Neurodivergence and Vulnerability to Addiction
Our last post reviewed our current understanding of different forms of neurodivergence - specifically ADHD, autism, and AuDHD - through the lens of neurobiology. Now, we’ll discuss why neurodivergent folks are at greater risk of developing substance use disorders.
It’s now understood in the field of psychology that neurodivergent people often experience more difficulty in the world than neurotypical folks. Over time, this experience manifests in an individual’s psyche as heightened reactivity to stress, difficulty with emotional regulation, and increased vulnerability to traumatic experiences. 8,11
But why exactly are neurospicy people more likely to struggle with addictions?
ADHD - understimulated and overactivated
Roughly 2-3x more likely to develop a SUD14
Most common substances used: nicotine, caffeine, stimulants, alcohol and cannabis 10
ADHD folks have a higher risk of addiction due both to their neurobiological makeup and their social experiences in a neurotypical world. Below, we’ll explore how two primary ADHD symptoms and three sub-symptoms illuminate the mechanism of this risk. This is not an exhaustive symptom list, but instead selected to help demonstrate the link between ADHD and addiction.
Hallmark ADHD symptoms
Executive Functioning Differences
This includes difficulty sustaining attention, memory issues (forgetfulness/losing items), difficulty completing tasks or projects, poor time management and disorganization, and struggles with planning and prioritizing.
For ADHD brains, stimulants can feel regulating, allowing one to access focus and motivation that can otherwise feel elusive or simply much harder than it does for neurotypical brains.7 Because stimulants streamline thinking and can smooth out executive functioning struggles, a neurodivergent person may be more likely to lean into compulsive stimulant use (if not receiving prescribed stimulant treatment) despite the known consequences.
Emotional Hyperarousal
This includes both impulsivity (difficulty controlling responses) and restlessness (difficulty relaxing).
If one is easily activated, substances like alcohol (or other “downers”) can be tempting to help someone reduce this intensity, to stay calm in social situations, and/or to generally stay in a window of emotionality others find acceptable.10
Nuanced ADHD behavior patterns
Dopamine Crashes
Inadequate dopamine signaling can lead one to “dopamine binge” - aka over-doing it on something that provides a person with ADHD the dopamine signals they’ve been lacking. When this person’s levels of dopamine plummet, which is more likely to occur after dopamine “binging”, this person’s existing ADHD tendency toward risky or impulsive behaviors increases significantly as the person seeks more stimulation to level out low dopamine levels.2
Rejection Sensitivity Dysphoria (RSD)
Because the world is built for neurotypical people, it’s easy for neurodivergent people to feel overwhelmed and exhausted trying to cope with all the ways the world is not built for them. This struggle creates a vulnerability to substance use, because substances can act as a short- (or medium-term) coping strategy for this sense of separateness and exclusion. In fact, trauma/cPTSD can result from untreated, undiagnosed, and socially stigmatized neurodivergence. This is why alcohol, which is highly socially available and accepted, can feel particularly good for neurodivergent people.
Hyperfixation
While hyperfixation isn’t typically discussed in terms of addiction, consider this - if a person with ADHD hyper-fixates on a behavior because it relieves both the stress and internalized shame of being unable to focus, and that compulsive behavior causes them negative consequences, they are very likely to meet diagnostic criteria for an addiction.
In this way, hyper-fixation on a compulsive behavior/addiction brings the consequences of the addiction front and center faster than for someone who’s neurotypical.10
Autism - riding the overstimulation rollercoaster
Significantly higher risk of SUD 3,5,6
Most common substances used: alcohol, cannabis, prescription benzos/”downers”
Due to the neurochemical profile discussed in the last post, folks with autism are sometimes described as having a “spiky” nervous system, meaning they experience many highs and lows - a “rollercoaster-like” experience in the world. A landmark 2016 population-based cohort study demonstrated that autistic individuals without an intellectual disability face a significantly higher risk of SUDs.
