Addiction and Autism: A Remarkable Comorbidity?

Abstract

ObjectiveAutism Spectrum Disorders (ASD) are well known for high prevalence's of comorbid conditions especially anxiety, obsessions, depression and challenging behaviours. In this article we will consider the evidence for an eventual comorbidity between ASD and Addiction (Substance Use Disorders (SUD) and explore the possible underlying explanations. MethodsA literature study on similarities between Addiction and ASD (at a phenotypical and neurobiological level) as well as a case note review on a year cohort of 200 consecutive admissions in an adult addiction psychiatry unit was studied here. ResultsIn our pilot-survey 8 (men) on 118 patients were diagnosed with autism spectrum disorder. This is substantially higher than in the general population (1%) but in line with other European studies.Autism spectrum disorders and addiction can both be perceived as developmental disorders in which a genetic predisposition and vulnerability interact with environmental factors. They can be induced by early stress thus affecting the proper functioning of the cortico-striatal dopaminergic regulation systems (and also the HPA axis). There is growing evidence that ASD and SUD share developmental dysregulations of the limbic and sensorimotor cortico-striatal regulations loops. ConclusionsThere are clear indications that a possible comorbidity of substance abuse disorder should be considered in cases of individuals with autism spectrum disorders. This finding is important for clinicians to take into account in assessing patients with addiction problems or ASD.time frame, and take responsibility for oneself and others. He managed to get the shopping done in time but was tidying the purchased items when he was expected to join a group therapy session. When one of the nurses confronted him, he went out of his mind, became very aggressive and bashed doors and broke windows whilst threatening the nurse verbally. Due to this unacceptable behaviour he was dismissed from the program immediately. A week later he came back to our outpatient clinic and was asked what had happened and had caused his extreme reaction. He said that he became very angry because the nurse had interrupted him. For him it was inconceivable that he should have joined the group leaving his task unfinished. In the clinical interview it became clear that this type of rigid behaviour, and his incapacity

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

“…Clinicians should recognize that people with physical and cognitive disabilities have higher rates of StUD and lower rates of treatment engagement than those without these disabilities. 220,221 In addition, StUD is associated with moderate cognitive deficits. 222 Patients with severe chronic health concerns tend to have a slower response to treatment with fewer days abstinent compared to patients without them.…”

“…Clinicians should recognize that people with physical and cognitive disabilities have higher rates of StUD and lower rates of treatment engagement than those without these disabilities 220,221 . In addition, StUD is associated with moderate cognitive deficits 222 .…”

Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders

“…However, there is limited research on how personality traits associated with ASD functioning may impact SUD treatment outcome. Recent research has acknowledged an overlap between different forms of psychopathology (including neurodevelopmental disorders such as ASD and attention deficit hyperactivity disorder [ADHD]), dysfunctional personality traits, and SUD (Carragher et al, 2014;van Wijngaarden-Cremers et al, 2014). The taxonomy of normal personality has played a major part in shaping dimensional models of personality pathology, and personality models based on factor analysis outlining general personality traits (e.g., Big-3, Eysenck and Eysenck, 1975;Big-5, Costa and McCrae, 1992;Temperament and Character Inventory [TCI], Cloninger et al, 1994) have shown strong links to all common forms of psychopathology (Kotov et al, 2017;Widiger and Simonsen, 2005;Widiger and Trull, 2007).…”

“…Although depression and anxiety are the most common kinds of comorbidity in AUD, personality disorder is also common and often disrupts psychiatric and psychotherapeutic treatment and causes premature discontinuation (SAMHSA, 2013). A few previous studies have indicated similar problems in AUD treatment with patients with autistic traits (Lalanne et al, 2015;van Wijngaarden-Cremers et al, 2014). For example, one study of autistic traits (i.e., not an autism spectrum disorder [ASD] diagnosis) and substance use patterns found that persons with behaviors associated with autism (e.g., social difficulties, propensity to engage in repetitive behaviors) were more likely to abuse alcohol and cannabis (De Alwis et al, 2014).…”

Systematic review of risk and protective factors associated with substance use and abuse in individuals with autism spectrum disorders

“…Although there are few empirical studies on the cooccurrence of substance abuse and ASD (van Wijngaarden-Cremers et al, 2014), a review conducted by Arnevik and Helverschou in 2016 identified 18 studies on co-occurring ASD and substance abuse. The review focused on epidemiology, patient characteristics, function of substance abuse, and existing interventions for this population.…”