Tuesday, July 3, 2018

Autism and Addiction: A Problem with Deep Roots

Take the red pill
Photo © Taston | Flickr / Creative Commons
[image: A white person's hand reaching for a blister pack of red & blue pills]

Maxfield Sparrow
unstrangemind.com

Autistic people stereotypically don’t drink alcohol, or take drugs. We love clear boundaries and rules, so we don’t do anything illegal. We’re generally less susceptible to peer pressure. And everyone knows drinking is a social activity, so obviously autistic people wouldn’t even drink, let alone become alcoholics. Right?

Wrong.

Not only do some autistics drink and/or use drugs, but we risk addiction as well. The roots of autistic people's addiction can go all the way back to childhood, so it’s very important to think about how we are raising autistic children today—if we want to help them avoid the pitfalls of addiction in the future.

Why Do Autistics Drink and/or Use Drugs?


This question is easy to answer. Ask any autistic person—even those who don’t drink alcohol or use drugs—and they will probably answer off the top of their head: Mind-altering substances lower inhibitions, helping people get past shyness or anxiety. It’s a form of self-medication. Alcohol and some kinds of drugs can also numb senses, which some autistics with painful sensory issues can find soothing.

Additionally, some autistics find their first circle of friends within a drug culture. This was the case for me. I was friendless through high school, but when I started meeting people who smoked cannabis I found it much easier to make friends with them. Many of them also used psilocybin and LSD, so they were used to being around people with much weirder behavior than mine. That first circle of friends even had a method to help me through intense emotions: they’d break out the cannabis, and we’d all smoke until we were happy again—or at least too stoned to remember why we weren’t.

A 2014 research article  in the Journal of Alcoholism and  Drug Dependence relates a case study of a 14-year-old girl with Asperger’s, Sarah, who had an experience similar to mine. Sarah’s parents were unaware of how deeply she had gotten involved in a drug community until she was arrested for selling drugs. It turned out drug dealers had been taking advantage of Sarah, both sexually and as a drug courier. The article says, “She confessed in a very naive manner that she thought these were her first real friends and would do anything to be their friend.”

We autistics may be more resistant to peer pressure, but our social isolation and craving for community can still make us vulnerable to manipulation by others. I was lucky that the social circle of drug users I first fell in with was not so malicious and self-serving as the one Sarah fell in with, but that’s all the difference in our experiences was: luck. Quite easily my story could have gone the way hers did. I was every bit as vulnerable as she was.

Why Do Autistics Have a Higher Risk of Addiction?


According to American Addiction Centers and a Washington University School of Medicine study, autistics are less likely to try alcohol and drugs at all—but those of us who do have a much higher risk of addiction than the general population. A Swedish study found an autism diagnosis doubles the risk of addiction. The 2014 Dutch research article I mentioned earlier conducted a survey of patients in a rehab facility. Using the latest diagnostic criteria, they evaluated 118 patients for autism and found that 6.7% were clinically diagnosable. Compare that to the 1% to 2% of the general population that is diagnosed or diagnosable as autistic, and it suggests that we autistics are over three times as likely to have addiction problems. If you then consider the lower overall usage rates among autistic people, that increased percentage represents a massive leap in addiction risk.

I think there are two big factors at play here: The first should be obvious from the stories in the last section: social acceptance. If we have never had friends and suddenly people are accepting us, “weird and all,” so long as we are drinking (or smoking or snorting or injecting) with them, we’re more likely to spend a lot of time drinking (smoking, snorting, etc.) so that we can spend more time enjoying that social acceptance. The more time we spend in a bottle, the more likely we are to get hooked.

The other factor is a potential biological predisposition for addiction. I don’t want to go too far down that rabbit hole, but you can look at a study that found autistic genetics were more common among both humans and mice who voluntarily drank excessive amounts of alcohol, as well as reading more about the structural differences in autistic brains involved with lower impulse control and disruptions of the dopaminergic regulatory circuits—both neurological traits more likely to contribute to addiction.

What Makes Traditional Rehab Programs a Poor Fit for Autistics?


In a nutshell, almost everything. Rehab programs tend to use group dynamics as part of the treatment. Patients are encouraged to bond, and to help one another through the process. These expectations are unfair to many autistics, who tend to get singled out for social non-conformity, to self-isolate, or get rejected by the group. This affects treatment for autistics who cannot access the model in use.