Sensory Differences
Those with high sensory sensitivities (i.e. sensory avoiders):
This experience of the world often includes frequent/constant activation and discomfort. Substances can momentarily alleviate that discomfort, allowing one to continue with other activities and/or socialize without sensory distraction.6
For some autistic and AuDHD people, simply the experience of being in one’s body can be overwhelming as their brains struggle to regulate the amount of sensory input they consciously register. A podcast by two therapists with AuDHD described the internal, somatic experience of an autistic or AuDHD person with this joke: “Autistic body, 1 star, would not recommend”.7 If you’re living a “1 star body experience”, the relief provided by substances like alcohol or benzodiazepines can be seductive. It’s easy to understand why someone with this experience might choose to prioritize short-term relief through substance use over their long-term health.
Those with low sensory sensitivities (i.e. sensory seekers):
Sensory seekers with autism need more sensory input in order to feel regulated, and therefore they often seek highly stimulating environments to provide this for themselves.
Once in these high stimuli environments, they may use alcohol to cope with the social demands or any other elements of the environment that trigger their non-sensory autistic differences in an overwhelming way.8
Shutdown vs. meltdown
Autistic nervous systems are frequently wired with a “hyper-reactive alarm center”8 and respond in different ways when the alarm center is activated.
Shutdown: some nervous systems shut down due to overstimulation - dissociation, going quiet or mute, and numbness.
Meltdown: others respond by melting down - crying, stimming uncontrollably, becoming increasingly emotional.
Social Differences
Autistic people are more likely to struggle with understanding social norms and expectations, which can create a sense of alienation. Substances can act as “social lubrication” to reduce this friction and allow autistic people to experience greater levels of social connection.
For example, while studies show autistic people tend to have more negative views of alcohol use overall, for those who do imbibe, the rates of alcohol use and addiction are higher than amongst NT drinkers.3,5,6
Masking, or social camouflaging, to either consciously or unconsciously suppress natural autistic traits is one way autistic people attempt to cope with their natural variation. This can look like suppressing stimming (repetitive body movements that create predictability in one’s soma and nervous system), forcing eye contact, or planning/scripting conversations.
The use of substances such as alcohol and cannabis (and sometimes benzos/downers) can also suppress social inhibition, creating a temporary release valve that allows an autistic person to tolerate social environments and interactions longer before becoming exhausted. To summarize, alcohol, cannabis or benzos/opiates can help autistic people reduce masking in the short term, allowing them to conserve energy.4,5
Special Interests
Special interests can sometimes lead to addictions. Especially in those socialized as women, special interests are more likely to include socially expected/condoned activities (such as exercise, gaming, work), which the autistic person approaches with intensity. This intensity, when applied to a compulsive coping behavior that provides short term benefit at the expense of long term consequences (like gambling), can breed a behavioral addiction.
AuDHD - the burnout teeter-totter
High SUD risk due to complex internal needs4
Most common substances used: polysubstance use
AuDHD folks experience both autism and ADHD, often synergistically. They’re most likely to engage in high levels of long-term masking, contributing to very high rates of burnout. This can make self-medicating with substances both more desirable and more dangerous.
SUD rates are higher among AuDHD people than among autistic or ADHDers alone.4
The combination of ADHD (classically seeking high stimulation and novelty) with autism (seeking low stimulation and predictability) can create an internal feeling of intense friction and cognitive overload. An untenable internal state is an incredibly high predictor of self-medicating behavior as a way to find relief.4
Masking is higher amongst AuDHD people, leading to higher levels of social substance use to reduce the anxiety of un-masking - which can provide them temporary relief and reduce depletion and burnout.7
Polysubstance use is higher for AuDHDers due to the desire to balance out the traits of both ADHD and autism. Imagine this - an AuDHD person uses caffeine, adderall and/or nicotine to help them focus during the day, and uses alcohol, cannabis and/or opioids to help them socialize and/or sleep in the evening. While this helps them function in the short term, it also affects their appetite, sleep quality, and finances, and they quickly build tolerance to all the substances they use. Eventually, it starts to feel like they must trade how they feel in the long term (as well as when they first wake up in the morning) with how they feel during the majority of their day.
If you’re interested in working with a therapist around addiction and neurodivergence,
References
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