OARacle Newsletter

Substance use disorder is a widespread problem that affects one in 10 Americans, including autistic adults. While there is evidence-based programming for adults who engage in unhealthy substance use, those programs are not designed for autistic people.

In their 2023 OAR-funded study, ADAPT: Development of a Substance Use Disorder Prevention Class for Autistic Adults, Laura Graham Holmes, Ph.D., developed and pilot-tested “Alcohol and Drug Choices for People on the Autism sPecTrum” (ADAPT), designed with and for autistic adults. The study aimed to assess:

• Feasibility: Could the ADAPT program be delivered successfully to autistic adults?
• Acceptability: Did participants find the program useful and satisfying?
• Preliminary effectiveness: Did participants show improvements in their substance use
• knowledge, readiness to change, and ability to cope with substance use urges?
• Exploratory clinical outcomes: Did participants experience reduced feelings of isolation, and improvements in anxiety and depression?

Dr. Holmes is a clinical psychologist and an assistant professor at City University of New York’s Hunter College.

Methodology

The researchers co-designed the ADAPT program with autistic collaborators who were in recovery. The team developed a weekly, six-session, online, group intervention with two to three take-home worksheets for each session. A psychologist and social worker, one of whom was autistic and the other in recovery, co-facilitated the sessions.

Dr. Holmes and her research team recruited 40 individuals to participate. Seventeen participated in ADAPT and 23 participated after the six-week waitlist period. They all completed surveys before and after the program and an interview after receiving the intervention. When asked what substance(s) they wanted to target in the workshop, 62.5% of all participants reported they wanted to work on their alcohol use, 42.5% indicated cannabis, 10% indicated nicotine, and 3% indicated other substances.

Outcomes

The ADAPT program proved feasible to implement, with most participants (88%)

attending at least five out of the six sessions. Overall, participants found the program helpful, rating it an average of eight out of 10, and felt it was worth their time, rating it an average of nine out of 10. In interviews, participants discussed:

What Worked

• The autistic/non-autistic facilitation team
• The focus on self-determination and harm reduction

Suggestions for Improvement

• More time to discuss their challenges and triumphs instead of educational information

Dr. Holmes noted in her final report that many suggestions were helpful and will be incorporated into future interventions.

Changes in Substance Use

While Dr. Holmes did not necessarily expect to find changes in substance use after the participants finished the program, the research team did target several concepts that are expected to affect someone’s substance use. ADAPT participants:

• Increased their knowledge and confidence about how to seek help for SUD if needed
• Identified and increased their motivation to change (87 to 90%)
• Were more likely to report being in the “action” phase of change after completing ADAPT
• Improved on coping with urges to use substances, specifically in avoiding situations where they might be tempted to use substances

In addition, participants felt less socially isolated over time. They also reported lower depression and anxiety scores compared to before ADAPT.

Practical Findings

This study illuminated the need for programs like ADAPT. The research team noted that people who were not using substances attempted to join the group simply to have a place to learn about healthy substance use with other autistic people. Autistic people in recovery also wanted to join to connect with other autistic people about being sober.

Many autistic people start using substances to cope with difficulties, such as negotiating social interactions, sensory overwhelm, chronic pain, or mental health conditions. They also may turn to substance use as a socially acceptable self-stimulatory behavior. The goals autistic people have for controlling substance use also vary, ranging from abstinence to moderation. The research team found that people appreciated being able to identify and pursue their own goals without a one-size-fits-all agenda. For example, some participants were using medicinal cannabis to address chronic pain, and they wanted to be able to moderate their use to maintain its usefulness rather than to quit.

Participants also appreciated having facilitators with lived experience as an autistic person and another who was in recovery. The autistic facilitator could authentically validate experiences and effectively facilitate discussions about things like sensory coping strategies.

Dr. Holmes noted that providers should be prepared to screen for substance use disorders among autistic people and to refer them to the best available treatment if needed. She also reported that more individualized recommendations and treatment are needed. For example, some participants had great difficulty with common substance use treatment such as Alcoholics Anonymous (AA) groups, which require social negotiation. Others appreciated group treatment, including AA or other groups with less religious overtones. All wanted groups that were focused on substance use disorder in the context of being autistic and to connect with other autistic people facing the same challenges.

Given the promising results of this study, Dr. Holmes plans to seek funding for a larger study, testing ADAPT compared to autistic people in a support group.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.