Autism & addiction – part 2

In this second part of Autism & addiction, we will continue to explore the dramatic shift in the narrative surrounding addiction in autistic populations. This article explores the barriers to accurately diagnosing and effectively treating substance use disorders (SUD) in autistic individuals.

VIII. Challenges in diagnosis & treatment

Despite growing recognition of the intersection between autism and addiction, significant barriers remain in accurately diagnosing and effectively treating substance use disorders (SUD) in autistic individuals. These challenges are rooted not only in diagnostic blind spots, but also in the design of treatment systems that rarely accommodate neurodivergent minds.

Why addiction is underdiagnosed in autistic populations

Addiction is frequently missed or mischaracterized in autistic individuals. One reason is that substance use in autism doesn’t always follow expected patterns. Many autistic people use substances alone, at home, and in structured ways—forms of use that may not immediately raise red flags in clinical settings.^[1]Increased risk for substance use-related problems in autism spectrum disorders: A population-based cohort study (Butwicka et al., 2017) Others may present as quiet, withdrawn, or less obvious, masking the severity of their substance dependence.

Moreover, autistic individuals often describe substance use as a tool for regulation rather than recreation. As a result, they may not see themselves as having an addiction, and may not seek help until the consequences become severe—or until someone else intervenes.^[2]Substance use disorder in individuals with autism spectrum disorder: A retrospective chart review in a specialized addiction unit (Ressel et al., 2022)

Diagnostic overshadowing and clinician bias

One of the most persistent obstacles is diagnostic overshadowing—when clinicians attribute all of a person’s difficulties to their autism diagnosis, failing to recognize co-occurring conditions like anxiety, depression, trauma, or substance use.^[3]Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting (Saqr et al., 2020) Conversely, in late-diagnosed or undiagnosed individuals, addiction may be treated in isolation while the underlying autism remains unidentified.

Clinician bias also plays a role. Some professionals may mistakenly believe that autistic individuals are “less likely” to engage in substance use due to stereotyped notions of social avoidance or rigidity. These assumptions ignore the lived realities of late-diagnosed adults, multiply marginalized groups, and autistic people navigating environments that are chronically overwhelming or unsafe.^[4]It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare (Cunningham et al., 2023)

Why traditional rehab often fails

Most substance use treatment models are built around group-based, emotionally expressive, and verbally intensive formats. These models often emphasize interpersonal sharing, confrontation, and abstract reasoning—all of which can be inaccessible or counterproductive for many autistic individuals.^[5]It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare (Cunningham et al., 2023) Sensory environments in rehab centers—bright lights, unpredictable noises, lack of privacy—can be dysregulating or even traumatic.

Furthermore, programs rarely address autistic-specific experiences such as:

• Masking and autistic burnout

• Sensory overload as a trigger for relapse

• Alexithymia and difficulty recognizing emotional cues

• Literal communication styles that don’t align with metaphoric or motivational approaches

Without modifications, autistic individuals are more likely to drop out of treatment early, feel misunderstood, or exit without meaningful change.

The need for autism-adapted SUD treatment

There is an urgent need to develop and implement autism-adapted addiction treatment frameworks. Promising adaptations include:

• Pacing and structure: shorter sessions, clear expectations, and routine-based programming

• Sensory accommodations: low-stimulation spaces, noise-canceling headphones, and quiet zones

• Communication adjustments: visual aids, concrete language, and reduced pressure for eye contact or spontaneous sharing

• Individualized care plans that integrate trauma history, masking, and sensory regulation into the recovery process

Multidisciplinary teams that include both autism specialists and addiction professionals are best positioned to deliver this care. Peer support from autistic individuals with lived recovery experience can also provide validation and culturally competent guidance that traditional providers may lack.

IX. Promising interventions

As recognition of the unique addiction risks faced by autistic individuals grows, so too does the push for more inclusive, affirming, and evidence-based treatment models. The years 2020–2025 have seen important strides in the development of autism-adapted interventions that honor sensory profiles, identity, and trauma histories—offering hope for more effective and humane care.

Tailored therapies: sensory-informed, trauma-aware, & neurodivergent-affirming

Emerging treatment models prioritize individualized care over traditional one-size-fits-all rehab protocols. Effective programs now integrate:

• Sensory-informed environments that reduce overstimulation and support regulation through tools like weighted blankets, noise-canceling headphones, and low-light spaces

• Trauma-aware frameworks that recognize the high rates of complex PTSD, masking trauma, and medical trauma in autistic populations

• Neurodivergent-affirming practices, which reject the pathologization of autistic traits and instead frame substance use within the context of unmet needs and survival strategies

MDMA-assisted psychotherapy: a groundbreaking adjunct

One of the most notable clinical advances has been the development of MDMA-assisted psychotherapy for autistic adults with social anxiety. Clinical trials have shown that MDMA, when administered in a controlled therapeutic setting, can increase emotional openness, empathy, and social ease in autistic individuals—without the sensory or cognitive overload typically associated with social situations.^[6]Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study (Danforth et al., 2018)

Though not yet formally approved for addiction treatment, the findings from MDMA trials have implications for substance use recovery, particularly in addressing trauma, social withdrawal, and emotional numbing. As the FDA reviews broader therapeutic applications of MDMA-assisted therapy, many clinicians are watching closely to explore its use as an adjunct for autistic individuals with co-occurring SUD and trauma.

