Background

Autistic individuals might be more likely to misuse substances than non-autistic individuals. Better understanding of these patterns can help clinicians identify strategies to reduce substance use, protecting physical and mental health. The aim of this study was to compare the experiences of substance use between autistic and non-autistic adolescents and adults.

Methods

This study is a mixed-methods study, including both quantitative (closed-ended questions) and qualitative (one open-ended question) online assessments. Data were collected as part of a larger study, the Autism and Physical Health Survey, in which we administered an anonymised, online questionnaire to autistic and non-autistic individuals aged 16–90 years. In the present study, we investigated data on substance use or misuse, using two overlapping but separate samples from the survey (one sample with complete quantitative responses and one sample with complete qualitative responses). Binary measures of substance use were investigated using unadjusted and adjusted binomial logistic regression models. Content analysis was used to compare experiences of autistic and non-autistic adolescents and adults. We used Fisher's exact tests to assess differences in frequency of reporting particular qualitative themes and subthemes.

Findings

Survey recruitment was done between Feb 7, 2018, and Aug 26, 2019. At the end of the recruitment, 3657 individuals had accessed the survey. After excluding duplicates as well as participants with missing or incomplete responses, we had data from 2386 participants (1183 autistic and 1203 non-autistic participants; 1571 female and 815 male participants) for the quantitative analyses and data from 919 participants (429 autistic and 490 non-autistic participants; 569 female and 350 male participants) in the qualitative analyses. The samples for the quantitative and qualitative analyses were predominantly composed of female individuals, White individuals, UK residents, and those without intellectual disability. Autistic individuals were less likely than non-autistic individuals to report consuming alcohol regularly (16·0% of autistic individuals vs 22·2% of non-autistic individuals; adjusted model: odds ratio [OR] 0·69, 95% CI 0·55–0·86; p=0·0022) or binge-drinking (3·8% vs 8·2%; adjusted model: OR 0·38, 0·26–0·56; p<0·0001). Autistic male participants were less likely than non-autistic male participants to report ever having smoked (50·8% of autistic male participants vs 64·6% of non-autistic male participants; adjusted OR 0·50; 0·32–0·76; p=0·0022) or ever using drugs (35·4% vs 52·7%; adjusted OR 0·53; 0·35–0·80; p=0·0022). Regarding our qualitative analyses, among participants who reported a specific motivation for drug use, compared with non-autistic individuals, autistic individuals were nearly nine times more likely to report using recreational substances to manage behaviour (OR 8·89, 2·05–81·12; p=0·0017) and more likely to report using recreational substances to manage mental health symptoms (OR 3·08, 1·18–9·08; p=0·032). Autistic individuals were also more likely to report vulnerability associated with substance use (OR 4·16, 1·90–10·05; p=0·00027), including childhood use of drugs and being forced or tricked into using drugs.

Interpretation

Autistic individuals might be less likely than non-autistic individuals to report engaging in substance misuse. They also report using drugs to self-medicate. Clinicians should be aware of vulnerability linked to substance use among autistic patients and should work cooperatively with patients to effectively manage autistic and comorbid symptoms.

Funding

Autism Research Trust, Rosetrees Trust, Cambridge and Peterborough NHS Foundation Trust.

中文翻译：

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了解自闭症青少年和成人的物质使用：一种混合方法

背景

自闭症患者可能比非自闭症患者更容易滥用药物。更好地了解这些模式可以帮助临床医生确定减少药物使用、保护身心健康的策略。本研究的目的是比较自闭症和非自闭症青少年和成人之间的物质使用经历。

方法

本研究是一项混合方法研究，包括定量（封闭式问题）和定性（一个开放式问题）在线评估。数据是作为一项更大的研究的一部分收集的，即自闭症和身体健康调查，在该研究中，我们对 16-90 岁的自闭症和非自闭症个体进行了匿名的在线问卷调查。在本研究中，我们使用来自调查的两个重叠但独立的样本（一个具有完整定量响应的样本和一个具有完整定性响应的样本）调查了有关物质使用或滥用的数据。使用未经调整和调整的二项式逻辑回归模型研究了物质使用的二元测量。内容分析用于比较自闭症和非自闭症青少年和成人的经历。我们使用了费舍尔

发现

调查招募于 2018 年 2 月 7 日至 2019 年 8 月 26 日期间进行。在招募结束时，有 3657 人参与了调查。在排除重复以及回答缺失或不完整的参与者后，我们有来自 2386 名参与者（1183 名自闭症参与者和 1203 名非自闭症参与者；1571 名女性和 815 名男性参与者）的数据用于定量分析和来自 919 名参与者（429 名自闭症和 490非自闭症参与者；569 名女性和 350 名男性参与者）在定性分析中。定量和定性分析的样本主要由女性、白人、英国居民和没有智力障碍的人组成。自闭症个体比非自闭症个体报告定期饮酒的可能性更低（16·0% 的自闭症个体与22·2% 的非自闭症个体相比；调整模型：优势比 [OR] 0·69, 95% CI 0·55–0·86；p=0·0022）或暴饮暴食（3·8% vs 8·2%；调整后的模型：OR 0·38, 0·26–0·56；p<0·0001）。自闭症男性参与者报告曾经吸烟的可能性低于非自闭症男性参与者（50·8% 的自闭症男性参与者与64·6% 的非自闭症男性参与者；调整后的 OR 0·50；0·32-0· 76；p=0·0022）或曾经吸毒（35·4% vs52·7%；调整或 0·53；0·35–0·80；p=0·0022)。关于我们的定性分析，在报告有特定吸毒动机的参与者中，与非自闭症个体相比，自闭症个体报告使用娱乐性物质来管理行为的可能性几乎是 9 倍（OR 8·89, 2·05-81 ·12；p=0·0017）并且更有可能报告使用娱乐性物质来管理心理健康症状（OR 3·08, 1·18–9·08；p=0·032）。自闭症个体也更有可能报告与物质使用相关的脆弱性（OR 4·16, 1·90-10·05；p=0·00027），包括童年吸毒和被迫或诱骗吸毒。

解释

自闭症患者可能比非自闭症患者更不可能报告从事药物滥用。他们还报告使用药物进行自我治疗。临床医生应意识到自闭症患者与物质使用相关的脆弱性，并应与患者合作以有效管理自闭症和共病症状。

资金

自闭症研究信托基金、玫瑰树信托基金、剑桥和彼得伯勒 NHS 基金会信托基金。