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Holmes LG, Xuan Z, Quinn E, Caplan R, Sanchez A, Wharmby P, Holingue C, Levy S, Rothman EF. Alcohol Use Patterns Among Underage Autistic and Non-Autistic Youth. J Autism Dev Disord 2023:10.1007/s10803-023-06086-4. [PMID: 37751088 PMCID: PMC11253551 DOI: 10.1007/s10803-023-06086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years. METHODS Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0-1 drinking episodes in past year) versus those who drank 2 + times in past year. RESULTS Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates. CONCLUSION Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.
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Affiliation(s)
| | - Ziming Xuan
- Boston University School of Public Health, Boston, USA
| | - Emily Quinn
- Boston University School of Public Health, Boston, USA
| | - Reid Caplan
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Amelia Sanchez
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Peter Wharmby
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Calliope Holingue
- Center for Autism and Related Disorders, Department of Mental Health, Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Emily F Rothman
- Department of Occupational Therapy, Boston University, Boston, USA
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Trovini G, Amici E, Bauco P, Matrone M, Lombardozzi G, Giovanetti V, Kotzalidis GD, De Filippis S. A comprehensive evaluation of adverse childhood experiences, social-emotional impairments, and neurodevelopmental disorders in cannabis-use disorder: Implications for clinical practice. Eur Psychiatry 2023; 66:e77. [PMID: 37702087 PMCID: PMC10594251 DOI: 10.1192/j.eurpsy.2023.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs), social-emotional impairments (SEIs), and neurodevelopmental disorders (NDs) are frequent in psychiatric disorders, including substance-use disorders. We aimed to determine the prevalence of ACE, SEI, or ND in individuals with cannabis-use disorder (CUD). We compared individuals with preCUD-onset ACE, SEI, or ND to those without. METHODS We crosssectionally studied 323 inpatients or outpatients with a history of past or current CUD, aged 12-35 years (mean age 22.94 ± 4.79), 64.5% of whom were male. The sample was divided into two groups: the non-premorbid (N = 52) and the premorbid ACE/SEI/ND group (N = 271). Within the premorbid group, further subgroups were based on ACEs, SEI, and NDs. We also analyzed other substance use and psychiatric symptoms/diagnoses based on the non-premorbid-premorbid dichotomy in the CUD sample. RESULTS Pre-CUD ACE-SEI-ND had higher prevalence of bipolar, schizoaffective, borderline personality, and attention-deficit/hyperactivity disorders, and a history of agitation, hallucinations, and self-injury. The ACE group had higher rates of agitation, depression, delusions, hallucinations, eating disorders, and use of cocaine, amphetamines, and hallucinogens than the SEI or ND. Patients in the premorbid group initiated cannabis use at an earlier age, experienced the first comorbid psychiatric episode earlier, and were hospitalized earlier than those in the non- premorbid ACE-SEI-ND group. CONCLUSIONS PreCUD-onset ACE, SEI, or ND conditions in individuals with CUDare linked to earlier onset of comorbid mental illness. Furthermore, ACEs contribute to significant and potentially severe clinical symptoms, as well as the use of substances other than cannabis.
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Affiliation(s)
| | | | - Piergiorgio Bauco
- Department of Psychiatry, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | - Georgios D. Kotzalidis
- Clinica Villa Von Siebenthal, Rome, Italy
- NESMOS Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Rome, Italy
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3
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Underwood JFG, DelPozo-Banos M, Frizzati A, Rai D, John A, Hall J. Neurological and psychiatric disorders among autistic adults: a population healthcare record study. Psychol Med 2023; 53:5663-5673. [PMID: 36189783 PMCID: PMC10482712 DOI: 10.1017/s0033291722002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-occurring psychiatric disorders are common in autism, with previous studies suggesting 54-94% of autistic individuals develop a mental health condition in their lifetime. Most studies have looked at clinically-recruited cohorts, or paediatric cohorts followed into adulthood, with less known about the autistic community at a population level. We therefore studied the prevalence of co-occurring psychiatric and neurological conditions in autistic individuals in a national sample. METHODS This retrospective case-control study utilised the SAIL Databank to examine anonymised whole population electronic health record data from 2001 to 2016 in Wales, UK (N = 3.6 million). We investigated the prevalence of co-occurring psychiatric and selected neurological diagnoses in autistic adults' records during the study period using International Classification of Diseases-10 and Read v2 clinical codes compared to general population controls matched for age, sex and deprivation. RESULTS All psychiatric conditions examined were more common amongst adults with autism after adjusting for age, sex and deprivation. Prevalence of attention-deficit hyperactivity disorder (7.00%), bipolar disorder (2.50%), obsessive-compulsive disorder (3.02%), psychosis (18.30%) and schizophrenia (5.20%) were markedly elevated in those with autism, with corresponding odds ratios 8.24-10.74 times the general population. Depression (25.90%) and anxiety (22.40%) were also more prevalent, with epilepsy 9.21 times more common in autism. CONCLUSIONS We found that a range of psychiatric conditions were more frequently recorded in autistic individuals. We add to understanding of under-reporting and diagnostic overshadowing in autism. With increasing awareness of autism, services should be cognisant of the psychiatric conditions that frequently co-occur in this population.
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Affiliation(s)
- Jack F. G. Underwood
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
| | | | - Aura Frizzati
- Cedar Healthcare Technology Research Centre, Cardiff & Vale University Health Board, Cardiff, UK
| | - Dheeraj Rai
- Bristol Medical School, Bristol Population Health Science Institute, Bristol, UK
| | - Ann John
- Population Data Science, Medical School, Swansea University, Swansea, UK
| | - Jeremy Hall
- Division of Psychological Medicine and Clinical Neurosciences, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
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Pijnenburg LJ, Kaplun A, de Haan L, Janecka M, Smith L, Reichenberg A, Banaschewski T, Bokde ALW, Quinlan EB, Desrivières S, Grigis A, Garavan H, Gowland P, Heinz A, Ittermann B, Martinot JL, Martinot MLP, Nees F, Orfanos DP, Paus T, Poustka L, Hohmann S, Millenet S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Velthorst E. Autistic traits and alcohol use in adolescents within the general population. Eur Child Adolesc Psychiatry 2023; 32:1633-1642. [PMID: 35318541 PMCID: PMC10460309 DOI: 10.1007/s00787-022-01970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
It has been suggested that autistic traits are associated with less frequent alcohol use in adolescence. Our study seeks to examine the relationship between autistic traits and alcohol use in a large adolescent population. Leveraging data from the IMAGEN cohort, including 2045 14-year-old adolescents that were followed-up to age 18, we selected items on social preference/skills and rigidity from different questionnaires. We used linear regression models to (1) test the effect of the sum scores on the prevalence of alcohol use (AUDIT-C) over time, (2) explore the relationship between autistic traits and alcohol use patterns, and (3) explore the specific effect of each autistic trait on alcohol use. Higher scores on the selected items were associated with trajectories of less alcohol use from the ages between 14 and 18 (b = - 0.030; CI 95% = - 0.042, - 0.017; p < 0.001). Among adolescents who used alcohol, those who reported more autistic traits were also drinking less per occasion than their peers and were less likely to engage in binge drinking. We found significant associations between alcohol use and social preference (p < 0.001), nervousness for new situations (p = 0.001), and detail orientation (p < 0.001). Autistic traits (social impairment, detail orientation, and anxiety) may buffer against alcohol use in adolescence.
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Affiliation(s)
- Lisa J Pijnenburg
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, The Netherlands.
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Anais Kaplun
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - Magdalena Janecka
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Seaver Autism Center for Research and Treatment, New York City, NY, USA
| | - Lauren Smith
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Seaver Autism Center for Research and Treatment, New York City, NY, USA
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Erin Burke Quinlan
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sylvane Desrivières
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, 91191, Gif-sur-Yvette, France
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont, Burlington, VT, 05405, USA
- Department of Psychology, University of Vermont, Burlington, VT, 05405, USA
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, NG, UK
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - Jean-Luc Martinot
- Maison de Solenn, Paris, France
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging and Psychiatry", UniversityParis Sud, University Paris Descartes, Sorbonne Université, Paris, France
| | - Marie-Laure Paillère Martinot
- Maison de Solenn, Paris, France
- Department of Child and Adolescent Psychiatry, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
- Institute of Cognitive and Clinical Neuroscience, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Square J5, Mannheim, Germany
| | | | - Tomáš Paus
- Department of Psychology, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, M6A 2E1, Canada
- Department of Psychiatry, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, ON, M6A 2E1, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Medical Research Council - Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- PONS Research Group, Department of Psychiatry and Psychotherapy, Humboldt University, Campus Charite Mitte, Berlin, Germany
- Institute for Science and Technology of Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, People's Republic of China
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Seaver Autism Center for Research and Treatment, New York City, NY, USA
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Mutiso VN, Ndetei DM, Muia EN, Masake M, Alietsi RK, Onsinyo L, Musyimi C, Mamah D. Risk of autism spectrum disorder and association of its symptoms with psychiatric and substance use disorders in non-clinical student sample in Kenya: cross-sectional study. BJPsych Open 2023; 9:e160. [PMID: 37605834 PMCID: PMC10486240 DOI: 10.1192/bjo.2023.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The prevalence and patterns of autism spectrum disorder (ASD) symptoms/traits and the associations of ASD with psychiatric and substance use disorders has not been documented in non-clinical students in Sub-Saharan Africa, and Kenya in particular. AIMS To document the risk level of ASD and its traits in a Kenyan student population (high school, college and university) using the Autism-Spectrum Quotient (AQ); and to determine the associations between ASD and other psychiatric and substance use disorders. METHOD This was a cross-sectional study among students (n = 9626). We used instruments with sufficient psychometric properties and good discriminative validity to collect data. A cut-off score of ≥32 on the AQ was used to identify those at high risk of ASD. We conducted the following statistical tests: (a) basic descriptive statistics; (b) chi-squared tests and Fisher's exact tests to analyse associations between categorical variables and ASD; (c) independent t-tests to examine two-group comparisons with ASD; (d) one-way analysis of variance to make comparisons between categorical variables with three or more groups and ASD; (e) statistically significant (P < 0.05) variables fitted into an ordinal logistic regression model to identify determinants of ASD; (f) Pearson's correlation and reliability analysis. RESULTS Of the total sample, 54 (0.56%) were at high risk of ASD. Sociodemographic differences were found in the mean scores for the various traits, and statistically significant (P < 0.05) associations we found between ASD and various psychiatric and substance use disorders. CONCLUSIONS Risk of ASD, gender characteristics and associations with psychiatric and substance use disorders are similar in this Kenyan sample to those found in Western settings in non-clinical populations.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Esther N. Muia
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Monicah Masake
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K. Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lydia Onsinyo
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St Louis, Missouri, USA
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McKowen J, Berger A, Towbin J, Yule AM, Woodward D, Nowinski L, Forchelli G, Meyers RJ, Joshi G, Wilens TE. A Manualized Behavioral Therapy Intervention for Youth with Autism Spectrum Disorder and Substance Use Disorder. Case Rep Psychiatry 2023; 2023:8998160. [PMID: 37038552 PMCID: PMC10082677 DOI: 10.1155/2023/8998160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Research highlights the increasing overlap of autism spectrum disorder and substance use disorders in young people. However, no behavioral treatments exist addressing this comorbidity despite great need. A team of clinicians developed an integrated behavioral protocol addressing substance use in youth with autism spectrum disorder. The multidisciplinary team developed 12 youth, 7 parent, and 3 joint modules based on established evidence-based therapies shown to have effectiveness separately addressing autism spectrum and substance use. Two cases are discussed to illuminate this integrated intervention. Adaptations to the protocol were made during feedback from patients and their parents. Further research is needed to determine the effectiveness of this preliminary protocol.
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Affiliation(s)
- James McKowen
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy Berger
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Joshua Towbin
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, 720 Harrison Avenue, Suite 915, Boston, MA 02118, USA
| | - Diana Woodward
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Lisa Nowinski
- Lurie Center for Autism, Massachusetts General Hospital, 1 Magurie Road, Lexington, MA 02421, USA
| | - Gina Forchelli
- Lurie Center for Autism, Massachusetts General Hospital, 1 Magurie Road, Lexington, MA 02421, USA
| | - Robert J. Meyers
- Center of Alcoholism, Substance Abuse and Addiction, University of New Mexico, 2650 Yale Blvd., NM 87106, USA
| | - Gagan Joshi
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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7
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Scott M, Leppanen J, Allen M, Jarrold C, Sedgewick F. Longitudinal Analysis of Mental Health in Autistic University Students Across an Academic Year. J Autism Dev Disord 2023; 53:1107-1116. [PMID: 35802290 PMCID: PMC9264293 DOI: 10.1007/s10803-022-05560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autistic people have worse mental health (MH) than non-autistic people. This proof-of-concept study explored feasibility of longitudinal research with autistic university students, focusing on their MH and coping styles across an academic year. METHODS Twenty-two students took part at all timepoints. They completed four rounds of online MH questionnaires. RESULTS Over 80% of students were retained. They started the year with high levels of all MH issues, which remained stable across the year. Network Change analysis showed the connections between MH and coping style changed over time. CONCLUSIONS Autistic students are engaged participants who are likely to take part in longitudinal research. While MH levels were stable, it may be that coping styles are a useful target for intervention.
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Affiliation(s)
- Matthew Scott
- School of Education, University of Bristol, Bristol, UK.,School of Psychology, University of Cardiff, Cardiff, UK
| | - Jenni Leppanen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Melissa Allen
- School of Education, University of Bristol, Bristol, UK
| | - Chris Jarrold
- School of Psychological Science, University of Bristol, Bristol, UK
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8
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Association between autistic traits and binge drinking: Findings from Japan. Soc Psychiatry Psychiatr Epidemiol 2023; 58:217-226. [PMID: 35610390 DOI: 10.1007/s00127-022-02299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Substance misuse may be elevated in some individuals with autism spectrum disorder (ASD). As yet, however, little is known about the association between autistic traits (AT) and substance use/misuse in adults. This study examined the association between AT and binge drinking (BD) among individuals in Japan. METHODS Data were analyzed from 1452 individuals aged 18 and above collected during an online survey in February 2021. Self-reported information was obtained on BD assessed as consuming 5 or more (males) or 4 or more (females) drinks containing any kind of alcohol within a 2-h period. AT were assessed with the Japanese version of the Autism Spectrum Quotient - the AQ-J-10. Logistic regression analysis was used to examine associations. RESULTS The prevalence of past-month BD was significantly higher in individuals with AT compared to those without AT (42.7% > 27.6%). In a fully adjusted analysis that controlled for mental health (anxiety, depression) and attention-deficit/hyperactivity disorder symptoms, individuals with AT had significantly higher odds for BD once a week or more often (OR: 1.54, 95%CI: 1.04-2.29). AT were also associated with significantly higher odds for BD among women (OR: 2.27, 95%CI: 1.08-4.76), and those aged 18-34 (OR: 2.37, 95%CI: 1.09-5.18) and aged 60 and above (OR: 2.15, 95%CI: 1.02-4.53). CONCLUSION Individuals with AT have higher odds for BD. Increased efforts to detect alcohol use/misuse in adults with AT and AT in adults misusing alcohol may be efficacious in efforts to manage symptoms and eliminate harmful alcohol misuse.
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9
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Rothman EF, Holmes LG, Brooks D, Krauss S, Caplan R. Reasons for alcohol use and non-use by underage U.S. autistic youth: A qualitative study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:213-225. [PMID: 35499489 PMCID: PMC9626389 DOI: 10.1177/13623613221091319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT What is already known about the topic? Hazardous alcohol use is when a person's drinking puts them at increased risk for negative events (e.g. health problems or car crashes). Some studies show that autistic people may be at greater risk for hazardous alcohol use than non-autistic people, while other studies have found that hazardous alcohol use is less common among autistic people than non-autistic people. We need to learn why autistic underage youth choose to drink alcohol or not. The goal of this study was to learn from US autistic youth about their attitudes and behavior related to alcohol. Forty autistic youth aged 16-20 years old were interviewed.What this article adds? Youth described several reasons why they choose to drink alcohol, including feeling like non-autistic people are more accepting when drinking, that it puts them in a less irritable or bored mood, helps them cope with problems, and helps them fit in. Reasons for not drinking alcohol include worries about becoming addicted, medication interactions, not liking the taste, fear of experiencing hangover and other health problems, and concern about acting foolish when drunk.Implications for practice, research, or policy Results reveal that hazardous alcohol use in autistic adults could have its roots in underage experiences that give autistic youth temporary relief from social anxiety, feeling lonely, and challenges with sensory processing. Right now, there are no evidence-based alcohol prevention programs in the United States for autistic people. One or more such programs may be needed. The results from this study could be used to adapt existing programs for non-autistic youth to the unique needs and risk factors of autistic youth.
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10
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Brosnan M, Adams S. Adapting Drug and Alcohol Therapies for Autistic Adults. AUTISM IN ADULTHOOD 2022; 4:214-223. [PMID: 36606157 PMCID: PMC9645670 DOI: 10.1089/aut.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Autistic people may be at a higher risk of drug and alcohol misuse than the general population. Autistic people, however, are under-represented within drug and alcohol support services. This is the first survey of drug and alcohol therapists' perceptions of current service provision for autistic clients and recommendations for reasonable adjustments that therapists can make to enhance successful outcomes. Methods We conducted an online survey of 122 drug and alcohol therapists, exploring therapists' demographics, training and experience with autistic clients, approaches and adaptations used with autistic clients, and therapists' confidence with autistic clients. Within two focus groups, 11 members of the autistic and broader autism (e.g., family members, professionals) communities reflected on the reasonable adjustments reported by therapists. Results Most therapists had autistic clients and most therapists had received no autism-specific training. Alcohol misuse was the most common presenting issue, and most therapists reported that treatment outcomes were less favorable for autistic clients than for other groups. Therapists perceived that barriers to successful outcomes were (1) a lack of autism-specific training, (2) a need to adapt therapy for autistic clients, and (3) a lack of shared perspective between the therapist and the autistic client. Previous research has identified a range of reasonable adaptations and, when asked, therapists were moderately confident in their ability to deliver these. Members of the autistic and broader autism communities coproduced guidance detailing how therapists can best adapt their practice for autistic clients including how to structure sessions and the language to use within sessions. Conclusion This study highlights a need for practical and theoretical training for drug and alcohol therapists to support successful adaptation to current service provision for autistic clients and to develop a shared perspective on the desired aims and outcomes of the therapeutic process.
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Affiliation(s)
- Mark Brosnan
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Sally Adams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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11
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Roux AM, Tao S, Marcus S, Lushin V, Shea LL. A national profile of substance use disorder among Medicaid enrollees on the autism spectrum or with intellectual disability. Disabil Health J 2022; 15:101289. [DOI: 10.1016/j.dhjo.2022.101289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
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12
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McKowen J, Woodward D, Yule AM, DiSalvo M, Rao V, Greenbaum J, Joshi G, Wilens TE. Characterizing autistic traits in treatment-seeking young adults with substance use disorders. Am J Addict 2021; 31:108-114. [PMID: 34957636 DOI: 10.1111/ajad.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/04/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
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. SCIENTIFIC SIGNIFICANCE This study is, to our knowledge, the first to have examined the prevalence, morbidity, or clinical characteristics, associated with ASD symptoms in a SUD-specific population.
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Affiliation(s)
- James McKowen
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Woodward
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M Yule
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Vinod Rao
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Greenbaum
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Gagan Joshi
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
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13
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Kunreuther E. Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight. Psychiatr Clin North Am 2021; 44:35-49. [PMID: 33526236 DOI: 10.1016/j.psc.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.
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Affiliation(s)
- Elizabeth Kunreuther
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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14
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Haasbroek H, Morojele N. A Systematic Literature Review on the Relationship Between Autism Spectrum Disorder and Substance Use Among Adults and Adolescents. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00242-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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15
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Anderson SAR, Catallozzi M. Autism Spectrum Disorder and the Risk of Substance Use Disorder: A Call for Targeted Screening and Prevention in Adolescents. JAMA Pediatr 2021; 175:e205376. [PMID: 33393966 DOI: 10.1001/jamapediatrics.2020.5376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Ann R Anderson
- Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.,Vagelos College of Physicians & Surgeons, Columbia University, New York, New York.,Mailman School of Public Health, New York, New York
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16
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Kaltenegger HC, Doering S, Gillberg C, Wennberg P, Lundström S. Low prevalence of risk drinking in adolescents and young adults with autism spectrum problems. Addict Behav 2021; 113:106671. [PMID: 33080544 DOI: 10.1016/j.addbeh.2020.106671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) have high rates of "comorbidity". Research on concurrent substance use (disorder) in ASD, however, is scarce and findings have been inconsistent. This study aims at assessing the prevalence of risk drinking in adolescent and young adult twins with and without autism spectrum problems. Data from a Swedish longitudinal nationwide twin study were analyzed. Across three age groups of 15- (N = 10,050), 18- (N = 7,931) and 24-year-olds (N = 2,882) prevalence rates of risk drinking were compared between twins with and without an ASD proxy diagnosis and between different ASD subgroups based on comorbid proxies for attention-deficit/hyperactivity disorder (ADHD) and/or Learning Disorder (LD). ASD, ADHD, and LD were assessed using the Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC), and risk drinking was captured by the Alcohol Use Disorders Identification Test (AUDIT; age 18 and 24) and another set of self-report questions (age 15). In each age group, the prevalence of risk drinking in ASD was lower than in individuals without ASD, yet increasing continuously with age. Exploratory subgroup ASD analyses showed a trend towards risk drinking being more common among individuals with co-existing ADHD or LD problems than among those without "comorbidity", although sample sizes were too small to draw any certain conclusions. This study indicates low prevalence of risk drinking in adolescents and young adults with autism spectrum problems and highlights the need for further research on alcohol use in individuals with ASD and comorbid disorders.
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17
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Adhia A, Bair-Merritt M, Broder-Fingert S, Nunez Pepen RA, Suarez-Rocha AC, Rothman EF. The Critical Lack of Data on Alcohol and Marijuana Use by Adolescents on the Autism Spectrum. AUTISM IN ADULTHOOD 2020; 2:282-288. [PMID: 36600961 PMCID: PMC8992854 DOI: 10.1089/aut.2019.0051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Emerging evidence suggests that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, U.S. population-based estimates of substance use by autistic youth are limited. The aim of this perspective article was to highlight the lack of data sets that collect information about alcohol and marijuana use by autistic youth in the United States. We used a four-step investigation to identify potential data sources that could provide an estimate of the prevalence of alcohol and/or marijuana use in autistic youth, without regard to whether those estimates would be robust. We identified a total of 19 potential U.S. data sources. Of these, only one included information about both autism and alcohol and/or marijuana by youth. There is too little research on substance use by autistic adolescents, and rigorously collected data would benefit the field. Our recommendations include increased federal funding for data collection from autistic youth on substance use, additional questions on nationally representative surveys that assess autism status in multiple ways, and the use of robust measures of substance use that allow for characterization of substance use according to multiple dimensions. As the number of autistic youth identified increases and these youth transition into adulthood, better understanding of their substance use patterns is critical for developing health promotion efforts that appropriately and fully serve the needs of autistic youth. Lay summary Why is this topic important?: Alcohol is the most commonly used substance among adolescents, and marijuana is the most commonly used illicit drug. Previous studies suggest that at least some autistic individuals may be at increased risk of substance use disorder compared with allistic counterparts, potentially to control social anxiety or facilitate social interaction. However, to the best of our knowledge, estimates of substance use by autistic youth in the United States are limited.What is the purpose of this article?: This study was performed to highlight the lack of data sets that collect information about alcohol and/or marijuana use by autistic youth in the United States. We systematically reviewed U.S. data sources on child and/or adolescent health, disability, and/or substance use to identify sources that could generate estimates of the prevalence of substance use among autistic adolescents in the United States, even if those estimates may not be stable due to small sample sizes or other methodological weaknesses.What is the perspective of the authors?: The authors are a team of allistic researchers. M.B.-M. and S.B.-F. are pediatricians. E.F.R. and A.A. are public health researchers. S.B.-F. has an extensive background in providing clinical health care services to children with autism and is an autism researcher. R.A.N.P. and A.C.S.-R. are master's level public health research assistants. E.F.R., A.A., and M.B.-M. are adolescent health research experts. E.F.R. has an adolescent daughter on the autism spectrum. Our collective positionality is that we identify as people who are not autistic and who select to focus on research that we hope will benefit autistic people and society in general.What did the authors find?: Based on our four-step investigation, we identified 19 U.S. data sources that had the potential to generate estimates of the prevalence of alcohol and/or marijuana use in autistic youth. Only one included information about both autism and substance use.What do the authors recommend?: The National Institutes of Health (NIH), and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Drug Abuse (NIDA), specifically, should prioritize funding data collection from autistic youth and adults on alcohol and marijuana use, misuse, hazardous use, dependence, and use disorders. In addition, it is critical that nationally representative surveys and data sources include robust questions on autism and substance abuse. This includes assessing autism status in multiple ways (e.g., self-report, diagnosis by a clinician, neuropsychology reports). Substance use questions should include age of first drink or use, frequency of use, quantity of use per day or within a certain number of hours, expectancies, consequences of use, and indicators of alcohol use disorder.How will these recommendations help autistic individuals?: These findings highlight a critical gap in the literature on substance use among autistic youth. Substance use is recognized as a pressing adolescent health problem, and autistic youth deserve evidence-based substance use prevention strategies. Without an estimate of substance use by autistic youth, it is difficult to justify to funding entities the expenditure of resources on the development of evidence-based substance use prevention strategies to benefit them.
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Affiliation(s)
- Avanti Adhia
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Address correspondence to: Avanti Adhia, ScD, Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, P.O. Box 359960, Seattle, WA 98104, USA
| | - Megan Bair-Merritt
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Rocio A. Nunez Pepen
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Annieliesa C. Suarez-Rocha
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Emily F. Rothman
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
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18
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Kunreuther E. Autism Spectrum Disorder and Substance Use Disorder: A Dual Diagnosis Hiding in Plain Sight. Child Adolesc Psychiatr Clin N Am 2020; 29:467-481. [PMID: 32471596 DOI: 10.1016/j.chc.2020.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with autism spectrum disorder (ASD) have a significantly higher risk for developing a substance use disorder (SUD) than the general population yet literature addressing cooccurring ASD and SUD is scarce. This article explores connections between ASD and SUD and the impact on development, screening and treatment. The article proposes culturally constructed narratives associated with both diagnoses may be responsible for the dearth of research and literature. Constructed narratives of ASD and SUD do not naturally intersect and the resulting disconnect can create a cognitive dissonance that could allow the medical and general community to neglect this life-threatening dual diagnosis.
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Affiliation(s)
- Elizabeth Kunreuther
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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20
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Constantino JN, Strom S, Bunis M, Nadler C, Rodgers T, LePage J, Cahalan C, Stockreef A, Evans L, Jones R, Wilson A. Toward Actionable Practice Parameters for "Dual Diagnosis": Principles of Assessment and Management for Co-Occurring Psychiatric and Intellectual/Developmental Disability. Curr Psychiatry Rep 2020; 22:9. [PMID: 32008108 PMCID: PMC6995447 DOI: 10.1007/s11920-020-1127-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Although treatment algorithms and parameters for best practice are readily available for all major syndromes of psychiatric impairment, the occurrence of psychiatric syndromes in individuals with intellectual and developmental disability (IDD) invokes serious contextual challenges for interpretation of symptoms, diagnosis, and optimization of treatment, both for clinicians and for the service sectors in which care and support of individuals with IDD are delivered. Recognizing that there exist very few definitive resources for best practice under the circumstance of this form of "dual diagnosis," the Missouri Department of Mental Health convened an expert panel to conduct a focused review and synthesis of the relevant scientific literature from which to develop guidance in the form of decision support to clinicians. This article summarizes the findings for three of the most common and impairing clusters of psychiatric symptoms that co-occur with IDD-aggression, depression, and addictions. RECENT FINDINGS Individuals with IDD are at high risk for the development of psychiatric symptoms (PS), which often manifest uniquely in IDD and for which evidence for effective intervention is steadily accruing. Interventions that are commonly implemented in the IDD service sector (e.g., functional communication training and positive behavioral support planning) are capable of mitigating severe behavioral impairment, yet rarely invoked when dual diagnosis patients are seen in the psychiatric service sector. Conversely, state-of-the-art interventions for traumatic stress, pharmacotherapy, and psychotherapy have proven capable of improving behavioral impairments in IDD but are typically restricted to the psychiatric service sector, where there exist significant barriers to access for patients with IDD, including limitations imposed by diagnostic eligibility and practitioner experience. Bridging these gaps in knowledge and clinical capacity across the respective IDD and PS service sectors should be of very high priority in strategizing the care and support of IDD patients with serious co-occurring psychiatric conditions.
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Affiliation(s)
- John N. Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Shae Strom
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Michael Bunis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Cy Nadler
- Children’s Mercy Kansas City, Kansas City, MO USA
| | - Teresa Rodgers
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Julia LePage
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Connie Cahalan
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Amber Stockreef
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Lucas Evans
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Rachel Jones
- Missouri Department of Mental Health, Jefferson City, MO USA
| | - Alyssa Wilson
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO USA
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21
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Kaltenegger HC, Philips B, Wennberg P. Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study. Scand J Psychol 2019; 61:416-422. [PMID: 31840273 DOI: 10.1111/sjop.12595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/04/2019] [Indexed: 11/27/2022]
Abstract
Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients' (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants' autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients' consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.
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Affiliation(s)
- Helena C Kaltenegger
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany
| | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Peter Wennberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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22
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Helverschou SB, Brunvold AR, Arnevik EA. Treating Patients With Co-occurring Autism Spectrum Disorder and Substance Use Disorder: A Clinical Explorative Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2019; 13:1178221819843291. [PMID: 31024216 PMCID: PMC6472168 DOI: 10.1177/1178221819843291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/15/2019] [Indexed: 12/04/2022]
Abstract
Background: Substance use disorders (SUDs) have been assumed to be rare in individuals
with autism spectrum disorder (ASD). Recent research suggests that the rates
of SUD among individuals with ASD may be higher than assumed although
reliable data on the prevalence of SUD in ASD are lacking. Typical
interventions for SUD may be particularly unsuitable for people with ASD but
research on intervention and therapy are limited. Methods: This study addresses ways of improving services for individuals with ASD and
SUD by enhancing the competence of professionals in ordinary SUD outpatient
clinics. Three therapists were given monthly ASD education and group
supervision. The participants were ordinary referred patients who wanted to
master their problems with alcohol or drugs. Four patients, all men
diagnosed with ASD and intelligence quotient (IQ) ⩾ 70 completed the
treatment. The participants were given cognitive behavioural therapy (CBT)
modified for their ASD over a minimum of 10 sessions. The therapies lasted
between 8 and 15 months. Standardised assessments were conducted pre- and
post-treatment. Results: Post-treatment, 2 participants had ended their drug and alcohol abuse
completely, 1 had reduced his abuse, and 1 still had a heavy abuse of
alcohol. Physical well-being was the most prevalent reported positive aspect
of drug or alcohol use, whereas the experience of being left out from social
interaction was the most frequent negative aspects of intoxication. Conclusions: CBT may represent a promising treatment option for individuals with ASD and
SUD. The results suggest that patients’ symptoms can be reduced by providing
monthly ASD education and group supervision to therapists in ordinary SUD
outpatient clinics. This group of patients need more sessions than other
client groups, the therapy has to be adapted to ASD, ie, direct,
individualised, and more extensive. Moreover, the patients need
psychoeducation on ASD generally, social training, and support to organise
several aspects of their lives and some patients need more support than can
be provided in an outpatient clinic.
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Affiliation(s)
- Sissel Berge Helverschou
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Anette Ræder Brunvold
- SUD Outpatient Clinic, Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
| | - Espen Ajo Arnevik
- Section for Addiction Research, Department of Addiction Treatment, Oslo University Hospital, Oslo, Norway
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Abstract
Earlier detection and effective, evidence-based practices are gradually improving outcomes for people with autism spectrum disorder (ASD). Although some continue to need intensive support as adults, an increasing number are now going to college, becoming independent, and marrying. With the transition to adulthood, people with ASD will face a number of significant challenges. Health care providers who are knowledgeable about these challenges can help foster better outcomes and support those requiring higher levels of care. We summarize the challenges faced by youth with ASD as they transition into adulthood and note areas where more research is needed. [Pediatr Ann. 2017;46(6):e219-e223.].
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