Autism and Alcohol Use

How are Autism and Alcohol Connected?

Autism and alcohol misuse may seem unrelated. However, some people with autism drink in excess, though not as many as others. 

Those with autism who do drink have a high risk of developing an alcohol use disorder (addiction). 

What is Autism?

Autism refers to several developmental disorders that affect 1 in 54 children. 

Autism is four times more common in boys than girls. It affects all racial, ethnic, and socioeconomic groups.¹ 

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

Some 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 

Autism shares similar qualities with attention deficit hyperactivity disorder (ADHD). However, ADHD is a different condition that’s not a 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. 

They share common autistic traits like:³

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

Despite the shared traits, it is difficult to diagnose ASD. There is no medical test. Instead, doctors observe a child’s behavior and development. 

Doctors can detect ASD as early as 18 months of age. However, many diagnoses are made at a later age, which can lead to delayed intervention.²

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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} 

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 that there is a connection:

• In a Swedish study, the risk of substance use was high among people with ASD. Substance use includes not only alcohol but also illegal drugs, pain medications, and other harmful substances.⁵
• Young people with ASD usually don’t take part in social or binge drinking. If they do, there is a high chance that they will repeat the behavior. This puts them at a greater risk of developing alcohol addiction. People with more autistic traits also have a higher tendency to use alcohol, nicotine, and cannabis.^{6, 7}
• The rate of substance use disorder 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 alcohol behavior. Others who are socially withdrawn are less prone to alcohol use.⁸

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. Some drink alcohol to bond with other people, build social networks, or reduce awkwardness. Adults with high-functioning autism even blend in well while drinking. 

Here’s the danger: people with ASD typically repeat the same things. Drinking can become a routine. Eventually, they become alcohol-dependent. This makes the diagnosis and treatment of alcohol addiction more diffiicut.^{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 or not. 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 they are 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 alcohol and substance use disorder. 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 both ASD and alcohol addiction. It involves educating the person about alcohol addiction and the factors that keep them addicted. 

CBT also deal 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. 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. 
• The therapy should be stable and predictable: A person with ASD thrives on predictability. It is important to maintain routines, activities, the schedule of sessions, and even the same therapist. 
• Increase the length of sessions: The duration of therapy should also be extended.
• The therapy should be structured, thorough, and detailed: It’s better if there are written plans, notes, and assignments.
• Use more visuals: For example, drawings or cartoons can help the patient visualize concepts. 
• Spend more time on emotional education and stress management: To ensure they receive comprehensive care. 
• Involve parents and caregivers: This is to ensure they are comfortable during the treatment sessions. 
• Choose therapists who have previously worked with ASD patients: They should be persevering and patient. They should also offer support and 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.

Not all behavioral treatments work for everyone. Some approaches can even create anxiety and fear in people with ASD.

For example, people with ASD tend to drop out of 12-step programs and large self-help groups. They also don’t do well in a residential setting where they are out of their comfort zone.¹³ 

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Resources for People With Autism

You can find helpful information about autism spectrum disorder from the following websites and organizations: 

• Centers for Disease Control and Prevention (CDC): U.S.A.’s public health agency. CDC has a dedicated page for autism spectrum disorder containing basic information about treatment and intervention services. 
• National Autistic Society: A British organization for people with ASD and their families. It provides advice and guidance, adult residential services, employment programs, and professional development.
• Autism Society: A national charitable organization based in the U.S. It 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 individuals with Asperger syndrome and related autism spectrum disorders. 
• National Professional Development Center on Autism Spectrum Disorder (NPDC): A U.S.A.-funded program that promotes evidence-based practices for children and youth with ASD. 
• Organization for Autism Research (OAR): An organization founded and led by parents and grandparents of children with ASD. The site hosts guides and other resources for advocates and families. OAR also provides employment support and scholarships for people with ASD.