Recognizing A Dual Diagnosis
It can be difficult to identify a dual diagnosis. It takes time to tease out what might be a mental health disorder and what might be a drug or alcohol problem. The signs and symptoms also vary depending upon both the mental health problem and the type of substance being abused, whether its alcohol, recreational drugs, or prescription medications. For example, the signs of depression and marijuana abuse could look very different from the signs of schizophrenia and alcohol abuse. However, there are some general warning signs that you may have a co-occurring disorder:
- Do you use alcohol or drugs to cope with unpleasant memories or feelings, to control pain or the intensity of your moods, to face situations that frighten you, or to stay focused on tasks?
- Have you noticed a relationship between your substance use and your mental health? For example, do you get depressed when you drink? Or drink when youre feeling anxious or plagued by unpleasant memories?
- Has someone in your family grappled with either a mental disorder or alcohol or drug abuse?
- Do you feel depressed, anxious, or otherwise out of balance even when youre sober?
- Have you previously been treated for either your addiction or your mental health problem? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?
Dual diagnosis and denial
Autism & Alcohol: The Effects Of Drinking On The Spectrum
Autism and alcohol affect everyone differently, so its little wonder why the effects of alcohol on autistic people are so diverse. In the past, this has frustratingly meant that a lot of research on the topic of autism and alcohol is contradictory and, in general, lacking something which presents huge missed opportunities within autism academia .
To right this wrong and hopefully provide a bit more clarity on the correlation between autism and alcohol, this week, I wanted to look at the different ways that alcohol impacts the autistic community including why autistic people are twice as likely to form addictions and what autistic people can do to get support when excessive drinking becomes habitual.
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Were Too Honest For Our Own Good
You would think that being truthful was something you would want to promote but, in the interest of sparing someones feelings, apparently, were expected to lie from time to time and, whats more, if you dont then youre the jerk!
Known as a white lie, this is something many autistic people have struggled with, due to our literal way of thinking. However, recent studies into autistic people and lying have suggested that its not quite as simple as we wont lie because we cant. Instead, reports fromQueens University have found that, when autistic people do speak out of turn, its because we see the make-believe as mean and often believe that it will be less upsetting, to tell the truth .
Given the reasoning behind this, I think it would do more harm than good to try and change this behaviour in autistic people. So, if you ask us a question you dont like the answer to, just remember that this is an opinion an opinion which, though indisputable in our eyes, is not necessarily fact.
The Domains Of Alcohol
Although nearly every type of Axis I and II disorder in both DSM IV TR and ICD 10 Classifications, as well as most disorders from the 0-3 coding manual can be expressed by individuals with effects of prenatal alcohol exposure, there have been efforts to better characterize the common clinical features associated with ARND. While neurodevelopmental deficits may exist in a range of severity, all cases of individuals with FAS have some degree of ARND. The following neurodevelopmental domains have been found to be disrupted in clinical psychiatric cases of both FAS and ARND . As indicated in the diagram, prenatal alcohol exposure can lead to mood dysregulation and autonomic arousal, cognitive and executive dysfunctions, language and social skills deficits, and multi-sensory functional and perceptual deficits. Some individuals can have one or more domains of impairment, as indicated by the overlapping areas in the Venn diagram.
Figure 1.
Mood dysregulation and/or Autonomic Arousal:
As young children, the sensory integration issues involving sensitivity to sounds, environmental noise, lights, fans, easily irritated by voices, loud music, smells, tastes, even touch continue, and are often misunderstood as deliberate defiance.
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Does Drinking During Pregnancy Have A Link To Autism
Roisin Ryan explores data from the Millennium Cohort Study to understand if there is evidence of a link between drinking during pregnancy and autism in their child.
At present, women in the UK are advised to abstain from alcohol in pregnancy completely, but studies have estimated that up to 75% of women in the UK drink some alcohol during pregnancy.
Drinking alcohol in pregnancy has been shown to affect the brain development of children with fetal alcohol syndrome disorder being the most well-known disorder. Some recent studies have also suggested a link between alcohol in pregnancy and autism spectrum disorder.
Autism spectrum disorder is a neurodevelopmental disorder that affects 1 in 130 people worldwide.
It is a spectrum disorder because the symptoms of autism can vary a lot from person to person. People with ASD may have difficulty communicating and forming relationships with others, and view the world differently to those without autism. They may also have difficulty with abstract concepts and with language development. Overall, it results in a large burden for individuals, their families, and the state, and is estimated to cost 25 billion annually in the UK.
Our study used the Millennium Cohort Study data to investigate if alcohol use in pregnancy was associated with a childhood diagnosis of autism spectrum disorder.
