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08 Jul 2021, 6:24 am

Why autistic people tend to self-medicate at much higher rates

It was summer 2018, and I was talking to the governor of Colorado.

John Hickenlooper was, at that point, running for president (he later dropped out and got elected to the Senate instead). During this moment of our interview, however, I found myself speaking not just as a journalist, but as an autistic person. I felt the need to explain something important about neurodiversity to this powerful neurotypical man who told me he was concerned about allowing autistic people to smoke marijuana because he believed they could "have an inclination to bipolar" or become "almost schizophrenic."

Hickenlooper mentioned an unnamed friend whose child had a bad reaction to the drug, although he seemed impressed by my argument that many of my successes occurred not in spite of but because I medicated myself with marijuana for various mental health ailments. A year later Hickenlooper seemed to acknowledge the validity of my perspective when he added, "I don't know enough to be able to speak specifically about the autism spectrum. And I probably shouldn't have said that."

Elizabeth Weir of the University of Cambridge's Autism Research Center was first author on the Lancet Psychiatry piece, which studied 919 people — including 429 autistic individuals — and found that "compared with non-autistic individuals, autistic individuals were nearly nine times more likely to report using recreational substances to manage behaviour and more likely to report using recreational substances to manage mental health symptoms."

"Self-medication is a big issue," Weir told Salon. People in the study talked about "dealing with mental health alongside autism, and having autism symptoms that they wanted to manage, and not getting enough support from physicians," she said, adding that those people "needed to self-medicate, I guess, for those symptoms that they wanted to manage."

She has heard stories of suicide attempts, of people using drugs to manage eating disorders or being forced to take drugs at a young age — but there were also hopeful stories. Weir talked to people whose lives were utterly transformed, for the better, once they received their autism diagnosis.

"It really surprised me to have so many different people specifically say, 'The reason I stopped abusing drugs is because of my autism diagnosis, because I finally as an adult got diagnosed and understood the experiences I was having better,''' Weir explained.

Though for all the dangers Weir says self-medication can pose, many people with autism extol the virtues of substances like alcohol, marijuana and even psilocybin — found in hallucinogenic mushrooms — which they say can help them cope.

Sharon Kaye-O'Connor, an autistic psychotherapist who specializes in neurodiversity, explained to Salon why autistic people may see an appeal in self-medicating.

Some autistic folks may self-medicate with substances in an attempt to cope with anxiety or an overwhelming sensory environment," Kaye-O'Connor said via email. "Autism is so frequently undiagnosed, or misdiagnosed as other conditions, which then makes it difficult for things like sensory issues to be properly understood and addressed. If an autistic person's sensory issues are mislabeled as anxiety or another condition, it is a missed opportunity to help someone better understand and accommodate their sensory needs.

"For some autistic adults, it may feel like they are living in an overwhelming world with little support. It can be incredibly difficult to find health care providers who truly understand autism and the autistic experience."

Russell Lehmann of "Autism Parenting Magazine" added another important observation — that people on the spectrum may use mind-altering substances not as an escape from reality, but as lubricant on the wheels of processing reality.

"When I am high I immediately gain a broader perspective on what it means to be human and am able to look back at my usual sober state with more objective hindsight, which I can then generate into foresight," Lehmann wrote to Salon.

Despite the anecdotes, Weir says self-medication is not necessarily a good thing, and may sometimes cover up issues that might be better addressed through other treatment methods.

Weir also expressed concern about overdosing, especially for drugs that manage physical and mental pain.

"There are possible drawbacks, but also I completely understand why people are doing it when they aren't receiving adequate support from healthcare providers," she said

Professionally Identified and joined WP August 26, 2013
DSM 5: Autism Spectrum Disorder, DSM IV: Aspergers Moderate Severity.

“My autism is not a superpower. It also isn’t some kind of god-forsaken, endless fountain of suffering inflicted on my family. It’s just part of who I am as a person”. - Sara Luterman


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08 Jul 2021, 11:11 am

I didnt know that we self-medicated at higher rates than general population.I have self medicated with caffeine i think but nothing else.


