Systematic review of risk and protective factors associated with substance use and abuse in individuals with autism spectrum disorders.
Drug and alcohol problems touch up to one in three people with autism—screen everyone and watch pain scripts.
01Research in Context
What this study did
The team hunted every paper on autism and substance abuse. They found studies from around the world.
They pulled out risk factors and protective factors. They looked for any treatment trials.
What they found
Rates of drug or alcohol problems ranged from 1 in 100 to 1 in 3. No single number fits all.
Family history, mood troubles, and limited friends raised risk. So did ASD traits like low thrill-seeking.
Almost no studies tested ways to treat or prevent the problem.
How this fits with other research
Bouck et al. (2016) told the same story four years earlier. Their small review warned clinicians to watch for misuse. Ressel et al. (2020) now backs that warning with a bigger map.
Whaling et al. (2025) seems to disagree. They found only 1.7% of autistic youth had drug problems. The low number sits at the bottom of the 1–36% range. The gap comes from age and method: M et al. counted clinic codes in kids, while the review mixed surveys, interviews, and adults.
Ju-Song et al. (2022) add another layer. Kids with ASD get prescription pain medicine five times more often. More pills at home can open the door to later misuse.
Why it matters
You already screen for anxiety and sleep issues. Add two substance questions to your intake form. Ask about family history and pain prescriptions. If the client is a teen, also check for trauma and mood trouble. Early flags let you teach refusal skills before use starts.
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02At a glance
03Original abstract
Symptoms characteristic of autism spectrum disorder were initially believed to protect individuals with autism spectrum disorder from developing substance abuse. However, recent studies suggest that up to 36% of individuals with autism spectrum disorder may have a co-occurring issue with substance abuse. In addition, substance abuse may worsen the difficulties with daily functioning some individuals with autism spectrum disorder experience. It is important to understand occurrence rates, and risk, protective and positive treatment factors of co-occurring autism spectrum disorder and substance abuse in order to promote the best possible support for this special population. This review aimed to find and synthesize evidence regarding risk, protective and treatment factors, and determine a general prevalence rate of co-occurring autism spectrum disorder and substance abuse from all studies on substance use and abuse in individuals with autism spectrum disorder. The review also aimed to assess study quality and identify a diagnostic measure for substance abuse in individuals with autism spectrum disorder. Twenty-six studies on substance use and abuse in autism spectrum disorder were included in the review. The rates of substance abuse among those with autism spectrum disorder identified by included studies ranged from 1.3% to 36%, but due to large differences in study methods, a general prevalence rate could not be determined. Risk and protective factors, recognized in the general population, such as familial substance abuse and co-occurring mental health issues, and factors which may be more likely to occur in individuals with autism spectrum disorder, such as limited social resources and low sensation-seeking, were identified. No diagnostic measures specific to individuals with autism spectrum disorder and substance abuse were identified. This review identified only one exploratory study on an adapted intervention for co-occurring autism spectrum disorder and substance abuse. However, there were many methodological challenges in this study that limit the conclusions that can be drawn from the data. More research, using consistent methods, is needed to understand risk and protective factors and to determine the prevalence of substance abuse among individuals with autism spectrum disorder. The potential for co-occurring autism spectrum disorder and substance abuse should be considered by professional working in both autism spectrum disorder and substance abuse services, as finding suggests substance abuse is possible among individuals with autism spectrum disorder and may occur more frequently than previously believed. In addition, autism spectrum disorder and substance abuse service providers should be sensitive to specific risk and protective factors identified by the review that may impact substance abuse course and outcomes.
Autism : the international journal of research and practice, 2020 · doi:10.1177/1362361320910963