There were patterns in the types of women who drank:
Data from the Millennium Cohort Study is available from the UK Data Service.
Prevalence Of Alcohol Abuse And Autism
One study showed that the risk of substance abuse in people with ASD is double that of people without ASD. Another study found that 35% percent of individuals with six or more autistic traits were alcohol-dependent, compared to 20% of individuals with no autistic traits. However, the risk may depend on how severe someones ASD is. Doctors are not sure which traits in ASD may make someone more likely to struggle with substance use, and which traits may make them less likely to use substances like alcohol. Therefore, more research is needed on the topic.
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Links Between Autism And Addiction
At first glance, addiction and autism wouldnt seem to be connected. Addiction normally develops in the teens or early 20s. ASD usually is diagnosed at a much younger age, as early as 18 months.
Sometimes, however, the symptoms of autism are overlooked until the teens or adulthood. One person with ASD wasnt diagnosed until his mid-30s, at which time he was struggling with addiction. That missing information helped to explain his addiction.
Until recently, most researchers believed that people with autism rarely became addicted because:
- They are regimented rule-followers. They dont want to use drugs.
- They are isolated from their peers. They dont face pressure to use drugs to fit in.
- People with severe autism cant live independently. They dont have opportunities to go out, find, and use drugs.
That beliefbased on limited and ambiguous empirical datanow seems to be very wrong except in the most severe cases.
According to a Swedish study, when people with ASD have average or better intelligencethats 70% of themthey may be twice as likely to have a SUD as their peers. The likelihood is even higher for people with ADHD.
Like autism, addiction also has a genetic component. The best evidence now suggests that there is a biological predisposition towards addiction. Thats why some people can have one drink and stop while others feel compelled to continue until they pass out.
Counselling Approaches For People With Autism & Addiction
Autism is a broad spectrum and for this reason, there is not one simple counselling approach that will be suitable. Many forms of therapy may be applied for those with autism, including the following:
1. Cognitive behavioural therapy
CBT has been shown to be very effective in the treatment of childhood depression, anxiety and OCD and it can be successfully used for those with autism when adapted to suit their needs can help a person to identify negative thoughts and as a result, challenge them and change the behaviours that they cause.
This can be particularly useful for people with autism in tackling one-track thinking, polarised thinking or fantastical thinking.
2. Solution-based brief therapy
This may be beneficial for autistic people as it takes a very clear and concise approach which is conducive with the way that the autistic brain functions.
This therapy helps patients to manage situations which may arise in the future and can be very effective in those with Aspergers which is a form of autism.
3. Psychoanalytic approaches
These approaches re used as a way of looking deeper into the unconscious mind and can help those with autism improve in areas such as relationships and self-awareness. However, many people with the condition may find this type of treatment a challenge so it should be approached mindfully.
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But Those On Psychotropic Agents For Autism Seemed To Attenuate Their Risk
byKristen Monaco, Staff Writer, MedPage Today January 4, 2021
Substance abuse problems were more prevalent among those with autism spectrum disorder than among sex- and age-matched controls, according to a Taiwanese study.
A retrospective analysis of nearly 6,600 people found that those with autism had a significantly higher risk for substance use disorder than those without autism , reported Chih-Sung Liang, MD, of the National Defense Medical Center in Taipei, and colleagues.
As shown in their study online in JAMA Pediatrics, the risk was driven mainly by a three-fold increased risk for drug use disorder , followed by a two-fold higher risk for alcohol use disorder .
In addition, those with autism and co-morbid substance use disorder had a more than three-fold higher risk of death during an average follow-up period of 8.1 years.
Interestingly, the researchers said, people who were taking psychotropic agents for the treatment of their autism had a reduced risk of developing SUD. Those receiving one agent saw a 40% reduced risk for SUD , while those taking multiple agents had a 63% reduced risk . And those on multiple agents with a cumulative defined daily dose above 365 saw the lowest risk for developing SUD .
“In other words, the risk of SUD could be reduced if patients with ASD maintain a stable condition,” Liang’s group said. “This finding should remind psychiatrists and the families of patients with ASD of the importance of ASD treatment.”
Disclosures
Newest Study Joke: Drinking While Pregnant Causes Autism
Maybe we can write a play, a murder mystery about autism, and call it âAlcohol and Old Sperm.âAs this study was flying around the lists last night, most people concurred these researchers have it backwards. Drinking doesnât cause autism. But autism can cause drinking.
Read about the study HERE.Kim Stagliano is Managing Editor of Age of Autism.
