Understanding Substance Use in Autistic Adolescents and Adults

Introduction

While most conversations about autism focus on communication, learning, or social differences, one area that’s been largely overlooked is substance use.
A major study published in 2021 — Understanding the Substance Use of Autistic Adolescents and Adults — set out to change that.

It examined how and why autistic people use alcohol, cannabis, and other substances, and how their experiences differ from those of non-autistic people.

• Why This Research Matters
• Study Overview
• Key Findings
  • 💬 1. Motives — Coping Over Pleasure
  • ⚡ 2. Risk Factors
  • 🧩 3. Gender and Age Differences
  • 🧠 4. Service Gaps
• Protective Factors
• Implications for Policy and Practice
• The Bigger Picture
• Citation

Why This Research Matters

• Substance use is a public-health issue — but most research has centred on neurotypical populations.
• Autistic people face unique stressors: sensory overload, social anxiety, and emotional exhaustion from masking.
• The researchers wanted to understand whether those factors shape substance-use patterns — and whether autism-specific approaches could help.

Study Overview

The review compiled data from multiple countries and existing research on autistic adolescents and adults.
It explored:

• How often autistic people use substances
• Why they use them
• What risks and protective factors exist
• How clinical services can better identify and support autistic people struggling with addiction or misuse

The researchers found that while overall rates of substance use may be lower among autistic people, the reasons behind use are often much more complex.

Key Findings

💬 1. Motives — Coping Over Pleasure

Unlike non-autistic peers who might drink or use recreationally, many autistic adults report using substances to cope, not to party.
Common reasons included:

• Reducing anxiety or sensory discomfort
• Managing depression or intrusive thoughts
• Easing social stress or the pressure to “fit in”

This pattern aligns with what psychologists call self-medication, where a person uses substances to regulate mood or function in a difficult environment.

⚡ 2. Risk Factors

Certain factors increased the likelihood of substance-related problems:

• Co-occurring ADHD or mood disorders, which amplify impulsivity and emotional swings
• Trauma and bullying, often tied to growing up autistic without support
• Late diagnosis, meaning years of unmanaged stress before self-understanding

Interestingly, intellectual disability often acted as a protective factor, possibly because of stronger family supervision or reduced access to substances.

🧩 3. Gender and Age Differences

• Autistic women may be at higher risk for substance-related problems than autistic men, especially when masking or trauma are involved.
• Older autistic adults showed higher rates of substance use, possibly reflecting later-life stressors, isolation, or delayed diagnosis.

🧠 4. Service Gaps

Clinicians often miss substance-use issues in autistic clients because:

• They assume autistic people “don’t drink or use drugs.”
• They lack autism-specific screening tools.
• Stigma and communication barriers make it hard for autistic people to seek help.

This creates a paradox: autistic people may have lower rates of use overall but higher risks of harm when they do use.

Protective Factors

Not every autistic person who drinks or uses will develop problems.
The study identified several protective influences:

• Supportive family or peer networks
• Early autism diagnosis and self-understanding
• Structured daily routines and clear coping strategies
• Sensory-friendly environments that reduce stressors
• Access to therapy focused on emotion regulation rather than punishment or abstinence-only rules

Implications for Policy and Practice

The researchers recommend that addiction and mental-health services adopt neurodiversity-informed care — programs that understand autistic cognition and sensory experience.

The Bigger Picture

This research highlights that autistic people don’t fit the usual stereotypes around substance use.
They may be less likely to drink or use overall — but more likely to do so for self-soothing or survival reasons, which makes the risks different, not smaller.

For neurodivergent communities and recovery advocates, the message is clear:

Support must start from understanding, not assumptions.

Citation

Harvard, C., & Autistica Research Team. (2021). Understanding the Substance Use of Autistic Adolescents and Adults. Autistica Research Network. PMC8310943