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Decreased risk for substance use disorders in individuals with high-functioning autism spectrum disorder

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Abstract

The objective of this study was to evaluate the risk for developing a substance use disorder (SUD, alcohol or drug abuse or dependence) in individuals with high-functioning autism spectrum disorder (ASD). Subjects with high-functioning ASD were derived from consecutive referrals to a specialized ambulatory program for ASD at a major academic center from 2007 to 2016. Age-matched controls and attention-deficit hyperactivity disorder (ADHD) comparison subjects were derived from three independent studies of children and adults with and without ADHD using identical assessment methodology. Cox proportional hazard models were used to analyze the prevalence of SUD (alcohol or drug use disorder). Age of onset of SUD was analyzed with linear regression models. Our sample included 230 controls, 219 subjects with ADHD, and 230 subjects with ASD. The mean age for the ASD subjects was 20.0 ± 10.3 years. Among ASD subjects, 69% had a lifetime prevalence of ADHD, and the ASD subjects had significantly higher rates of other psychiatric psychopathology compared to ADHD and control subjects (p < 0.001) ASD subjects were at significantly decreased risk for developing a SUD compared to ADHD (hazard ratio (HR) = 0.22, p < 0.001) and control subjects (HR = 0.62, p = 0.04). The age of onset of a SUD was significantly older in ASD subjects, mean age 21.7 years, when compared to ADHD and control subjects (both p < 0.005). Individuals with ASD are at decreased risk to develop a SUD, and when they do, the onset is significantly later than ADHD and controls.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are not publicly available.

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Funding

This work was supported by the National Institutes of Health and the National Institute of Drug Abuse (Grant Number: K12DA00357-17) and the Massachusetts General Hospital Pediatric Psychopharmacology Council.

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Authors and Affiliations

  1. Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA

    Amy M. Yule, Maura DiSalvo, Joseph Biederman, Timothy E. Wilens, Nina T. Dallenbach, Daria Taubin & Gagan Joshi

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA

    Amy M. Yule, Joseph Biederman, Timothy E. Wilens & Gagan Joshi

  3. Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA, 02118, USA

    Amy M. Yule

Authors
  1. Amy M. Yule
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  2. Maura DiSalvo
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  3. Joseph Biederman
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  4. Timothy E. Wilens
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  5. Nina T. Dallenbach
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  6. Daria Taubin
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  7. Gagan Joshi
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Corresponding author

Correspondence to Amy M. Yule.

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Conflict of interest

Amy Yule, MD is currently receiving grant support from the NIH (NIDA). She was a consultant to the Phoenix House from 2015 to 2017 and is currently a consultant to the Gavin House and BayCove Human Services (clinical services). Joseph Biederman, MD, in the past 36 months, receives/received research support from the following sources: Genentech, Headspace Inc., Lundbeck AS, Neurocentria Inc., PamLab, Pfizer Pharmaceuticals, Roche TCRC Inc., Shire Pharmaceuticals Inc., and Sunovion Pharmaceuticals Inc. He is/was a consultant for Aevi Genomics, Alcobra, Akili, Guidepoint, Ironshore, Jazz Pharma, Medgenics, Piper Jaffray, and Shire. He received honoraria from the MGH Psychiatry Academy for tuition-funded CME courses. Dr. Biederman had a financial interest in Avekshan LLC, a company that develops treatments for attention-deficit hyperactivity disorder (ADHD); his interests were reviewed and managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. Through MGH corporate licensing, he has a US Patent (#14/027,676) for a non-stimulant treatment for ADHD, a US Patent (#10245271) on a treatment of impaired cognitive flexibility, and a patent pending (#61/233,686) on a method to prevent stimulant abuse. Dr. Biederman’s program received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Bracket Global, Ingenix, Prophase, Shire, Sunovion, and Theravance; these royalties were paid to the Department of Psychiatry at MGH. Timothy Wilens, MD receives or has received grant support from the following sources: NIH(NIDA). Dr. Timothy Wilens is or has been a consultant for Neurovance/Otsuka, Ironshore, KemPharm and Vallon. Dr. Timothy Wilens has published books: Straight Talk About Psychiatric Medications for Kids (Guilford Press); and co/edited books ADHD in Adults and Children (Cambridge University Press), Massachusetts General Hospital Comprehensive Clinical Psychiatry (Elsevier) and Massachusetts General Hospital Psychopharmacology and Neurotherapeutics (Elsevier). Dr. Wilens is co/owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire). Dr. Wilens has a licensing agreement with Ironshore (BSFQ Questionnaire). Dr. Wilens is Chief, Division of Child and Adolescent Psychiatry and (Co) Director of the Center for Addiction Medicine at Massachusetts General Hospital. He serves as a clinical consultant to the US National Football League (ERM Associates), U.S. Minor/Major League Baseball; Phoenix House/Gavin Foundation and Bay Cove Human Services. Gagan Joshi, MD is currently receiving research support from F. Hoffmann-La Roche Ltd. as a site Principal Investigator (PI) for two multi-site clinical trials and the Demarest Lloyd, Jr. Foundation. In 2019, he received a speaker’s honorarium from the American Academy of Child and Adolescent Psychiatry, in 2018, he was supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number K23MH100450, Pfizer Pharmaceuticals, and the Simons Center for the Social Brain as a PI for investigator-initiated studies. He also served on the Governor's Council for Medical Research and Treatment of Autism in New Jersey and as a reviewer and member of an editorial board for the NIMH. He received speaker’s honoraria from the Israeli Society of ADHD and the Canadian Academy of Child and Adolescent Psychiatry. Maura DiSalvo, MPH, Nina T. Dallenbach, BS, and Daria Taubin, BA declares that they have no conflict of interest.

Ethics approval

The human research committee at Massachusetts General Hospital approved this study, and this study has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

For subjects with ADHD and controls, adults provided written informed consent to participate and for children under the age of 18 years, parents provided written informed consent to participate, and children and adolescents provided written assent to participate. For subjects with ASD, we received institutional review board approval to review, analyze, and report anonymously on these subjects and a waiver of informed consent was granted.

Consent for publication

Not applicable. Information is anonymized and the submission does not include images that may identify any persons.

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Yule, A.M., DiSalvo, M., Biederman, J. et al. Decreased risk for substance use disorders in individuals with high-functioning autism spectrum disorder. Eur Child Adolesc Psychiatry 32, 257–265 (2023). https://doi.org/10.1007/s00787-021-01852-0

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