Systematic review of risk and protective factors associated with substance use and abuse in individuals with autism spectrum disorders

• Published in: Autism : the international journal of research and practice 2020-05, Vol.24 (4), p.899-918
• Main Authors: Ressel, Madelaine, Thompson, Brittni, Poulin, Marie-Hélène, Normand, Claude L, Fisher, Marissa H, Couture, Germain, Iarocci, Grace
• Format: Article
• Language: English
• Subjects: Adolescents; Adults; Anxiety; Asperger Syndrome; At Risk Persons; Attention Deficit Hyperactivity Disorder; Autism; Averages; Behavior Disorders; Belonging; Clinical Diagnosis; Comorbidity; Coping; Drug abuse; Drug use; Emotional Disturbances; Environmental Influences; Executive Function; Externalizing problems; Family Influence; Incidence; Intellectual Disability; Intervention; Medical treatment; Mental Disorders; Mental health; Outcomes of Treatment; Personality Traits; Pervasive Developmental Disorders; Prevalence; Protective factors; Research methodology; Resilience (Psychology); Risk; Sensation seeking; Social Capital; Social Influences; Social networks; Social resources; Social support; Substance Abuse; Support networks; Symptoms (Individual Disorders); Systematic review
• ISSN: 1362-3613; 1461-7005
• DOI: 10.1177/1362361320910963

A systematic review of autism spectrum disorder and substance use and abuse was conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol guidelines (an internationally recognized standardized methodological framework for conducting systematic review). The objectives of the review were to update and extend findings reported by Arnevik and Helverschou’s review of the autism spectrum disorder and substance use literature by (1) evaluating study quality via the Mixed-Methods Appraisal Tool; (2) examining autism spectrum disorder and substance abuse diagnostic measures; (3) reporting on the prevalence of co-occurring autism spectrum disorder and substance abuse; and (4) identifying risk, protective, and positive treatment factors. Twenty-six studies on substance use and abuse in autism spectrum disorder were identified through a search of MEDLINE, PsycINFO and Google Scholar. Average study quality score was 75.4%. Prevalence rates of substance abuse among samples with autism spectrum disorder ranged from 1.3% to 36%, but due to variability in sample characteristics and diagnostic measures, a general prevalence rate could not be established. Risk and protective factors, recognized in the general population, such as familial substance abuse and comorbid externalizing disorders, and factors, which may be more likely to occur in individuals with autism spectrum disorder compared to the general population, such as few social resources (i.e. sense of social belonging, breadth of social support networks, and level of social capital) and low sensation-seeking, were identified. One intervention study was identified; however, methodological limitations preclude any conclusion regarding positive treatment factors at this time. More research, using standardized measures and comparable samples, is needed to understand risk and protective factors and to determine the prevalence of co-occurring substance abuse and autism spectrum disorder. Lay Abstract Symptoms characteristic of autism spectrum disorder were initially believed to protect individuals with autism spectrum disorder from developing substance abuse. However, recent studies suggest that up to 36% of individuals with autism spectrum disorder may have a co-occurring issue with substance abuse. In addition, substance abuse may worsen the difficulties with daily functioning some individuals with autism spectrum disorder experience. It is important to understand occurrence rates,