Sarah Hendrickx and Matthew Tinsley discuss the potential links between autism and alcohol addiction, and the need for improved autism awareness amongst alcohol support services. Sarah and Matthew are co-authors of the book Asperger syndrome and alcohol.

Throughout my time of working in the autism field, the subject of alcoholism in relation to autism continues to pop up on a fairly frequent basis. It was this that led me to suggest to my autistic friend and recovering alcoholic Matt Tinsley, that we write a book on the subject back in 2008 (Asperger syndrome and Alcohol, Hendrickx & Tinsley, JKP).

At the time, I contacted every expert in the autism field that I could think of (Tony Attwood, Uta Frith to name just a couple) to ask if they thought Matt and I were on to something and all said: Yes, there is definitely a potential link, but it would be tricky to research. One of the main reasons for this is that many adults are undiagnosed, and alcohol can act as a successful coping strategy, hiding autistic difficulties for many years before the alcohol becomes a problem in itself. This was very much Matt’s story, as he says:

‘The chief aspect of my autism which resulted in extremely heavy use of alcohol to cope was a near constant sense of anxiety. I also was socially awkward and discovered alcohol turned me into a much more relaxed person. Of course, I was unaware of my autism at the time and it’s only in retrospect that I can understand why it worked so well.’

Alcohol for Matt enabled him to function in the workplace and develop and maintain relationships. Alcohol actually helped him to be less affected by sensory stressors and it helped manage his anxiety. Alcohol essentially lessened the impact of his autism. One study by the Mental Health Foundation in 2006, found that 65% of alcoholics admitted to rehab suffered from social anxiety. Could some of these be undiagnosed autistic people? Nobody knows.

‘Sensory problems which I have now such as loud noises and certain textured clothes being very uncomfortable were numbed to a certain extent by drink. Being overwhelmed with information when being given instructions was also not a problem when drinking as I felt able to retain the information. This may sound like the opposite to the way alcohol would affect NTs, but I think that is the key to its success for me, until it became life–threatening – it made me feel and act in a much more neurotypical way.’

‘Alcohol enabled me to do jobs where anxiety might have been crippling (working in an environment with constant contact with the public). Instead, despite being technically drunk, I was very efficient at my jobs and was able to cope doing such jobs for 17 years.’

For Matt and others that I have come across over the years, the point comes when the level of alcohol required for functioning becomes unsustainable and consequently serious health issues occur. For Matt, that was severe liver damage, collapse and certain death if he continued to drink.

In certain substance misuse services, it is a requirement to be ‘dry’ before you can be accepted for treatment. In the case of some autistic people, the alcohol is their coping strategy against the extreme anxiety caused by being autistic and living in a non-autistic, social, flexible world. It may therefore be the case that some (possibly undiagnosed) autistic people cannot access support as the removal of the alcohol may make them incapable of leaving the house. More awareness of the potential of autism resulting in problem drinking is required within alcohol support services, and there needs to be recognition of the signs as it may be that this type of client has no autism diagnosis:

‘The signs to look for that a person with an alcohol problem might also be autistic could be unusual eye-contact, special interests (is there a certain level of nerdiness in what interests the drinker, or do they have one subject at which they are expert at?). Is their use of language (grammar and syntax) unusual in any way, does their conversation sound odd or pedantic? Also, they may just present themselves, as I did, with the conviction that they are autistic and have just discovered why they are like they are. This should definitely be paid attention to and not dismissed.’

Self-knowledge of autism which can come as a result of a diagnosis can go a long way in helping an individual with a drink problem to understand who they are and why life feels so overwhelming. Alcohol services may need to consider alternative approaches for treatment which meet the needs of the autistic cognitive profile which may be substantially different.

In my experience, Cognitive Behaviour Therapy (CBT) adapted for use with autistic people can be extremely beneficial in helping to support the core anxiety which may be at the root of the need for alcohol. For Matt, a residential CBT rehab unit and a complete change of lifestyle has allowed him to live alcohol-free for a number of years.  His diagnosis gave him the knowledge to realise his own anxiety as an autistic person, and his need to reduce the demands upon him.

Ultimately, in my opinion, autistic people live well when they know themselves, their strengths and their limitations, and are able to navigate a path through a complex social and changeable world without needing to rely on harmful panaceas. For professionals I believe this should be the goal of support, especially in a world where alcohol is perceived as an accepted social tool.