Another case study in the Dutch article is that of Peter, a 20-year-old undiagnosed autistic. Peter couldn’t complete a task in time for his rehab group therapy session, and then had a meltdown when a staff member interrupted his work. Because he broke windows and threatened a nurse, Peter was kicked out of the inpatient program. When he returned to the outpatient clinic, staff looked more closely and realized Peter was autistic. When the rehab center changed their approach—taking autism into account and changing their behavior to accommodate Peter’s needs—he became cooperative and easy to work with, rather than frighteningly unpredictable and angry.

What Should Autistic-centered Rehab look like?


While the need for autistic-understanding rehab programs is currently largely unmet, some facilities and programs are starting to appear. American Addiction Centers suggests individualizing the program by getting to know the autistic person’s strengths and weaknesses, and giving them opportunities to work alone as well as in groups. Educate staff better about autism. Set a pace that works better with the autistic person’s needs. Use a variety of teaching methods to mesh better with minority learning styles.

Foundations Recovery Network emphasizes the importance of autism acceptance. “The goal isn’t to change these people, but to help them live comfortably within their own skin, so they won’t be tempted to lean on drugs and alcohol instead.” In fact, their program sounds like just what I needed when I first learned about my own autism, even though I wasn’t grappling with addiction issues at that time:
“We don’t attempt to label, brand or otherwise stigmatize people who have Asperger’s syndrome or addictions, but we do try to help people accept their conditions and limitations, so they won’t use harmful substances to mask their pain. The work is hard but it can be quite rewarding, and it could lead to a completely different kind of life for people who have always struggled to connect, to collaborate and to heal.”
But the “innovation” of seeing a person as a unique individual and shaping their treatment program to fit them rather than trying to squash them into the shape of a one-size-fits-all program shouldn’t stop with helping autistic addicts. Every human being is unique. I often feel like the entire notion of “neurotypical” is just smoke and mirrors because every brain is different so how could there possibly be a “default brain type”? Neurotypical is more like a concept that some people’s experience is more in alignment with rather than an accurate descriptor for any single human being.

So let’s reform rehab programs all the way: not just making them autistic-friendly but friendlier to all types of human beings. Autism and addiction creates a “perfect storm” in which two human experiences that are grossly misunderstood and regularly mistreated co-occur. Author Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, expressed this beautifully when she said, “with any other psychological or developmental or neurological condition, we’d recognize that human beings are unique individuals.” This intersection of harm suggests that those of us who care about the abuses enacted against autistics in the name of treatment should care about similar abuses against those suffering addiction (and vice versa).

What Can We Do to Stop Addiction Before It Starts?


While there is a strong case for addiction being wired in genetically/neurologically*, author Johann Hari has been spreading the word in the last few years that “the opposite of addiction is connection.”

In his Ted Talk, “Everything You Think You Know About Addiction is Wrong,” Hari talks about the famous cocaine-drinking lab rats. We’ve all heard of them: the rats are offered plain water and cocaine-laced water and they drink so much cocaine they end up killing themselves. But no one until recently had thought of offering the rats an enriched environment. When the rats had a fun cage filled with toys and things to explore, including other rats to socialize with, they still drank cocaine from time to time, but in moderate amounts rather than lethal doses.

I think this is what makes autistics so vulnerable to addiction (as well as many other unfortunate life outcomes): the difficulty we have in connecting with other people. I know I might sound like a broken record, but yet again we see an issue that points back to the importance of autism acceptance. When autistics are encouraged to accept, love, and celebrate who they are, breakthroughs occur. When the people surrounding autistics show acceptance and provide a safe space, allowing autistics to drop their social masks and live more authentically, breakthroughs occur.

Every step toward true autism acceptance is a step away from addiction and a step toward healing.

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*Alastair Mordey, programme director at The Cabin Addiction Services Group, writes that 40% to 60% of addiction cases come down to genetics, saying, “The actual ‘disease of addiction’ almost always pre-exists actual drug use, which may seem illogical. However, that is only because the word addiction is an inaccurate term we use to describe the second part of the illness, the behavioural part.”