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Dual Diagnosis: Asperger’s And Addiction

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 27, 2019

How you think, feel, and interact with the world around you can vastly shape the way that you encounter and react to substance use and abuse. While contending with an addiction can be very daunting, dealing with a co-occurring disorder can be even more overwhelming. Here we talk about the dual diagnosis of Asperger syndrome and addiction.

The National Institute of Neurological Disorders and Stroke (NINDS) tells us that Asperger Syndrome (AS) is a developmental disorder and an Autism spectrum disorder (ASD). The American Psychiatric Association (APA) defines an ASD as “a complex developmental disorder that can cause problems with thinking, feeling, language and the ability to relate to others. It is a neurological disorder, which means it affects the functioning of the brain.”

What Are The Characteristics of Asperger Syndrome?

According to the University of Michigan’s Health System, “People with Asperger syndrome have normal intelligence and language development, but also have some autistic-like traits. They may have trouble with social skills, sensory input, and making transitions, and may need rigid routines…. Some experts believe AS is like a “high-functioning autism.”

NINDS lists the following characteristics of Asperger Syndrome:

  • Repetitive routines or rituals
  • Peculiarities in speech and language
  • Socially and emotionally inappropriate behavior
  • Inability to interact successfully with peers
  • Problems with non-verbal communication
  • Clumsy and uncoordinated motor movements

People with AS struggle with cognitive and intuitive processes that are related to social situations and generally find it very hard to empathize with other people. Though some people with this condition might progress through these elements of the disorder without too much issue, for some, these things can result in a state of isolation, loneliness, or alienation, which may then lead to anxiety and depression—all things that may precede or add to a person’s risk of developing an addiction.

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Why Do People That Suffer From AS Suffer From Substance Abuse And Addiction?

Like anyone else, the reasons why a person suffers from an addiction are varied and based on the diverse background and circumstances that are specific to each person. However, for a person that suffers from AS, there are unique challenges that derive themselves from the disorder that may push a person towards drug or alcohol use as a means to self-medicate or moderate certain tendencies.

A case report published in the journal BMC Psychiatry that discussed two instances of individuals with High-Functioning Autism (HFA) using alcohol and psychostimulants “to cope with their anxiety and improve their cognitive abilities and social skills,” wrote that “the maladaptive use of alcohol, which is probably underestimated in this population, might be connected with their poor social problem-solving skills, such as poor self-reported empathy, and impaired emotion recognition skills.”

Here becomes evident some of the core reasons why a person with AS might drink or do drugs—to cope with the ways that they interact and react to themselves and the surrounding people, specifically to alleviate anxiety. The study went on to speak about how a study participant had an excessively rigid and strictly enforced schedule (something that is common to many people with AS) and how when it was disrupted, “he showed increased anxiety and an intense craving for alcohol and smoking which led him to consume both substances in a compulsive manner.”

What is also interesting in the above quote is when they cite that this abuse is “probably underestimated in this population.” Why is that? The report’s authors continue, surmising that it could be because “adults with HFA may superficially display a ‘normal’ façade when they drink alcohol, which may explain why their alcohol dependency is not better diagnosed.”

Though some research suggests that individuals with AS have lower instances of developing substance use disorders, they are not immune. The above study commented on why these rates might be lower, stating that “This is attributed to the fact that they display few sensation-seeking traits and an introverted personality overall.”

Though a person with AS might have decreased communication or social interactions that could potentially limit their access to peer-pressure or circumstances that would allow access to drugs and alcohol, they may yet procure and come to abuse either.

It is in fact due to this—an AS person’s decreased social skills—that a person may begin using drugs or alcohol in the first place. These intimidating social situations and interactions can cause stress that a person with AS attempts to moderate by drinking or using other drugs. Due to the often compulsive nature of AS, once a person begins this cycle they may find themselves caught in it more and more to points of excess, to the extent that it develops into an addiction.

According to the CDC, “ASD is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189).” This is especially worrisome, when you consider research on gender differences and addiction. A 2011 publication in the APA’s Journal of Abnormal Psychology found that men are at a greater risk of developing substance abuse than women.

What Is Dual Diagnosis?

