Can Autistic People Drink Alcohol?

Navigating a relationship with alcohol is hard enough, but it’s even more difficult for neurodiverse people, especially people with autism. This article will shed light on how autism can influence our experience with alcohol and will look at some ways to make smart decisions to manage autism while drinking. We'll explore how autistic brains process alcohol differently, the potential risks involved, and strategies for safe consumption. Whether you're a person with autism, a caregiver, or a friend, understanding these dynamics can help foster safer and more enjoyable social experiences.

What Is Autism?

It’s no exaggeration to say that autism is one of the most hotly debated and disagreed-upon developmental disorders out there. More formally known as Autism Spectrum Disorder (ASD), autism is incredibly complex and multifaceted. There’s no single way to characterize it (which is why it’s described as a “spectrum”), but it generally involves challenges in social interaction and communication, restricted interests, sensitivity to sensory input, and the presence of repetitive behaviors.

Let’s be clear right off the bat: autism is not a mental illness. It is not a “curable” condition, much like having blonde hair or being introverted isn’t an illness. In the past, autism was characterized as such in the field of psychiatry, but as our understanding has evolved, so has the view of the wider scientific community.

Now autism is considered part of the spectrum of neurodiversity — the natural diversity in the way humans think and act, with each person having their own perspectives, interests, strengths, and weaknesses.

Autism’s causes are not fully understood, but there are a lot of theories. Research indicates that genetics is highly involved, and environmental factors also play a part: this is the scientific equivalent of saying, “It could be anything!” Therefore, we have no one “test” for autism; instead, a diagnosis is reached only careful consideration and input from multiple specialists.

Beyond origins, definitions, and classifications, much of the modern study of autism is focused on how to support and nurture autistic people so they can grow into their full selves in a society that may not always fit with them.

Understanding the Spectrum

Autism is often described as a spectrum due to the vast diversity in the ways it manifests. Some people with autism require significant support in their daily lives, while others may have “stealthy” symptoms that aren’t necessarily obvious. The spectrum quality of autism also means that no two people with autism are alike. Each person has a unique set of abilities, challenges, and quirks.

There’s significant debate about how autism relates to other conditions, especially attention deficit hyperactivity disorder (ADHD), epilepsy, and other developmental disorders. Even what qualifies as diagnostic criteria for autism is under debate. It’s a complex condition of ongoing research.

How Autistic Brains Work Differently

People with autism have distinct differences in brain connectivity and activity, particularly in regions related to sensory processing, social interactions, and communication. These differences from neurotypical (non-autistic) brains are responsible for the most common symptoms of autism: sensory sensitivity, difficulties in social processing, and unique communication styles.

An autistic person’s brain may process neurotransmitters differently.

• Serotonin (the “feel-good” hormone) is responsible for mood regulation and sometimes functions differently in people with autism. About 25% of autistic children show high levels of serotonin, which can lead to significant developmental differences in adulthood.
• Dopamine is another key player in autism. Dopamine is the “feel-good” neurotransmitter responsible for immediate rewards and pleasure (not to be confused with serotonin, which is responsible for overall mood regulation and behavioral patterns). Dopamine plays a key role in motivation and reward processing.
  
  People with autism often display roadblocks in the dopamine transportation system in the brain, which explains symptoms like sensory sensitivity and poor executive planning. The way dopamine works in autistic brains is similar to how it works in people with ADHD, fueling speculation that these two developmental disorders are related. In fact, it’s been estimated that more than half of people with autism also meet the diagnostic criteria for ADHD.

Any substance we introduce into our body interacts with the chemicals in our brain. So what do these differences mean for drinking alcohol?

Alcohol in the Autistic Brain

In addition to serotonin and dopamine, people with autism show distinct differences in two other neurotransmitters directly affected by alcohol: gamma-aminobutyric acid (GABA) and glutamate. In the short term, alcohol increases GABA, a calming neurotransmitter responsible for alcohol’s immediate relaxing effects. It also decreases glutamate, a stimulating neurotransmitter also involved in memory and learning.

As our body processes alcohol, it also ramps up glutamate production to get itself back into balance. As a result, the brain bounces back and ends up with more glutamate than GABA, which ultimately stimulates our central nervous system (CNS).

Dysfunctions in GABA and glutamate have been widely proposed as mechanisms behind the sensory overstimulation, increased anxiety, and mood dysregulation seen in autism. Alcohol is known to cause mood swings, which are symptoms of autism. Alcohol multiplies the dysfunction of GABA and glutamate, amplifying these symptoms.

