Characterizing autistic traits in treatment‐seeking young adults with substance use disorders

Abstract

Background and Objectives: Recent work highlights an increase in the overlap of autism spectrum disorder (ASD) and substance use disorder (SUD). Little is known about the presence of ASD symptoms in SUD-treatment-seeking populations. Methods:The informant-rated Social Responsiveness Scale-2 (SRS-2) was completed at intake to an outpatient SUD clinic for youth aged 16-26 (N = 69). Comparisons were made between those with elevated SRS-2 scores on demographic, psychiatric, and substance use variables.Results: Parents of sixty-nine patients with SUD completed the SRS-2. Fourteen (20%) (average age 18.7 ± 2.5) had elevated SRS-2 Total T-scores (≥66) and 55 (average age 18.1 ± 2.8) had non-clinical SRS-2 Total T-scores. There were few differences between groups; however, those with elevated SRS-2 Total T-scores were more likely to have a stimulant use disorder (odds ratio [OR] = 7.59, 95% confidence interval [CI] = 0.77, 101.88; p = 0.05) or an opioid use disorder (OR = 5.02, 95% CI = 0.59, 43.27; p = 0.08) than patients with normal SRS-2 Total T-scores as well as alcohol use in the week prior to intake.Discussion and Conclusions: A significant proportion of treatment-seeking SUD outpatients suffer from clinically elevated autistic traits. These findings highlight the importance of assessing for autistic traits in SUD treatment settings yet additional research is needed to determine if these findings are specific to the presence of ASD or secondary to sequelae of specific SUD presentations.

A Multi-Level Analysis of Biological, Social, and Psychological Determinants of Substance Use Disorder and Co-Occurring Mental Health Outcomes

“…The co-occurrence of substance use and psychopathology (dual diagnosis) can be explained by shared risk factors such as socioeconomic status and personality traits [30][31][32]. Many people with SUDs show psychiatric comorbidity, personality, mood, and anxiety disorders [12,[30][31][32][33], especially in cases of poly-drug use, where eating disorders, psychotic symptoms, schizophrenia [2], and PTSD (Post-Traumatic Stress Disorder) [4,34] can also be found; in some cases, the dual diagnosis of SUD and ASD (Autism Spectrum Disorder) is also found [35].…”

“…SUD and Autism Spectrum Disorder (ASD) are often found in comorbidity with each other, resulting in a dual diagnosis; in most of these cases, people use substances as a means to manage high levels of anxiety, stress, and social difficulties, including perceived social rejection [35]. The cause of this phenomenon seems mainly neurobiological, although its interaction with psychological aspects will be explored in depth in another paragraph.…”

“…Genetic predisposition can affect the brain's response to opioids and its ability to regulate the impulse for substance use on the one hand and affect an individual's vulnerability to developing psychological disorders such as anxiety or depression, which, in turn, are strongly linked to the risk of addiction [35]. For example, some theories suggest that individuals with autism spectrum disorder may possess dopaminergic differences in the fronto-cortical cortex, making them susceptible to repetitive pleasurable sensation seeking, with the risk of easily translating into addictive behaviors.…”

“…For example, some theories suggest that individuals with autism spectrum disorder may possess dopaminergic differences in the fronto-cortical cortex, making them susceptible to repetitive pleasurable sensation seeking, with the risk of easily translating into addictive behaviors. In addition, there appears to be a common dysregulation of the limbic system in individuals with SUD and ASD [35].…”

A Manualized Behavioral Therapy Intervention for Youth with Autism Spectrum Disorder and Substance Use Disorder

“…This large variability likely reflects the varied samples and methodologies used assessing SUD. Despite the lack of definitive data on substance use in people with ASD, it has been recently reported that 20% of young people aged 16-26 years old presenting for primary SUD treatment manifest prominent ASD traits as assessed by parental report on the social responsiveness scale–second edition (SRS-2) [ 16 ]. Althougth the SRS-2 is not an autism diagnostic tool, the results of this study suggest that when present, elevated autism traits by parental report appear to signal a distinct subset of clients (see McKowen et al [ 16 ] for additional information).…”