Community-based & identity-affirming recovery models

Beyond clinical settings, peer-led and community-based models are gaining traction. Programs that center autistic voice, autonomy, and mutual aid are more likely to retain participants and foster genuine healing. These include:

• Autistic-specific support groups that do not require verbal sharing or social eye contact

• Online recovery forums tailored to sensory needs and cognitive pacing

• Peer coaching models that pair autistic individuals in recovery with trained mentors who share lived experience

Early intervention & co-occurrence screening

Preventing addiction in autistic populations requires early, integrated screening. Clinicians should routinely assess for:

• Co-occurring ADHD, anxiety, and trauma

• Alexithymia and sensory dysregulation

• Signs of functional substance use (e.g., reliance on cannabis or alcohol to sleep, eat, or socialize)

Importantly, these screenings must be conducted with autism-informed language and sensitivity, recognizing that many autistic people underreport symptoms due to interoceptive and communicative differences.^[7]Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting (Saqr et al., 2020)

Early identification allows for targeted intervention—before functional use becomes compulsive dependence. Tools such as sensory profiles, regulation planning, and emotion-mapping can be introduced as preventative measures, empowering autistic individuals to build non-substance-based strategies for managing life’s demands.

X. Moving forward: prevention, awareness, & advocacy

As research increasingly shows the link between autism and substance use disorders (SUD), a clear call to action is emerging: prevention and recovery efforts must be reimagined through a neurodiversity-affirming lens. This means not only treating addiction in autistic people more effectively, but also changing the systems, narratives, and supports that shape their lives before addiction takes hold.

Educating professionals & families

One of the most urgent needs is training clinicians, educators, and families to recognize how addiction may present differently in autistic individuals. Autistic substance use often begins as a regulatory or coping mechanism—not impulsive thrill-seeking. Yet this is frequently missed or misinterpreted.

Health professionals must be educated to:

• Distinguish between stimming and substance-seeking

• Recognize alexithymia and sensory dysregulation as risk factors

• Avoid diagnostic overshadowing when addiction and autism co-occur

Family members, too, play a crucial role. When parents and caregivers understand the sensory, emotional, and social needs behind a young person’s behavior, they are better equipped to offer early support—and avoid punishment or dismissal that might drive substance use further underground.

Integrating substance use screening into autism care

Substance use screening should become a standard component of autism care, especially during adolescence and young adulthood when risk increases.^[8]Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting (Saqr et al., 2020) These screenings must be:

• Conducted with language and pacing suited to autistic communication styles

• Sensitive to sensory and cognitive profiles

• Framed in terms of support and curiosity, not shame or surveillance

Just as autistic care teams regularly assess for anxiety, depression, and trauma, screening for functional or compulsive substance use should be part of holistic care—whether or not the person appears “at risk” by neurotypical standards.

Empowering autistic people with regulation tools

Addiction prevention in autism is not about scaring people away from substances. It’s about offering accessible, affirming alternatives. Autistic individuals need tools and strategies for:

• Emotional regulation (e.g., identifying internal states, managing overwhelm)

• Sensory regulation (e.g., customizing environments, using stimming or weighted input)

• Self-understanding and narrative repair (e.g., reframing late diagnosis, embracing autistic identity)

Programs that teach interoceptive awareness, support autistic autonomy, and validate non-normative emotional experiences can reduce the felt need for substances in the first place.^[9]Investigating alexithymia in autism: A systematic review and meta-analysis (Kinnaird et al., 2020) Crucially, these tools must be made available early, before maladaptive habits take root.

Destigmatizing addiction in the autism community

Finally, we must dismantle the stigma that surrounds both autism and addiction. Many autistic people feel ashamed of their substance use, especially when they’ve internalized years of being told they are “too sensitive,” “not trying hard enough,” or “socially broken.” Others are dismissed as incapable of addiction altogether—a myth that leaves them isolated and invisible when they do need help.

To move forward, we must:

• Normalize discussions of addiction within neurodivergent spaces

• Share lived-experience stories that reflect the spectrum of substance use

• Shift from blame-based to needs-based language

When autistic people are seen not as problems to fix, but as individuals with real, valid needs, the path to healing becomes clearer—and far more humane.

XI. Conclusion

The belief that autism somehow protects against addiction has not held up under the weight of research—or reality. And yet, it would be equally inaccurate to claim that autism inherently predicts addiction. Context is everything.

What the evidence makes clear is this: autistic individuals are not immune to addiction, but they are vulnerable to it in ways that are often invisible, misunderstood, or ignored. Substance use in autism is rarely about thrill-seeking or defiance. More often, it emerges in response to chronic emotional distress, sensory overload, social alienation, and the daily labor of trying to survive in a world that isn’t built for your neurology.

Addiction in autistic populations is not a moral failing. It is not a lack of willpower. It is not a personality flaw. It is a relational, sensory, and regulatory issue—one that demands we approach care differently.

If we want to reduce addiction risk and improve recovery outcomes, we must create systems of care that:

• Are compassion-informed, not compliance-driven

• Integrate sensory and emotional regulation supports

• Recognize the role of trauma, alexithymia, and masking

• Center autistic voices in prevention, treatment, and policy design

Neurodivergent people deserve recovery frameworks that meet them where they are—not where the system assumes they should be.

The next chapter in addiction care must be neurodiversity-affirming. That means acknowledging difference without pathologizing it, understanding pain without minimizing it, and building bridges to healing that are both accessible and authentically inclusive.

Because when we design care for those most often left out, we make recovery more possible for everyone.