What’s the Link Between Autism and Alcoholism?

Are you autistic and think you might be drinking too much? Read on to learn about the link between autism and alcohol use disorder.

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For many autistic people, alcohol isn’t for enjoyment or partying — it’s for coping. Living in a world that was designed for neurotypical (or non-autistic) people can be exhausting, coming along with a slew of challenges on a day-to-day basis, from navigating unspoken social rules to managing sensory overload.

Many people with autism spectrum disorder (ASD) also have a substance use disorder, including alcohol use disorder (AKA alcoholism, alcohol addiction, or alcohol dependence). Researchers estimate that up to one in three autistic adults struggles with a substance use disorder (SUD) or alcohol use disorder (AUD).

Read on to learn more about the connection between autism and alcohol use disorder, including why this overlap is so common and what treatment looks like.

Autism and alcoholism: what’s the connection?

“Autistic folks often deal with social anxiety, sensory overload, and struggles in social interactions, and can use alcohol and other drugs to self-medicate,” says Beth Couture, MSS, LSW, a Charlie Health group facilitator.

Here’s a deeper look at why alcohol misuse may be more common among some autistic individuals:

Social lubricant

“Just like neurotypical people, people with autism can use alcohol as a social lubricant, as it can make it easier to navigate small talk and other social elements that might otherwise be uncomfortable,” Couture says.

Ease of masking

“Masking” means consciously or unconsciously hiding autistic traits to appear more neurotypical, fit in, and avoid discrimination. Drinking alcohol can make it easier for some autistic people to mask, which helps them feel like they fit in more, Couture says. “Being autistic in a society built for neurotypicality often comes with a sense of loneliness and not belonging, and alcohol can ease this and allow a sense of greater connection with others.”

Dulling sensory input

“Using alcohol can also dull excessive sensory input, which can help folks with autism feel less overwhelmed,” says Couture. However, it’s important to note that some autistic people experience the opposite effect and can become more overwhelmed while drinking, she adds.

Self-medicating for co-occurring disorders

Many autistic individuals have one or more co-occurring mental health conditions. They may use alcohol as a way to quell their symptoms. While alcohol may offer some short-term symptom relief, it tends to worsen symptoms over time and, of course, leads to the risk of alcohol misuse and dependence. 

Co-occurring disorders and AUD

The majority of people on the autism spectrum have co-occurring mental health disorders. Research shows that anywhere from 54% to 94% of autistic people have a co-occurring psychiatric disorder. Some of the most common ones include:

• Anxiety disorders
• Depression
• Attention-deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Bipolar disorder

Additionally, some physical health conditions are also commonly comorbid with autism, including:

• Sleep disorders
• Gastrointestinal disorders
• Epilepsy
• Headaches (migraines, tension headaches, and cluster headaches)

Regardless of whether an autistic person is dealing with a comorbid mental health or physical health condition, it can take a toll on their well-being. “As with neurotypical folks, if untreated, these conditions can lead to autistic folks’ feeling the need to self-medicate,” Couture says. “Medical issues can increase feelings of separation/lack of belonging in autistic folks, and this can lead to their using alcohol to feel a greater sense of connection with others.”

This is why addressing the underlying causes is crucial during treatment. If the underlying causes of self-medicating aren’t addressed, the cycle of alcohol use is more likely to continue or return.

Undiagnosed autism and alcoholism

Undiagnosed autism can further increase the risk of problematic drinking. “Folks with undiagnosed autism struggle with the same things as folks who are diagnosed, but with the added concern of not having external validation of their concerns,” Couture says. “Without an official diagnosis, autistic folks can find their concerns being dismissed or misunderstood by others — and even by themselves — and can therefore feel a greater need to mask or hide them.”

Neurodivergent individuals without an autism diagnosis may blame themselves for social difficulties, sensory overwhelm, or emotional regulation challenges, rather than understanding these experiences as part of autism. Over time, this can truly take a toll on well-being.

Other risk factors for developing alcohol use disorder

On top of being autistic, various other risk factors increase the odds of someone having AUD. These risk factors include:

• Starting drinking early (before age 15)
• Family history of alcohol use disorder or substance use disorder
• History of trauma, particularly childhood trauma

Compounding these risk factors, plus autism spectrum disorder, can significantly increase someone’s vulnerability to problematic drinking, especially when they’re lacking adequate mental health support.

