The objective of this study was to evaluate the risk for developing a substance use disorder (SUD, alcohol or drug abuse or dependence) in individuals with high-functioning autism spectrum disorder (ASD). Subjects with high-functioning ASD were derived from consecutive referrals to a specialized ambulatory program for ASD at a major academic center from 2007 to 2016. Age-matched controls and attention-deficit hyperactivity disorder (ADHD) comparison subjects were derived from three independent studies of children and adults with and without ADHD using identical assessment methodology. Cox proportional hazard models were used to analyze the prevalence of SUD (alcohol or drug use disorder). Age of onset of SUD was analyzed with linear regression models. Our sample included 230 controls, 219 subjects with ADHD, and 230 subjects with ASD. The mean age for the ASD subjects was 20.0 ± 10.3 years. Among ASD subjects, 69% had a lifetime prevalence of ADHD, and the ASD subjects had significantly higher rates of other psychiatric psychopathology compared to ADHD and control subjects (p < 0.001) ASD subjects were at significantly decreased risk for developing a SUD compared to ADHD (hazard ratio (HR) = 0.22, p < 0.001) and control subjects (HR = 0.62, p = 0.04). The age of onset of a SUD was significantly older in ASD subjects, mean age 21.7 years, when compared to ADHD and control subjects (both p < 0.005). Individuals with ASD are at decreased risk to develop a SUD, and when they do, the onset is significantly later than ADHD and controls.

本研究的目的是评估患有高功能自闭症谱系障碍 (ASD) 的个体发生物质使用障碍（SUD、酒精或药物滥用或依赖）的风险。患有高功能 ASD 的受试者来自于 2007 年至 2016 年连续转诊到一个主要学术中心的 ASD 专业门诊计划。年龄匹配的对照和注意力缺陷多动障碍 (ADHD) 比较受试者来自三项独立研究使用相同的评估方法对患有和不患有多动症的儿童和成人进行评估。Cox 比例风险模型用于分析 SUD（酒精或药物使用障碍）的患病率。使用线性回归模型分析 SUD 的发病年龄。我们的样本包括 230 名对照组、219 名患有 ADHD 的受试者和 230 名患有 ASD 的受试者。ASD 受试者的平均年龄为 20.0 ± 10.3 岁。在 ASD 受试者中，69% 的人终生患有 ADHD，与 ADHD 和对照受试者相比，ASD 受试者的其他精神病理学比率显着更高（p < 0.001) 与 ADHD（风险比 (HR) = 0.22， p  < 0.001）和对照组（HR = 0.62，p  = 0.04） 相比，ASD 受试者发生 SUD 的风险显着降低。与 ADHD 和对照组受试者相比，ASD 受试者 SUD 的发病年龄明显更大，平均年龄 21.7 岁（均p  < 0.005）。患有 ASD 的人患 SUD 的风险较低，当他们患上 SUD 时，其发病时间明显晚于 ADHD 和对照组。