CohortAutism : the international journal of research and practice2025

Comparing the prevalence of substance use disorders between persons with and without autism spectrum disorders.

Victor Lushin, Steven Marcus, Sha Tao and 3 others

PMID 40156509

WHAT IT FOUND

Substance use disorder diagnoses increased to 7% in autistic Medicaid enrollees by 2016, up from 1.75% in 2012.

After adjusting for co-occurring mental health conditions, autistic adults generally had lower rates of substance use disorders than non-autistic peers.

Key findings

01The prevalence of substance use disorder among autistic Medicaid enrollees without intellectual disability rose to 7% in 2016, compared to 1.75% in 2012.

02Half of the autistic enrollees without intellectual disability had at least one co-occurring mental health condition, compared to 23% of non-autistic enrollees.

03When analyses were adjusted for co-occurring mental health conditions, autistic adults generally showed a lower likelihood of substance use disorders than their non-autistic peers.

STILL TO COME

How it was doneWhat they found

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What it does not show

Substance use disorders are known to be underdiagnosed in administrative data, and this underdiagnosis may be disproportionately higher in autistic individuals due to diagnostic overshadowing or non-classical presentation of symptoms. The study excluded individuals with intellectual disability, so findings do not apply to that subgroup. The demographic composition of the groups differed significantly, with the autistic group being 77% male and the control group predominantly female. Neighborhood deprivation was measured using the Area Deprivation Index, which may lack precision in some geographic areas. Autism diagnoses were only captured between 2008 and 2016, potentially missing older individuals diagnosed before this period.

Declared interests

The authors declare no conflicts of interest. The study was supported by the National Institute of Mental Health and the U.S. Public Health Service.

The easy way to misread this

Do not interpret the rise in SUD diagnoses from 1.75% to 7% as evidence that substance use itself quadrupled in this population; the authors suggest this likely reflects improved detection and recording in Medicaid data.

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The study

Participants
1,134,125
Certainty of evidence
Low

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    Cite

    Victor Lushin, Steven Marcus, Sha Tao, et al. Comparing the prevalence of substance use disorders between persons with and without autism spectrum disorders. Autism : the international journal of research and practice. 2025.

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    Comparing the prevalence of substance use disorders between persons with and without autism spectrum disorders. — Applied Evidence