Alcoholism and autism research

Researchers have found a clear link between autism spectrum disorder and an increased risk for substance use disorders, including alcohol use disorder. In fact, research suggests that alcohol may be the most common substance used by autistic people. Additionally, they have found that certain autistic traits, including withdrawal, social avoidance, and rigidity, can feed into unhealthy drinking patterns.

Furthermore, people who have a co-occurring disorder (or multiple co-occurring disorders) may be even more likely to develop a SUD. For example, one study found that the highest rates of alcohol abuse were found in people with both autism and ADHD. 

However, if an autistic person has received treatment for their co-occurring disorder and takes a psychotropic medication for it (such as an antidepressant, for example), their risk of developing a substance use disorder is lower, research shows.  

This body of research is relatively new and still growing. We need more nuanced, thorough, long-term studies for a better understanding. We’re also lacking data on substance use in autistic teens. Researchers in the field are calling for more targeted studies in adolescents to better understand risk factors and protective supports earlier in life.

What are the signs of alcohol use disorder?

Not sure if your alcohol consumption is crossing into alcohol use disorder territory?

Some potential signs of alcohol use disorder include: 

• Drinking more than you intended to
• Trying to cut down on drinking, but being unable to
• Having cravings for alcohol so strong that it’s hard to think about anything else
• Your drinking is interfering with home, work, or school responsibilities
• Continuing to drink even though it’s causing problems in your life
• Choosing alcohol over other social or work activities 
• Drinking alcohol in dangerous situations
• Building a tolerance (needing to drink more alcohol to get the desired effect)
• Withdrawal symptoms when you stop or reduce drinking (such as shaking, sweating, or feeling nauseous) 

Even experiencing just two or more of these symptoms over the course of a year could indicate AUD. 

What are the treatment options for autism and alcoholism?

Managing autism and alcoholism is two-fold. On top of addressing the alcohol use disorder itself, it’s crucial to address the struggles underneath.

1. Support for alcohol use disorder

“Autistic people can find support for managing or stopping drinking in groups specifically designed for folks with autism who are struggling with addiction,” Couture says. “Such groups offer understanding and a social element, which can be extremely helpful to folks on the spectrum.”

Or, some autistic folks may benefit from general peer support groups like Alcoholics Anonymous (AA), Couture says. Everyone’s different and has different treatment preferences. For some, the structure, predictability, and shared language of these groups can be beneficial, while others may prefer more neurodivergent-affirming spaces.

Additionally, it’s important for people recovering from AUD to establish clear goals and routines to support sobriety, plus develop new hobbies and interests that don’t include alcohol or other substances, Couture adds. 

An important note: If you have severe alcohol use disorder, you may need medical support to avoid withdrawal if you stop drinking abruptly, since alcohol withdrawal can potentially be life-threatening. Consult a medical professional for guidance and medical support. 

2. Support for autism and co-occurring disorders

When seeking therapy to help manage ASD and co-occurring disorders, finding therapists who are neurodivergent-affirming to ensure that autistic traits are understood, embraced, and supported rather than pathologized or viewed as something to change.

“Autism-informed cognitive behavioral therapy can also be very helpful in changing core beliefs and negative thought patterns that can contribute to addictive behaviors in autistic folks,” Couture says. 

Depending on the specific co-occurring disorder, treatment can vary. For example, someone with OCD can greatly benefit from exposure and response therapy (ERP), while someone who’s a survivor of childhood trauma can benefit from trauma-informed therapies like eye movement desensitization and reprocessing (EMDR) or somatic experiencing.

“Meeting with a psychiatrist or other mental health professional can help autistic folks manage co-occurring disorders like anxiety and depression, and this can, in turn, reduce the need or desire to drink,” Couture says. have bipolar disorder, treatment typically involves mood stabilizers instead of antidepressants.

How Charlie Health can help

If you struggle with alcohol use disorder, Charlie Health can help. Our virtual Intensive Outpatient Program (IOP) offers more than once-weekly mental health treatment for people dealing with serious mental health conditions, including AUD and co-occurring disorders. 

We have a substance use disorder track that focuses on a holistic approach to addiction recovery, which allows you to address underlying mental health conditions as well as support getting sober. Plus, our clinical team practices neurodivergent-affirming therapy, helping neurodivergent folks embrace their neurodiversity rather than looking at it as something that needs to be changed.

An IOP is a great option for those with AUD who need more support than weekly therapy but don’t require the 24/7 monitoring of inpatient or residential care. With this kind of support, recovery is possible. Fill out the form below or give us a call to start your sobriety journey today.