The National Alliance on Mental Illness (NAMI) cites that “Dual diagnosis is a term for when someone experiences a mental illness and a substance abuse problem simultaneously.” In this case, the person is afflicted with a developmental disorder alongside of a substance abuse problem. The Substance Abuse and Mental Health Services Administration (SAMHSA) now refers to these as co-occurring disorders. They cite that the 2014 National Survey on Drug Use and Health found that “approximately 7.9 million adults in the United States had co-occurring disorders in 2014.”

Treating Co-Occurring Disorders

Individuals who have a dual diagnosis or co-occurring disorders need to receive care that recognizes and targets each of their disorders fully in order to beat their substance abuse and addiction. This is because, more often than not, the mental health disorder precipitates the substance abuse and addiction, and then later becomes aggravated by it as the substance use and abuse continues and accelerates. In order for these treatments to be successful, the treatment team must be familiar with and adept at handling both.

A paper published in the journal Psychiatry wrote that “Individuals diagnosed with co-occurring disorders often need more intense treatment due to the complexity of their case emphasizing the importance for clinicians to provide effective and efficient treatment to these patients.” This is especially true for individuals that suffer from AS. Being that AS is a developmental disorder it shapes the entirety of a person’s life, resulting in moderate to severe functional limitations that alter the day-to-day moments and routines of their life.

Though currently there is no treatment for AS or any other ASD, certain things can be done to help alleviate some of the concerns that stem from it within the context of addiction treatment. To start with, the addiction treatment team needs to be well-versed and highly trained in not only addiction medicine, but Asperger Syndrome. As we’ve noted, AS is often accompanied by comorbid conditions like depression and anxiety. These facets also need to be acknowledged and treated for true and lasting success. In some cases along with therapy, certain medicines may be useful in treating these comorbid conditions.

Due to the fact that a person within treatment is struggling with two conditions or more, they will likely have more than one person working on their case to establish and provide the standard and intensity of care that they require to achieve sobriety. It is crucial that these people remain in constant communication so that the therapy and treatment can continue to treat the dual diagnosis and grow to fit the patient’s changing needs.

Therapy As Treatment Tool

Some research suggests that Cognitive Behavioral Therapy (CBT) can help a person that suffers from AS and addiction to find success.

According to the National Institute on Drug Abuse (NIDA), “Cognitive-behavioral strategies are based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role. Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it.”

As we mentioned previously, people with AS may be prone to repetitive or compulsive behaviors, many of which—substance use and abuse included—could be detrimental to their health and well-being. CBT may allow the therapist a venue by which to teach a person with AS how to adapt and alter their thoughts as a way to change their feelings and behaviors in a manner that alleviates certain stress factors that might trigger drug or alcohol abuse.

We must consider here how a person with AS struggles with understanding emotions. For this reason, discussing the role emotions have may prove to be difficult and not always useful. Utilizing certain techniques that help to distance the person from this discussion so that they can view it more rationally may be helpful, such as diagraming or charting. Due to the fact a person with AS struggles in social settings, the therapist must be mindful of this and learn to read their verbal and nonverbal cues that may be present when the more obvious emotions are not.

Establishing goals and a clearly delineated method of achieving these concrete objectives may help a person with AS to better understand and achieve them.

When you’re choosing a facility, it is crucial that you find one that is adept at handling the dual diagnosis of developmental disorders, specifically AS and substance abuse. Take the time to do your research and ask questions. Despite the fact that a person needs help for substance abuse and addiction as soon as possible, this is not a process you should rush.

Taking the time to look into your options and check credentials can actually save you time in the long room by ensuring that you or your loved one receives the best standard of expert care that can help them gain sobriety and a long-lasting recovery.

Let Us Help You Find The Expert Care You Deserve

Having a drug or alcohol addiction can be overwhelming and confusing. It can be even harder and seem even more bleak when you’re struggling with a dual diagnosis. We can help you find hope by educating you on your choices and supporting you while you research and choose the best options for your recovery. Don’t let your co-occurring disorders hold you back—at we have highly-trained and compassionate professionals that will get you the specialized care you deserve. Contact us today, we are here to help you!

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