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January 4, 2021

Autism Spectrum Disorder and the Risk of Substance Use Disorder: A Call for Targeted Screening and Prevention in Adolescents

Author Affiliations
  • 1Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York
  • 2Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
  • 3Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
  • 4Mailman School of Public Health, New York, New York
JAMA Pediatr. 2021;175(2):e205376. doi:10.1001/jamapediatrics.2020.5376

Screening for substance use is a priority in adolescent health care.1 There has long been an acknowledgment of the link between psychiatric diagnoses and substance use disorders (SUDs).2,3 One of the cornerstones of the approaches to decreasing SUDs is to screen for and treat these other illnesses.

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1 Comment for this article
Substance (Ab)Use Means of Release from Stressors and Trauma Can Be Quite Addictive for ASD Adolescents.
Frank Sterle Jr. |
Notable adverse childhood experiences—including immense daily schoolyard stressors like chronic bullying—suffered by adolescents with Autism Spectrum Disorder can readily lead to a substance use disorder. This, of course, can also lead to an adulthood of debilitating self-medicating.

The greater the drug-induced euphoria or escape one attains from its use, the
more one wants to repeat the experience; and the more intolerable one finds their sober reality, the more pleasurable that escape should be perceived. By extension, the greater one’s mental pain or trauma while sober, the greater the need for escape from reality, thus the more addictive the euphoric escape-form will likely be.

If the ASD adolescent is also highly sensitive, both the drug-induced euphoria and, conversely, the come-down effect or return to their burdensome reality will be heightened thus making the substance-use more addicting.

I strongly feel that not only should all school teachers have received autism spectrum disorder (ASD) and Asperger’s Syndrome (AS) training, but that there should further be an inclusion in standard high school curriculum of a child development course which in part would also teach about the often debilitating condition.

It would explain to students how, among other aspects of the condition, ASD and AS people, including higher functioning autistics, are often deemed willfully ‘difficult’ and socially incongruent, when such behavior is really not a choice.