Alcohol Use and Autism: What We Know and Why It Matters

Introduction

A new study, “Alcohol Use Among Populations with Autism Spectrum Disorder” (Barber et al., 2024), looked at what we actually know about drinking and alcohol use disorders among autistic people.
While plenty of research exists on substance use in general, alcohol-specific studies are surprisingly rare — and this review shows why it’s important to study alcohol separately.

• Why This Study Matters
• What the Researchers Did
• What They Found
  • 🧩 1. Prevalence — How Common Is Alcohol Use Disorder in Autism?
  • 🔍 2. Risk Factors — Why Some Autistic People Develop Alcohol Problems
  • 💬 3. Motives — Why Do Some Autistic Adults Drink?
  • ⚖️ 4. Protective Factors — Why Some Autistic People Don’t Drink Much
• Consequences and Implications
• What Helps: Tailored Support
• What We Still Don’t Know
• Policy and Practice Recommendations
• Bottom Line
• Citation

Why This Study Matters

Alcohol use disorder (AUD) is one of the most common mental-health conditions globally. Yet, autistic people are rarely included in alcohol research — and when they are, their unique experiences often get overlooked.
The authors of this review wanted to fix that gap.

Their main goal:
👉 To bring together everything we currently know about how and why autistic people drink, what the risks and protective factors are, and how services could adapt.

What the Researchers Did

This was a narrative systematic review — meaning the authors collected and compared findings from all available studies on autism and alcohol.
They searched five major medical databases (like MEDLINE and PsychINFO) and found 22 studies published between 2003 and 2023.

Those studies came from many settings: addiction treatment centres, autism clinics, forensic (justice-related) facilities, and large national databases.

What They Found

🧩 1. Prevalence — How Common Is Alcohol Use Disorder in Autism?

• In large population datasets, about 1.6% of autistic people had an alcohol use disorder diagnosis.
• In clinical settings, that number jumped to 16%.
• For comparison, around 8.6% of the general population worldwide experiences AUD in their lifetime.

So while autistic people tend to drink less overall, those who do drink may face higher risks once alcohol becomes part of their coping routine.

🔍 2. Risk Factors — Why Some Autistic People Develop Alcohol Problems

The review identified four key risk factors:

• Age: Alcohol use tends to increase as autistic people get older.
• Co-occurring conditions: Especially ADHD, anxiety, or depression — all linked to higher AUD risk.
• Gender: Women were underrepresented in studies, but early evidence suggests autistic women might be at higher relative risk.
• Genetics: There may be overlapping biological pathways between autism and alcohol use disorder, though research is still limited.

💬 3. Motives — Why Do Some Autistic Adults Drink?

From interviews and qualitative research, two common motives emerged:

• Self-medication: Using alcohol to manage anxiety, sensory overload, or emotional distress.
• Social facilitation: Using alcohol to feel more relaxed or connected in social situations.

This means alcohol may serve a double role: helping some autistic people navigate social challenges, but also putting them at risk of dependence if it becomes a main coping tool.

⚖️ 4. Protective Factors — Why Some Autistic People Don’t Drink Much

Several traits and circumstances may actually reduce alcohol use risk:

• Strong family or household rules around alcohol
• Sensory sensitivities that make drinking unpleasant
• Structured routines that leave little room for impulsive behaviour
• Early diagnosis and access to autism-informed support
• In some studies, even psychotropic medication use was linked with lower alcohol use rates

Consequences and Implications

The review showed that when alcohol use disorder does occur in autism, it often leads to more severe consequences — like mental-health crises, self-harm, or increased suicide risk (especially among men).
In one study, autistic men with AUD had higher rates of suicide attempts than non-autistic peers.

Other consequences included:

• Physical health problems (alcohol-related somatic disease)
• Greater risk of interpersonal violence
• Increased feelings of social isolation

What Helps: Tailored Support

The good news: autism-adapted alcohol treatment works — when it’s actually offered.

One study found that a modified cognitive behavioural therapy (CBT) program that addressed sensory stress, communication styles, and emotional regulation helped autistic adults reduce alcohol use and anxiety.

Key takeaways for clinicians and support systems:

• Screen for alcohol use routinely in autistic patients
• Use clear, stigma-free language (avoid “addict” or “abuse”)
• Adapt therapy environments (quiet rooms, flexible timing)
• Focus on why the person drinks — not just how much

What We Still Don’t Know

The review also highlighted major research gaps:

• Why AUD seems to develop later in life for many autistic people
• How gender differences play out in alcohol use and help-seeking
• Whether certain genes or biological pathways overlap between ASD and AUD
• Which interventions are most effective for long-term recovery

Policy and Practice Recommendations

Bottom Line

Autistic people are not immune to alcohol problems — but they also don’t fit the typical “at-risk” profile.
Many drink less, yet when alcohol becomes a coping mechanism for social or sensory stress, the consequences can be serious.

This review calls for a more autism-informed approach to alcohol use — one that blends neuroscience, empathy, and practical support.

Citation

Barber, W., Aslan, B., Meynen, T., Marsden, J., Chamberlain, S. R., Paleri, V., & Sinclair, J. M. A. (2024). Alcohol use among populations with autism spectrum disorder: Narrative systematic review. BJPsych Open, 10(5), e117. PMCID: PMC11736162