The link between autism and addiction is also unsurprising to clinicians who work with people on the spectrum. Valerie Gaus, a psychologist in the New York City area, says of her clients with autism who have drinking or drug problems, many of the older ones turn to alcohol, whereas the younger ones tend to use marijuana.
Eric Hollander has seen a similar pattern. However, he says he treats more behavioral addictions, such as gambling. “I work with a lot of people with [autism] who have all kinds of impulsive behaviors,” says Hollander, director of the Autism and Obsessive Compulsive Spectrum Program at Albert Einstein College of Medicine in New York. “In fact, that’s one of the main targets when people come in for treatment. Either they’re out of control in terms of shopping on the internet or gaming, or they’re just addicted to the internet.”
Hollander has looked at similarities between obsessive compulsive disorder, addiction, and the impulsive and compulsive behaviors that occur in people with autism. He proposes that these conditions, all characterized by repetitive thought and behavior, should be grouped together as “obsessive compulsive spectrum disorders” in the diagnostic guidelines.
Impulsivity—acting quickly without thinking—and compulsivity, or being unable to stop an activity once it has started, are both problems of self-control, or “executive function.” Impulsivity is strongly linked with the risk for becoming addicted; addiction is defined as compulsive drug use that persists despite negative consequences. People with autism show signs of both impulsivity and compulsivity. For example, they frequently engage in repetitive, compulsive behaviors—dubbed “stimming”— to address either a lack of sensory stimulation or a surfeit of it. In the case of addiction, different types of addictive drugs can enhance or reduce sensation.
Tanea Paterson, a mother of two who lives in New Zealand, used drugs to deal with social stress, but also to cope with her sensory problems. A mixture of heroin and other illegal opioids, her drug of choice, “wound down my senses to a more bearable level,” she says. Using drugs also gave Paterson routines, she says. “They were predictable in an unpredictable world.”
Paterson kicked her addiction more than 10 years ago, but didn’t find out she has autism until 2015. Her son had previously been diagnosed with autism, and she convinced the therapist who had helped him to evaluate her. For Paterson, too, the diagnosis brought relief: “It was a lifting of so much guilt and shame in many, many ways,” she says.
Paterson had been bullied and excluded as a teenager before she found peers who used marijuana and were more accepting. In this group, she felt safer, she says. Others with autism and addiction also report that drug culture helps them feel accepted: Unusual behavior is expected when people are high, so they don’t stand out.