four times more common in boys than girls. Autism affects all racial, ethnic, and socioeconomic groups.¹ 

The disorder is clinically called autism spectrum disorder (ASD), which means symptoms vary from one person to another. The severity of symptoms differs depending on where someone falls on the autism spectrum. 

Conditions that used to be separately diagnosed are now a part of the autism spectrum. These include: 

• Autistic disorder
• Pervasive developmental disorder not otherwise specified (PDD-NOS)
• Asperger syndrome (AS)² 

Why is ASD Difficult to Diagnose?

It’s difficult to diagnose ASD because there is no medical test; instead, doctors observe a child’s behavior and development. ASD can be detected as early as 18 months of age, but many diagnoses are made at a later age. This can lead to delayed intervention.²

Autism also shares similar qualities with attention deficit hyperactivity disorder (ADHD). However, ADHD is a different condition not part of the autism spectrum. 

People with ASD have the same appearance as people without ASD. Their learning, thinking, and problem-solving abilities may range from gifted to severely challenged. People with ADHD may share common autistic traits like:³

• Difficulty in social interactions   
• Difficulty in verbal and non-verbal communications 
• Repetitive behaviors 

Does Alcohol Use Cause Autism?

Drinking during pregnancy does not cause ASD. However, drinking can cause fetal alcohol syndrome (FAS). 

ASD and FAS share symptoms. This is why ASD is usually mistaken to be caused by alcohol use.^{3, 4} 

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Does Autism Put You at a Higher Risk for Alcohol Misuse?

Doctors previously thought that autism and alcohol use were unrelated. However, several studies have determined there is a connection. One Swedish study found the risk of substance use was high among people with ASD.

These substances included:⁵

• Alcohol
• Illicit drugs
• Pain medication
• Other harmful substances

The rate of substance use disorder (SUD) in people with ASD ranges from 0.7% to 36%. It’s a wide range, which is why there are different levels of the autism spectrum.

For example, some people with ASD are good at hiding their alcoholic behavior. Others who are socially withdrawn are less prone to alcohol use.⁸

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5 Dangers of Drinking Alcohol With Autism

Drinking affects people with ASD in different ways. Some effects may appear to be good at first. But a deeper look reveals the dangers of autism and alcohol use. 

Here are five risks of drinking alcohol with autism:

1. Increased Risk of Alcohol Dependence

People with autism typically have poor social skills. However, adults with high-functioning autism may blend in well while drinking. 

This is because alcohol may help them:

• Bond or engage with people
• Build social networks
• Reduce awkwardness

This can be dangerous because people with ASD typically repeat the same things. Drinking can become a routine, which can eventually lead to alcohol dependence. This makes the diagnosis and treatment of alcohol addiction more difficult.^9,10 

2. Negative Impact on ASD Symptoms

Some people with ASD have anxiety and sensory problems. Alcohol can calm their nerves and help them be less affected by sensory stressors.¹¹

While drinking alcohol can lessen the impact of ASD symptoms, it does not eliminate the problem. It only masks the symptoms, making it harder to diagnose and manage ASD. 

3. Increased Risk of Self-Medication

People with ASD have a high tendency to use both alcohol and drugs to self-treat mental health symptoms.¹² This is dangerous as self-medication increases overdose risks.

4. Health Complications

Alcohol can lead to various health risks, regardless of whether the drinker has ASD. These conditions include:

• Alcohol poisoning
• Violent and risky sexual behaviors
• Injuries like falls and motor vehicle accidents
• Violence
• Mental health problems like depression, anxiety, and sleeplessness    
• High blood pressure, heart disease, and stroke
• Liver diseases
• Digestive problems
• Cancer
• Alcohol addiction

5. Unpleasant Withdrawal Symptoms

A person with ASD may suddenly stop drinking if told to stop. They may experience painful and sometimes life-threatening withdrawal symptoms, including:

• Headache
• Nausea
• Vomiting
• Anxiety
• Tremors
• Sleeplessness
• Hallucinations
• Heavy sweating
• Seizures
• Delirium tremens (DTs)

Treatment for Autism and Alcohol Addiction

Alcohol addiction and ASD have no cure. However, some approaches are available to help manage both alcohol problems and ASD symptoms.

Medications

If someone with ASD has symptoms that cause anxiety or depression, they may use antidepressants. Sometimes, medications are also prescribed to avoid further dependence.

People taking medications for ASD symptoms have a reduced risk of developing SUDs. Those who received one medicine had a 40% reduced risk. Those taking multiple medications had a 63% reduction.¹⁰

Behavioral Treatments

Cognitive behavioral therapy (CBT) is a core treatment for ASD and alcohol addiction. It involves educating the person about alcohol addiction and the factors that keep them addicted. CBT also helps with anxiety, which may be the cause of the person’s need for alcohol.¹¹ 

However, people with and without ASD respond differently to behavioral treatments and may negatively react to treatment.¹³ Therapists should adjust their methods to accommodate the unique needs of a person with ASD. 

Here are some treatment recommendations:⁸

• Individualize the therapy: It must meet their communication skills and comprehension challenges
• Use stable and predictable therapy: A person with ASD thrives on predictability, so it’s important to maintain routines, activities, the schedule of sessions, and the same therapist
• Increase session lengths: Extend therapy session duration
• Structure therapy with thorough details: It’s better to have written plans, notes, and assignments
• Use more visuals: For example, drawings or cartoons can help the person visualize concepts
• Ensure comprehensive care: Spend more time on emotional education and stress management
• Involve parents and caregivers: This ensures they are comfortable during the treatment sessions
• Choose therapists who have previously worked with people with ASD: They should be patient, supportive, and offer follow-up sessions even after the therapy ends
• Provide additional help: Most people with ASD need help in several areas, including housing, employment, social contacts, and leisure activities

Resources for People With Autism

You can find helpful information about ASD from the following websites and organizations: 

• Centers for Disease Control and Prevention (CDC): A U.S public health agency with a dedicated page for ASD, basic treatment information, and intervention services
• National Autistic Society: A British organization for people with ASD and their families that provides advice, adult residential services, employment programs, and professional development
• Autism Society: A national charitable organization based in the U.S. that provides phone support and hosts a free online database with information about autism-related programs and services
• The Asperger/Autism Network (AANE): An organization that provides information, practical guidance, and support for people with AS and related ASDs
• National Professional Development Center on Autism Spectrum Disorder (NPDC): A U.S.-funded program that promotes evidence-based practices for children and youth with ASD
• Organization for Autism Research (OAR): An organization that provides guides, resources, employment support, and scholarships for people with ASD