Mark Brosnan and Sally Adams from the University of Bath describe a project funded by Alcohol Change UK that aims to identify autism-friendly service provision for alcohol-related services.

A large population-based cohort study (Butwicka et al. 2016) identified that a diagnosis of autism without an intellectual disability is associated with a much higher increased risk of alcohol misuse and alcohol use disorder. The risk increases for autistic people whether or not there is associated attention deficit hyperactivity disorder (ADHD), and decreased if there was associated intellectual disability. Adjustment for parental age, region of birth, education and family income did not change these findings. 

Therefore, there is evidence that autistic people without an intellectual disability are at elevated risk from alcohol-related issues and may be a group who have members that could benefit from the advice and support offered by alcohol-related services.

Support for autistic people

It has long been realised that when alcohol-related issues emerge for autistic people, there is a need for improved autism awareness amongst alcohol support services (Hendrickx & Tinsley, 2016). 

Alcohol Change UK works to support people to have a healthy relationship with alcohol. Their aim is to provide advice and support to enable adults to live a life free from alcohol harm, whether they decide to drink or not.  Alcohol Change UK are aware that the advice and support offered by alcohol-related services may not be well suited to the needs of the autistic community.

With this in mind, they contacted the Centre for Applied Autism Research (CAAR) at the University of Bath to explore how alcohol support services could be adapted to ensure they support autistic people.

The research

The project has the aim of identifying autism-aware alcohol-related service provision.

Opinions were sought from two key groups, using online surveys:

• the autistic community
• current alcohol-related service providers.

The online survey for the autistic community was developed for those who drink alcohol and those who don’t, to try and capture the broadest range of alcohol-related experiences.

Questions cover the expectations of drinking alcohol and the motivations. These questions are taken from existing alcohol-related research literature with neurotypical populations, to explore their relevance to autistic populations. 

In addition, a new set of questions have been developed to identify whether there is a perception of alcohol affecting autism-specific characteristics reflected in the autism diagnostic criteria, such as social communication or sensory differences. 

Participants also self-reflect on the extent to which they feel the diagnostic criteria for autism impacts upon them on a 5-point scale from ‘Almost always/in almost all situations’ through to ‘Almost never/in almost no situations’. The criteria that features in the survey includes difficulties with social communication and interaction, and repetitive behaviours/intense interests.  

The online survey for current service providers is based upon CAAR’s previous work that has explored how therapists have adjusted their practice to be more autism-aware (Cooper et al. 2018). The survey asked about their experience with autistic clients and adaptations that could be made.

Early findings

An analysis of the data so far indicates that there is a positive correlation between feeling impacted by the autism criteria as described above, and frequency of drinking by people who self-report being autistic. 

Most service providers report having received no specific knowledge or skills sessions on autism during their training, and perceive that treatment outcomes for autistic clients are relatively unfavourable compared with other client groups.