Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study.
Agnieszka Butwicka, Niklas Långström, Henrik Larsson and 5 others
PMID 27734228WHAT IT FOUND
People with autism were more likely to have substance use problems than matched controls, especially with ADHD.
The study cannot prove cause, but clinicians should consider attention and prevention for substance use.
Key findings
01ASD probands had increased risk of any substance-related problem (OR 3.3; 95% CI 3.1-3.6), substance use disorder (OR 5.2; 95% CI 4.9-5.6), alcohol-related somatic disease (OR 5.9; 95% CI 2.7-13.0), substance-related crime (OR 1.4; 95% CI 1.2-1.5), and death (OR 3.0; 95% CI 1.3-6.9).
02Risk was higher when ASD co-occurred with ADHD (OR 8.3; 95% CI 7.4-9.2), while ASD with intellectual disability alone was not associated with any substance-related problems (OR 1.1; 95% CI 0.9-1.3).
03Unaffected relatives of ASD probands had weakly but significantly increased risk for any substance-related problem.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The register-based design likely underestimates absolute prevalence because people not in contact with treatment are missed. Detection bias may occur because ASD individuals with regular contact with habilitation and mental health services may have substance problems recorded more often. ADHD and intellectual disability were only counted when diagnosed, so undiagnosed or subthreshold conditions may remain. The study cannot tell whether shared family risk is genetic, environmental, or both. The analysis did not separate ASD subtypes, which might have different associations. People diagnosed with ASD under earlier ICD versions appeared less likely to develop substance-related problems, which may reflect diagnostic practice rather than a true difference. No individual consent was needed because data were register-based, so the study reflects recorded diagnoses and legal outcomes rather than self-reported use.
Declared interests
Funding was reported from The Swedish Institute, The Swedish Research Council through SIMSAM, and The Swedish Research Council for Health, Working Life and Welfare. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not read the increased risk as proof that ASD causes substance use problems or that treating ASD prevents them. This is a register-based cohort association, and ADHD comorbidity, diagnostic timing, and shared family factors may explain part of it.