Finding Addiction Treatment as a Neurodivergent Person

Is Neurodiversity a Risk Factor for Addiction?

Neurodiversity may increase the risk of addiction. One study found that Autistic people with average or above-average IQs were more than twice as likely to develop addictions.¹⁶ The risk is even higher for people who are also ADHD. But neither autism or ADHD causes addiction. And no matter what your diagnosis, treatment can help.

If you are neurodivergent, you may encounter more stressors than most neurotypical people. These stressors can affect your mental health. They may even make you more vulnerable to addiction.

Environmental and Systemic Barriers

Neurodivergent people experience many barriers that can increase the risk of substance misuse. Doctors, mental health providers, educators, and other authority figures may underestimate your capabilities. Perhaps because of this, neurodivergent people have lower employment levels¹⁷ than neurotypical people.

Trauma History

A history of trauma can be a major risk factor in the development of a substance use disorder. This is especially for neurodivergent people with more than one marginalized identity. People who experience systematic oppression may be more vulnerable to traumatic events.

Trauma history can also include relational traumas, like bullying and disconnection from caregivers.¹⁸ Many neurotypical parents don’t know how to meet their neurodivergent children’s needs. Even if your parents had good intentions, you might have experienced childhood trauma.

Masking and Social Disconnection

Surrounded by enforced neurotypical norms, many neurodivergent people develop masking behaviors.¹⁹ Masking is an adaptive response, in which people learn to hide neurodivergent characteristics. By appearing neurotypical, you may feel safer or get less negative feedback. For example, you might force yourself to make eye contact even when it feels painful. If you use these coping strategies often, you may or may not even realize that you’re masking. People with many forms of neurodivergence often show masking.²⁰ This can be an especially important issue for people who are Autistic or ADHD.

A neurodivergent person might use these strategies to cope with certain social situations. For example, you may copy other people’s body language and facial expressions. You might also base your behavior off of social cues you learned from movies and books.

Finally, you might use assimilation strategies as a way to fit in with others. For example, you might force yourself to interact with others even when you feel burned out. On the other hand, you might avoid social settings completely.

Sensory Differences

Many neurodivergent people are easily distressed by both over- and under-stimulation. Either can lead to meltdowns, shutdowns, and unhealthy coping strategies—like drug use. And once you start taking drugs, you might be especially vulnerable to addiction.

Some neurodivergent people have an especially high sensitivity to substances. You may also be less aware of their effects. This is because some neurodivergent people have differences in interoception²¹ (body awareness).

These factors can combine to make addiction a common challenge among neurodivergent people. Jesse Meadows describes their experience of alcohol use and neurodivergence:²²

“As a teenager, I could not deal with the school day sober, but despite being under some kind of influence on a daily basis, I also managed to get through it with average grades. In college, I drank heavily (among other substances), worked a job, took a full course load, and still somehow managed to make the Dean’s List every semester…

I didn’t consider that I was autistic because of alcohol, and I didn’t consider that I was an alcoholic because alcohol was not hindering my functioning — in many ways it was facilitating it. This is called ‘self-medication,’ and it’s something most people do with alcohol to some degree, although it seems to be somewhat different for autistic people.”

The Experience of Neurodiversity and Addiction

Many people develop addictions because it feels like drug use helps them socialize. This is true for both neurodivergent and neurotypical people. Drugs like ecstasy (MDMA) can also increase feelings of emotional connection.

In the right context, medication can be extremely helpful for people with neurodivergence. One study demonstrated that MDMA-assisted therapy can decrease social anxiety²³ in Autistic adults. Some neurodivergent people use substances,²¹ including alcohol, to achieve these effects:

• dulled sensory sensitivities, and relief from sensory overwhelm
• courage in intimidating social situations
• relaxed inhibitions
• increased energy to get through a demanding world
• sensory stimulation
• entertainment for an anxious or preoccupied mind
• silencing the inner critic

There is a significant overlap between addiction and neurodivergence. Because of this, it’s important to find a rehab that can provide affirming care. Certain indicators can tell you whether a program is a good fit for you.

Signs of a Neurodiversity-Affirming Treatment Center

At a neurodiversity-affirming rehab, providers will advocate for you. The staff will listen to you, and accommodate as many of your needs as they can. For example, you might be able to adjust your room’s lighting so it’s not too bright or overstimulating. You should also be able to give feedback about the type of treatment you receive.

Physical Environment

Many neurodivergent people are very attuned to their surroundings. To be accessible, the physical space of a treatment center should take this into account.²⁴ For example, rehab centers can offer some of these amenities:

• soft or natural lighting
• lighting accommodations (such as sunglasses)
• a quiet space with gentle white noise (such as a fan, white noise machine, or gentle music)
• a variety of sound accommodations (such as earplugs or headphones in several materials)
• a clean space with no strong or overpowering scents
• a variety of seating options, including different sizes, shapes, and textures
• a comfortable temperature, and ways to make adjust it (such as small fans and space heaters)
• blankets and sensory items (hand fidget toys, rings, chewy necklaces, etc.)