Let’s look at a few other ways alcohol’s effects manifest differently in those with autism:

• Sensory processing. Autistic people are often sensitive to sensory input: sound, light, touch, taste, and smell. Because alcohol dulls our senses, it dampens these symptoms at first. Once glutamate takes back control of the brain, however, sensory sensitivity is increased significantly, exacerbating this uncomfortable experience.
• Social cognition. Social interaction can be challenging for some autistic people. Alcohol's initial disinhibiting effects might make social situations feel more manageable or less anxiety-inducing at first. But as alcohol impairs cognitive functions, it can become increasingly difficult to judge appropriate social behavior and recognize social cues, which can affect safety and well-being.
• Emotional regulation. Autistic people may have difficulty regulating emotions: alcohol can magnify these challenges, which can result in pronounced mood swings or emotional responses while intoxicated and even the next day.
• Motor coordination and control. Impairment of motor coordination is a common effect of alcohol, and it might become more pronounced in autistic people, especially if they already face challenges in this area. It could manifest as increased clumsiness, difficulty with balance, or uncoordinated movements.
• Unusual behavioral responses. The response to alcohol can vary greatly among autistic people when they become intoxicated. Their response could lead to unusual or unexpected behaviors that might not align with typical signs of drunkenness.

While the effects of alcohol are generally the same in everyone, certain aspects of autism can be amplified by excessive or long-term alcohol use. Those same aspects of autism can fuel the use of alcohol to cope.

How Does Alcohol Impact Autism

Remember how dopamine works differently in people with autism? Since alcohol increases dopamine, it can actually mask some aspects of autism, including difficulty with social processing, focus and attention, and communication. As a result, autistic people tend to have a bigger dopamine response from alcohol than neurotypical people do, which puts them at a higher risk of alcohol use disorder (AUD) and other addictions.

Traditionally, it was thought that people with autism were less likely to develop addictions due to the stereotype of them being strict rule-followers who thrive in structure. However, a landmark Swedish study published in 2016 found that autistic people are 2 to 4 times more likely to develop addictions than neurotypical people.

The fact is, many autistic people report using alcohol to cope with social anxiety, overstimulation, and fitting in. Therefore, alcoholism is a particular risk, and it should be treated differently.

Treating AUD in People With Autism

Treatment for alcohol misuse should always be tailored to the individual, but certain common approaches may require adjustment for people with autism.

• Cognitive Behavioral Therapy (CBT). CBT is highly effective for treating AUD, and it’s also helpful for those with ASD. When treating alcoholism in someone with autism, it’s best to find a therapist specialized in ASD rather than one who specializes in substance misuse or addiction.
• Avoid group therapy. Social situations can be stressful, challenging, or anxiety-inducing for people with autism. The idea of sharing complex emotions in a group setting can be unappealing to many people, but for those with autism, it can be traumatic. Research shows that people with autism are more likely to stop participating in alcohol use treatment if they are required to participate in group therapy or 12-step programs.

Smart Drinking Decisions for Autistic People

Now let’s consider a few rules that can lead to smart drinking decisions for people with autism spectrum disorder.

1. Moderation is key. Starting slowly and monitoring intake are important first steps for anyone but especially for someone with ASD. Make a practice of alternating between alcoholic and non-alcoholic drinks. This can help in two ways: by slowing intake and by staying hydrated.
2. Self-awareness. Be aware that one person’s tolerance for alcohol may differ from another person’s response to it. Learn to recognize when enough is enough. There’s no need to feel pressured to keep up with others.
3. Mind your senses. Alcohol affects our sensory sensitivities. For those with ASD, drinking in a busy, loud, and crowded bar might not be the best choice of venue. Reactions to sensory inputs vary greatly, so staying mindful of alcohol’s effects is vital.
4. Make a plan. It’s critical to have a plan in place before drinking. This might include setting a limit on the number of drinks or deciding ahead of time not to drink in certain situations.
5. Medication interactions. Anyone taking medications to manage certain symptoms of autism should check with their doctor or pharmacist on the ways alcohol might interact with them. Some medications can intensify alcohol’s effects or be harmful when mixed.
6. Choose a safe environment. It’s best to drink in familiar, comfortable settings that feel safe and where it’s easy to leave early. Those with autism need to be aware of how alcohol impacts their ability to read social cues or regulate emotions, so keeping emotional as well as physical safety in mind is important. So is taking along a trusted friend or family member or having them on call as a safety monitor.

Summing Up

While everyone can benefit from moderation and mindful drinking, autistic people in particular may need to take extra steps to stay present and deliver their authentic self to the world.

If you’re autistic and worried that you may be misusing alcohol, there is hope, and you’re in control. Try the Reframe app to empower yourself with a personalized, neuroscience-backed plan to quit or cut back on drinking.