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09 Jul 2021, 2:56 am

I used to use magic mushrooms when they were legal, and I still think they helped me. I had a booklet about them by the Release people who were pretty much the only ones producing responsible stuff about recreational drugs, generally saying they didn't recommend them particularly but just giving a few enlightened do's and dont's to keep people safe. I saw them as more of a fun and a social thing than as medication, didn't know I had ASD back then. I've heard a few cautionary stories about them. One guy lost his sight for a few minutes, another couldn't get it together to get into his flat, another got scared out of his wits when his girlfriend put on an African death mask and jumped out of nowhere at him, as a playful prank. She didn't know he'd taken any mushrooms. He was in a very bad mood for some time afterwards. Nobody suffered any lasting harm, but those experiences were pretty traumatic.

There's a whole ethnic group that has marijuana as part of their life - Rastafarians and "hippies," with various attitudes to it, ranging from realistic to positively biased. I think it's seen more as a relatively safe and effective alternative to alcohol, though many are into both. I've not seen it do anybody any harm at all, except via law enforcement.

I looked into legal medical marijuana but it sounded like a lot of hassle and expense, and didn't seem all that likely that I could even get it, where I am. I've tried CBD but I had to use tons of it to feel any effect, and until they make it legal to grow hemp in the back yard there's no safe, cheap way of doing it. It's a great shame because I'd like to try high doses of CBD. I don't believe it's harmful and I think it would mellow me out a bit.

More recently, I messed with valerian but didn't get any strong evidence that it did anything at all. I use caffeine - perhaps strangely I add pure caffeine powder to decaffeinated tea so I can control the dose accurately. 200mg first thing most mornings to stop me feeling too groggy, then most days none after that, but sometimes a further 100mg later on in the day if I'm underslept. I also vape a lot of nicotine to keep me off tobacco (I'm an ex-smoker and vaping allowed me to quit) and possibly as a brain stimulant and mild antidepressant.

Beyond that, nothing. It's rare I even take analgesics. I don't really have much faith in medication generally (there are often unpleasant side effects and dangers) except short-term use for a specific condition, but I don't get clinically ill very often and even with flu I tend to just sweat it out without drugs. In a way I see all medication as self-medication, because if a doctor says he's going to put me on this or that, I'll just think "Sez you. I might take it if it looks like a good idea after I've researched it." I like the idea of people taking their lives into their own hands, I don't entirely trust the health professionals, though you have to know what you're doing to take control. In principle I'd keep unused, run-of-the-mill antibiotics around for a rainy day, to avoid the hassle and expense of seeing a doctor, if I was fairly sure they'd not degrade with storage, but I haven't actually done that.

I suppose Aspies might have a tendency to self-medicate, as they're often rather independent-minded and like to do things their own way, but that's just my conjecture.

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09 Jul 2021, 4:22 am

Part of the self-medication problem may stem simply from communication issues.

A light-hearted example: It was easier for me to learn to cut my own hair than to learn to communicate with hair stylists about what I want.
A heavier-hearted example: when I was misdiagnosed (exactly because of miscommunication), I wasn't able to communicate to the doctor that the pills he prescribed me worsened the problems instead of helping with them.

With such experiences consistent through one's life, no wonder many choose ways that bypass any need for communication with professionals.

Let's not confuse being normal with being mentally healthy.


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09 Jul 2021, 6:41 am

I'm fortunate that I have a very good relationship with my GP. I take stroke medicine but also ADHD meds, a low-dose atypical SSRI, a prescription sedative, and nightmare-controlling tablets. I don't really need or want anything else. That's more than enough as it is.

Pot is legal here but I don't like it. A lot of people use CBD, but I have no interest in it. I have an occasional drink but wouldn't consider it self-medicating.

I haven't had coffee in about 18 months, but I do like tea.

I guess my worst issue with doctors / pharmaceuticals is that I need very small doses compared to other people. I started my ADHD meds at 1/8 the normal starter dose. It took me a year to get to the normal dose. Some meds I can only nibble corner from the tablet or else it's just too strong for my system. Zoloft I could only tolerate 25mg but the doctor wanted me on 200mg, which was making me a zombie. If I can't have a tiny dose compounded, I won't take most meds.


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09 Jul 2021, 7:29 pm

I do CBD oil when I get a concussion. But i don't do anything else. I am not against people doing whatever works for them as long as they are safe and don't hurt others in the process

"I'm bad and that's good. I'll never be good and that's not bad. There's no one I'd rather be than me."

Wreck It Ralph