The Complex Relationship Between Autism and Substance Use Disorder

Autism Spectrum Disorder (ASD), or simply Autism, is a lifelong developmental condition that impacts how a person communicates, interacts with others, and learns. It’s characterized by challenges in social communication and interaction, as well as restricted, repetitive behaviors, interests, or activities. Autism is a spectrum condition, meaning it affects individuals differently and to varying degrees. While it’s a common assumption that people on the autism spectrum are less likely to drink or take drugs, recent research reveals a more nuanced and concerning reality – ASD may increase the risk of developing substance use disorders under certain circumstances. We must understand how autism and addiction overlap to improve diagnostic criteria and treatment approaches for this often-overlooked segment of the population. 

Challenging the Stereotype

There is an outdated perception that characteristics like risk aversion, strict rule-following and a general preference for social isolation shield people with ASD from substance abuse problems. However, these persistent stereotypes fail to account for the diversity of the autism spectrum. Recent studies have found that autistic people – especially those without intellectual disabilities – may use substances at rates comparable to or even higher than their neurotypical peers. Also, it has been our experience at R&A that teens and young adults that are on the autism spectrum can progress very quickly from experimentation to addiction once introduced to powerful, mood-altering substances. Marijuana seems to be a favorite drug of choice for young people in general including teens and young adults that are autistic. We know the marijuana of today is a very potent form of the drug with many different ways to ingest it and often young people on the spectrum can be misinformed, naïve or just unaware of the dangers of this drug and the potential for dependency. 

As autism rates increase due to increased awareness and improved diagnostic criteria, researchers have discovered that this community faces multiple unique challenges that may make them more likely to use drugs and alcohol. Variables such as a lack of emotional awareness, heightened sensory sensitivities and co-occurring mental health conditions can contribute to substance use as a coping mechanism in this population. 

Risk Factors

Several overlapping risk factors help explain why people on the autism spectrum might be vulnerable to substance use disorders (SUD’s).

1. Self-medication: Many autistic people experience co-occurring conditions such as anxiety, depression, ADHD or sensory processing issues. Drugs and alcohol could appear to be an approachable way to manage these challenges if you are a teen or young adult looking for relief from some of these symptoms. 
2. Social camouflaging: Many autistic people, especially those diagnosed later in life, have likely masked or downplayed behaviors like stimming for many years to fit in. Alcohol or drugs often become tools to reduce social anxiety or make social interactions feel more comfortable. 
3. Late diagnosis and lack of support: A delayed or missed diagnosis can lead to years of misunderstanding. People who do not receive the appropriate help or whose loved ones dismiss their struggles may use substances to manage their difficulties. It is not uncommon to find a young adult or even an older adult that has yet to be diagnosed as ASD and has suffered with feeling different during their life and has turned to substances in some form to cope with those feelings, trying to feel “normal.’ 
4. Executive functioning challenges: Impaired executive functioning, which is typical in ASD, can affect impulse control, decision-making and the ability to foresee long-term consequences, all of which are factors in the development of substance use disorders (SUD). 

Protective Factors

Conversely, some traits associated with autism can serve as protective factors against substance misuse.

• Preference for structure: Many people with ASD thrive on predictability and might avoid anything that throws their routine off track. Use of substances comes with a good amount of risk and fear of the unknown and requires a level of impulsivity that may not be alluring to someone with ASD. 
• Disinterest in social norms: A lack of concern for peer pressure or social conformity may reduce the likelihood of drinking or using drugs in response to peer pressure although a desire to fit in could still be a factor. 
• Sensory sensitivities: Unpleasant physical or mental effects of drug or alcohol use may deter some people from using substances. Some people that are ASD have reported experimenting with substances and finding some of the effects unpleasant. 

Clinical Challenges

Diagnosing and treating SUD in autistic people presents unique hurdles.

• Misinterpretation of symptoms: Health providers can misattribute substance use symptoms to autism traits or vice versa, leading to underdiagnosis or misdiagnosis.
• Lack of tailored treatment: Most traditional addiction programs are ill-equipped to meet autistic clients’ unique cognitive, communication or sensory needs. Many programs rely on group therapy to deliver programming and may lack a more individualized approach that is tailored to the learning differences and social challenges that those with ASD struggle with. 
• Communication barriers: Alexithymia, or difficulty articulating emotions or internal experiences, can hinder effective assessment and intervention. Also, much of addiction treatment is focused on learning to express emotions and connect socially with peers such as in 12-step programs, which can be a challenge with individuals on the autism spectrum. 

Integrated and Inclusive Care

A multidisciplinary, individualized approach is vital to adequately address the intersection of autism and substance use disorder. A well-rounded strategy should include the following components.

• Autism-informed SUD treatment: Treatment professionals should adapt their methods to accommodate sensory sensitivities, promote structure and use clear, direct communication. Unfortunately, at this time in 2025 there are not many treatment programs that treat addiction and have a good understanding of autism and how to deliver addiction treatment services to this population. 
• Early intervention: Identifying co-occurring conditions and providing timely support can reduce the risk of substance misuse. Also, identifying a teen or young adult with ASD that is beginning to experiment with substances and intervening in an effective way to discourage continued use is crucial to preventing these young people from developing more serious addiction problems. 
• Training for providers: Health professionals need additional education to recognize and respond to the unique presentations of SUD in clients on the autism spectrum. It is important for those professionals working with these young people to really understand their unique needs and be able to deliver a truly individualized treatment plan that is tailored to the neurodiverse client. 

As Awareness Grows, So Should Care

The relationship between autism and substance use disorder is complex, shaped by a combination of biological, psychological and social factors. Dispelling myths, recognizing the diversity within the autistic community and creating inclusive treatment options are critical for improved outcomes. 

At R&A Therapeutic Partners, Ray Estefania and Ana Moreno believe everyone deserves comprehensive, compassionate and capable help. We are very experienced working with ASD individuals who are also struggling with substance use and mental health issues. We can provide thorough substance abuse and mental health evaluations, therapeutic placement services and recovery coaching and monitoring as well as other very specialized services. The team at R&A is familiar with resources locally and around the country that understand how to treat individuals with this clinical profile. We also provide virtual counseling via telehealth, making our treatment accessible to people who live outside of South Florida. Reach out today to learn how we make healing possible.

At R&A Therapeutic Partners Raymond Estefania and Ana Moreno specialize in substance use and mental health disorder evaluations, treatment, intervention and therapeutic/educational consulting for clients throughout the greater South Florida area, as well as nationally and internationally. For more resources and information please visit Therapeutic-Partners.com or on Facebook.