Psychopharmacology
People With ASD May Be More Likely to Use Drugs
But those who take medication for their mental health are less at risk.
Posted January 5, 2021 Reviewed by Ekua Hagan
Parents sometimes wonder whether giving their child medication for mental health sends the message that a pill solves problems—and might encourage young people to experiment with drugs.
On the other hand, if the medication is effective, even only in part, it might make someone less likely to self-medicate with illegal drugs in search of relief.
A new study out this week provides a little bit of evidence that psychiatric medication can discourage substance use in people with autism spectrum disorder (ASD).
Researchers used to think that people on the autism spectrum were less likely to abuse drugs, including alcohol. But they were focused on people who were severely disabled. In the larger population of people on the autism spectrum, substance abuse is actually a higher risk than among the population without ASD.
In the new study, of nearly 33,000 people in Taiwan—including nearly 7,000 diagnosed with autism spectrum disorder (ASD)—researchers found that those with ASD were twice as likely to abuse alcohol and three times more likely to have a drug use disorder.
A 2016 study in Sweden had a similar result, finding that among people with ASD who have average or above-average intelligence quotients (IQs), the chance of addiction to either alcohol or other drugs doubled compared to their peers without ASD. The risk was greater in people who also suffered from attention deficit hyperactivity disorder (ADHD).
That study came as a surprise to researchers, but not so much to clinicians and people with ASD, as Maia Szalavitz explained in 2017. The new research backs it up.
The Taiwan study also contains a little bit of good news: Among those who were taking a psychiatric medication, the risk of a substance problem dropped by more than a third. We'd like that number to be bigger, but it's something.
It's especially important to consider medication if your child has tics or impulse problems. According to the Taiwanese data, if your child has ASD and tics and isn't taking any psychiatric med, his chance of a substance use disorder is more than six times higher. If he has an impulse control issue, his chance of either drug abuse or alcohol abuse is more than five times higher without medication.
Sadly, ASD and substance abuse were a deadly combination. The risk of death was three times higher in the group with both problems than those with neither.
The overlap between ASD and substance abuse may lead to new insights helping us cope with both conditions. Each involves repetitive behavior to manage emotions and they affect some of the same brain regions and genes. Maia Szalavitz explained this in detail in her piece in The Atlantic.
Beyond medication, what can you do now? Cognitive-behavioral therapy has been shown to work with ASD patients if the counselors are trained for this group.
As I wrote in October, "Can a Change in Diet Influence Autism Spectrum Disorder Symptoms?" current evidence doesn’t suggest that every child with ASD should be on one diet or another. You might experiment with diet alongside other therapies. If nothing else, minimizing abdominal pain and other GI symptoms, which are more common among people with ASD, will make your child more comfortable.
But if you're worried about sending the wrong message with prescribed medication, you can take some comfort. You have reason to think that the medication is also protecting your child from the temptations of alcohol and other drugs.
