National Medicaid data showed substance use disorder prevalence among autistic adults without intellectual disability quadrupled from 2012 to 2016, with cannabis and hallucinogen disorders particularly elevated in those aged 30-64.
Clinicians treating autistic adults, autism advocates, and anyone interested in substance use patterns in neurodivergent populations.
SUD prevalence among autistic adults (no ID) increased from 1.75% to 7% between 2012 and 2016
What the researchers found
By 2016, 7% of Medicaid beneficiaries with autism and no intellectual disability had at least one substance use disorder diagnosis, up from 1.75% in 2012 data. Adults with autism aged 30-64 were at elevated risk for cannabis and hallucinogen use disorders. Co-occurring mental health conditions (affecting 50% of autistic individuals vs 23% of non-autistic) likely compounded this risk.
Why it matters
Autistic adults are an underrecognized population at risk for substance use disorders. The rapid increase in SUD prevalence and the specific elevation of cannabis disorders in this group highlights a gap in both clinical awareness and intervention development.
The numbers in context
388,426 autistic enrollees vs 745,699 non-autistic. SUD prevalence in autism (no ID): 1.75% in 2012 to 7% in 2016 (4x increase). Ages 30-64: elevated cannabis and hallucinogen disorder risk. 50% of autistic individuals had co-occurring mental health conditions vs 23% of non-autistic.
How the study worked
Retrospective analysis of national Medicaid Claims data comparing substance use disorder prevalence among enrollees with autism (N=388,426) versus a random sample without autism (n=745,699). Examined associations by sex, age, co-occurring mental health conditions, and community-level social determinants.
What this study cannot tell us
Medicaid claims may undercount substance use disorders. Rising prevalence could partly reflect better diagnostic coding rather than true increases. Cannot determine causation. Autistic individuals with intellectual disability were analyzed separately.
How to read the evidence
Moderate: large national dataset with control group comparison, though limited by claims-based diagnosis and potential coding changes.
When this study was published
2025 study using Medicaid data through 2016.
The bigger picture
As autism awareness increases and more autistic adults access healthcare, clinicians need to be alert to substance use disorder risk. The finding that half of autistic individuals have co-occurring mental health conditions suggests substance use may partly be self-medication.
Questions still open
- Are autistic adults using cannabis to self-medicate social anxiety or sensory issues? Would autism-adapted substance use interventions be more effective? Is the increased prevalence driven by actual increases or better detection?
Common questions
Are autistic people more likely to develop substance use problems?
Why are cannabis disorders elevated in autistic adults?
Read the original research
Comparing the prevalence of substance use disorders between persons with and without autism spectrum disorders.
Autism : the international journal of research and practice, 29(7), 1674-1687
Citation
Lushin, Victor; Marcus, Steven; