Autistic adults who misuse alcohol are more likely to suffer with poorer mental health and wellbeing, according to a UK study published in SAGE.

The study surveyed 237 ‘high-functioning’ autistic adults aged 18-75 and explored the demographic and psychological predictors of alcohol use and misuse among the group.

While historically alcohol use has been considered rare among autistic adults, some more recent research appears to suggest that autism could in fact increase an individual’s risk for substance misuse, including alcohol misuse.

The study’s authors therefore set out to discover:

  1. The proportion of participants who abstain from, use and misuse alcohol;
  2. The associations between gender, relationship and employment status and alcohol use and misuse in autistic adults;
  3. The association between autistic trait severity and alcohol use and misuse;
  4. The associations between levels of depression, generalised anxiety, social anxiety and mental wellbeing and alcohol use and misuse in autistic adults;
  5. The association between levels of social camouflaging and alcohol use and misuse in autistic adults.

Autistic males are more likely to drink alcohol than autistic females

The survey found that the majority (55%) of the sample reported consuming alcohol occasionally to moderately, 15.2% were classified as hazardous drinkers and the remaining 30% reported abstaining from alcohol, which is higher than the 20.4% of adults who reported teetotalism in a 2017 general population survey.

Scores for independent variables across the three groups demonstrated a U-shaped pattern, with hazardous drinkers and non-drinkers scoring higher on autistic traits, depression, generalised anxiety and social anxiety than non-hazardous drinkers.

There was a similar pattern for mental wellbeing, with non-hazardous drinkers reporting the highest wellbeing, followed by non-drinkers, with hazardous drinkers reporting the lowest levels of wellbeing.

Taken together, these findings suggest that non-hazardous consumption of alcohol is associated with better mental health for autistic adults relative to teetotalism, while hazardous alcohol consumption is associated with poorer mental health in this group.

Being a male was found to reduce the likelihood of abstaining from alcohol, while autistic traits, such as depression, generalised anxiety and social anxiety were associated with both an increased likelihood of teetotalism and hazardous drinking, while mental wellbeing reduced this risk.

No significant relationship between alcohol use and camouflaging was found, suggesting that although camouflaging is related to mental health problems generally, it did not seem to directly increase likelihood of alcohol use or misuse among this sample.

These findings suggest that an individual’s gender and level of autistic traits may be the most significant predictors of alcohol use among autistic adults.

“Screening for alcohol use should form part of routine physical healthcare”

In response to the findings, the authors of the study recommend that: “Screening for alcohol use should form part of routine physical healthcare and mental health assessments for autistic adults given that a significant proportion of these individuals may be misusing alcohol.

“An individualised approach should then be taken to explore the unique combination of factors involved in alcohol misuse for those identified to be at-risk, in order to pave the way for tailored treatment and support.”

They added that clinicians should be aware that autistic adults may be using alcohol for both similar (e.g. self-medication of mental health problems) and different (e.g. to cope with sensory overstimulation during socialisation) reasons to non-autistic adults. Alternative coping strategies should therefore be discussed and trialled to minimise hazardous alcohol use in this group.