Treatment Program Format

You’ll feel most at ease and supported at a rehab with programming designed to be affirming. You’ll also be able to engage in treatment more fully and benefit as much as possible.

Here are some important aspects to look for in a neurodiversity-affirming treatment program:²⁵

• Therapy goals center on your needs and your values.
• Support animals are welcome in the space.
• You can see an overview of what processes look like from intake to end of the program. This should tell you what to expect at each stage, and what you should bring with you or how to prepare.
• The team asks how you communicate best (ex. speech, text or writing based, or symbolic or graphic), and invites you to communicate in that way.
  You have the freedom to stand, change your position, or leave to take breaks during sessions.
• Therapists are willing to slow down or pause to make sure you have enough time to process.
• You have the option to meditate and do deep breathing exercises.
• You can use a consistent structure and session agenda, if you find that helpful.
• Providers regularly check in about your comfort with pacing and speed of sessions.
• You can access printed or recorded copies of any homework assigned between sessions.

When you’re first starting recovery, these adjustments can make all the difference. Remember that, as you select a rehab program, you have the right to ask for what you need. That may include certain approaches to treatment, types of therapy, or other resources.

Selecting a Treatment Approach as a Neurodivergent Person

There’s a great deal of variation under the umbrella of neurodiversity. Even within a single neurotype, certain therapies may be a good fit for some people, and not for others. In rehab, you’ll work with a team of providers to find the treatments that work best for you.

Occupational Therapy

During addiction recovery, a focus on sensory needs is key. This helps neurodivergent people practice self-regulation through healthy coping strategies.²² Jesse Meadows shares their thoughts on what has worked for them:

“What’s really helped me need less alcohol are sensory-based techniques — designing a ‘sensory diet’²⁶ for myself, understanding what triggers and what soothes, and setting up my life in a way that accommodates my needs.”

For example, Meadows limits the time they spend masking. This helps them navigate triggers and cravings.

Community-Based Group Therapy

During recovery, you can work against shame by connecting with other neurodivergent people.²¹ This is a crucial part of healing. In these community spaces, you can learn to unmask in a way that makes sense for you. It can be helpful to do this around people who share some part of your experience.

Devon Price, an Autistic social psychologist and the author of Unmasking Autism: Discovering the New Faces of Neurodiversity,²¹ dreams of how these relationships can change the world:

“I want Autistic people to experience less shame about who they are, and to learn to take off the restrictive masks that have trapped us for decades. The first step to unmasking is accepting who you are, and finding others with similar experiences. You don’t need a piece of paper from an assessor to begin to do that.”

Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)²⁷ can help you reconnect with your body. Sessions can decrease the intensity of your physical response to triggers. This approach is especially helpful for people with a history of trauma.

Less Effective Treatments

Cognitive behavioral therapy (CBT) can be highly effective—for neurotypical patients. But, data shows that CBT can be far less effective for Autistic people.²¹ When providers are first taught how to communicate with Autistic people, the CBT they offered is more likely to help with addiction recovery.

Most importantly, any program that requires you to mask or work toward neurotypical goals that you don’t value will not be a good fit. The important thing is to find a rehab whose values align with your own. In an affirming environment, you’ll get support from providers who view you as the expert in your own needs.

Embrace Healing as a Neurodivergent Person

In this neurotypical world, many things aren’t set up in a way that works for neurodivergent people. Because of this, you might not trust healthcare providers to understand what you need. And that can make the idea of getting help feel stressful and confusing.

The right rehab program won’t ask you to change to fit in. Instead, your team should be sensitive to your needs, and willing to support you in any way they can.

When you’re ready to start addiction recovery, you have the right to accessible, affirming treatment. Connect with a rehab that specializes in neurodiversity to get your questions answered.