Posted by Age of Autism on March 23, 2008 at 07:08 AM in Current Affairs, Kim Rossi, Science|Permalink |
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Trouble With Emotional Processing
People with ASD may struggle not only in communicating their feelings, but in simply knowing what their feelings are. The inability to swiftly process emotions can lead a person to turn to alcohol for solace.
For people with ASD, drinking may seem like a comforting activity they can repeat when they feel anxious. Unfortunately, repeated episodes of drinking increase a persons risk of alcoholism.
Carry On The Conversation:
What improvements would you like to see in autism and addiction research? Let me know in the comments below. And, if you would like to read about 5 ways to beat anxiety then check out this article:5 Tips to Help Manage Anxiety in Autistic People.
As always, I can also be found on Twitter , on Instagram and via my email: .
If you like what you have seen on the site today, then show your support by liking the . Also, dont forget to sign up to the Autistic & Unapologetic newsletter where I share weekly updates as well as a fascinating fact I have found throughout the week.
Thank you for reading and I will see you next week for more thoughts from across the spectrum.
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Autism And Alcohol Addiction Treatment
Therapy is a core treatment for ASD, with cognitive behavioral therapy and pragmatic speech therapy being helpful in some people with the disorder. Depending on the ASD symptoms, sometimes medications may be used. For example, if someone with ASD has symptoms that cause them anxiety or depression, then an antidepressant may be used. Similarly, therapy is a core treatment for alcohol abuse. Sometimes medications may be used to help the person avoid alcohol in the future.
If you struggle with alcohol use, whether or not you have ASD, you are not alone. Our professionals at The Recovery Village Drug and Alcohol Rehab are here to help you. Contact us today to learn more.
Are Substance Use Disorders A Symptom Of Autism
Substance use disorders arent usually a symptom of autism. Those with autism are more likely to experience other symptoms, which include:
| poor social functioning |
| repetitive behaviors |
Sometimes, symptoms can resemble other conditions, such as bipolar disorder, attention deficit hyperactivity disorder, and social anxiety disorder. It can be difficult to sort these conditions from the issues caused by autism and alcohol.4
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Do People With Asd Have More Issues With Substance Use Disorders
Doctors know that an estimated 29.5 million people in the United States struggle with substance abuse, according to an article in the journal Substance Abuse: Research and Treatment.1 Of those, an estimated 23 percent have attention deficit hyperactivity disorder .1
However, doctors dont know exactly how many people with autism also struggle with substance use disorders. They do have some estimates that may range anywhere from 0.7% all the way up to 36%.1 One study suggested the range is anywhere from 11% to 29% percent over a persons lifetime.5
The more sociable, intelligent, or confident a person with an ASD is, the more they might struggle with their autism and alcohol use.1 Those who are very socially withdrawn are less likely to experience an alcohol issue. Those who are less social will show a weaker link between their autism and alcohol addiction.
Why Substance Use Makes Depression And Anxiety Worse
Self-medicating with recreational drugs and alcohol works temporarily to alleviate symptoms of anxiety or depression because they affect the same brain regions that the disorders do. But the result is that teens feel even worse when not using. Thats one reason substance use is a risk factor for suicide in kids with depression, Dr. Taskiran notes.
Another negative effect of substance use is that it undermines treatment. First, it diminishes a teenagers engagement in therapy, and hence its effectiveness. Second, if she is taking prescription medication, it may lower the effectiveness of that medication. The drugs and the medications target the same areas of the brain, explains Dr. Taskiran. When meds have to compete with drugs or alcohol, they are less effective. Also, its not uncommon with kids who are using substances to be noncompliant with their meds.
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How Useful Are Group Interventions In Autism Addiction Counselling
Many people with autism find social skills difficult to learn and implement. But it may be surprising to learn that group sessions can be particularly helpful when used alongside one to one therapy. These allow the individual to gain new social skills in a safe environment, often with other people facing similar struggles. In this situation, a person with autism may be able to more clearly pick up on their strengths, giving them a heightened feeling of confidence.
Many of those with autism find making friends a challenge. But these groups provide an opportunity to create new social circles and share common goals. In a group setting, people may look at how to manage change, how to alter certain behaviours and how to develop skills.
Factors That Increase The Risk Of Addiction
There is little doubt that some people are more at risk of developing addiction than others. This may be because of hereditary factors or it could be due to the environment in which the individual finds themselves. Those people who feel alienated from other people and struggle with social interactions seem to be particularly prone to substance abuse. This is because alcohol or drugs can make people feel more sociable while making them less self conscious. It is for this reason that people who suffer from conditions such as autism may be more at risk of addiction.
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