Reviewed by Rajnandini Rathod

1. Milton, D., Ridout, S., Murray, D., Martin, N., & Mills, R. (2020, September 25). The Neurodiversity Reader: Exploring concepts, lived experiences and implications for practice [Edited book]. https://www.pavpub.com/mental-health/the-neurodiversity-reader [↩]
2. Sinclair, J. (2012). Don’t mourn for us. Autonomy, the Critical Journal of Interdisciplinary Autism Studies, 1(1). https://www.larry-arnold.net/Autonomy/index.php/autonomy/article/view/AR1 [↩]
3. Throw away the master’s tools: Liberating ourselves from the pathology paradigm • neuroqueer. (2021, August 1). https://neuroqueer.com/throw-away-the-masters-tools/ [↩]
4. Price, D. (2022). Unmasking autism: Discovering the new faces of neurodiversity. New York: Harmony Rhodale. [↩] [↩]
5. Belek, B. (2019). Articulating sensory sensitivity: From bodies with autism to autistic bodies. Medical Anthropology, 38(1), 30–43. https://doi.org/10.1080/01459740.2018.1460750 [↩]
6. Phung, J., Penner, M., Pirlot, C., & Welch, C. (2021). What I Wish You Knew: Insights on Burnout, Inertia, Meltdown, and Shutdown From Autistic Youth. Frontiers in Psychology, 4981. [↩]
7. Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64(1), 135–168. https://doi.org/10.1146/annurev-psych-113011-143750 [↩]
8. Rose, M. (2020). Neuro emergent time: Making time make sense for ADHD and Autistic people. Retrieved https://martarose-neurodivergentcreators-com.ck.page/9d449add24 [↩]
9. Moore, D. R. (2006). Auditory processing disorder (APD): Definition, diagnosis, neural basis, and intervention. Audiological Medicine, 4(1), 4-11. [↩]
10. Grove, R., Hoekstra, R. A., Wierda, M., & Begeer, S. (2018). Special interests and subjective wellbeing in autistic adults. Autism Research, 11(5), 766-775. [↩]
11. Doyle, N. (2020). Neurodiversity at work: A biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108–125. https://doi.org/10.1093/bmb/ldaa021 [↩]
12. Adams, N., & Liang, B. (2020). Trans and autistic: Stories from life at the intersection. Jessica Kingsley Publishers. [↩]
13. Jones, D. R., Nicolaidis, C., Ellwood, L. J., Garcia, A., Johnson, K. R., Lopez, K., & Waisman, T. (2020). An expert discussion on structural racism in autism research and practice. Autism in Adulthood, 2(4), 273–281. https://doi.org/10.1089/aut.2020.29015.drj [↩]
14. Decoding the overlap between autism and ADHD. (2018, February 7). Spectrum | Autism Research News. https://www.spectrumnews.org/features/deep-dive/decoding-overlap-autism-adhd/ [↩]
15. Untangling the ties between autism and obsessive-compulsive disorder. (2019, February 27). Spectrum | Autism Research News. https://www.spectrumnews.org/features/deep-dive/untangling-ties-autism-obsessive-compulsive-disorder/ [↩]
16. Butwicka, A., Långström, N., Larsson, H., Lundström, S., Serlachius, E., Almqvist, C., Frisén, L., & Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: A population-based cohort study. Journal of Autism and Developmental Disorders, 47(1), 80–89. https://doi.org/10.1007/s10803-016-2914-2 [↩]
17. Das, M., Tang, J., Ringland, K. E., & Piper, A. M. (2021). Towards accessible remote work: Understanding work-from-home practices of neurodivergent professionals. Proceedings of the ACM on Human-Computer Interaction, 5(CSCW1), 183:1-183:30. https://doi.org/10.1145/3449282 [↩]
18. Gratton, F. V. (2019). Supporting transgender autistic youth and adults: A guide for professionals and families. Jessica Kingsley Publishers. [↩]
19. Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical Psychology Review, 89, 102080. https://doi.org/10.1016/j.cpr.2021.102080 [↩]
20. Miller, D., Rees, J., & Pearson, A. (2021). “Masking is life”: Experiences of masking in autistic and nonautistic adults. Autism in Adulthood, 3(4), 330–338. https://doi.org/10.1089/aut.2020.0083 [↩]
21. Price, D. (2022). Unmasking autism: Discovering the new faces of neurodiversity. Harmony/Rodale. [↩] [↩] [↩] [↩] [↩]
22. Meadows, J. (2021, April 6). Alcohol: An autistic masking tool? Medium. https://jessemeadows.medium.com/alcohol-an-autistic-masking-tool-8aff572ca520 [↩] [↩]
23. Danforth, A. L., Grob, C. S., Struble, C., Feduccia, A. A., Walker, N., Jerome, L., Yazar-Klosinski, B., & Emerson, A. (2018). Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: A randomized, double-blind, placebo-controlled pilot study. Psychopharmacology, 235(11), 3137–3148. https://doi.org/10.1007/s00213-018-5010-9 [↩]
24. Hughes, J. (2016). Increasing Neurodiversity in Disability and Social Justice Advocacy Groups. Retrieved from https://autisticadvocacy.org/wp-content/uploads/2016/06/whitepaper-Increasing-Neurodiversity-in-Disability-and-Social-Justice-Advocacy-Groups.pdf [↩]
25. Wilson, S. (2017). How is counselling experienced by people with Asperger’s syndrome? : A qualitative study [Ph.D., University of the West of England]. https://uwe-repository.worktribe.com/output/900983 [↩]
26. musingsofanaspie. (2014, February 18). Sensory diet. Musings of an Aspie. https://musingsofanaspie.com/2014/02/18/sensory-diet/ [↩]
27. RMT, J. M., PhD, LPCC-S, LICDC-CS, REAT, & MFT, S. D., PsyD. (2021). Healing addiction with emdr therapy: A trauma-focused guide. Springer Publishing Company. [↩]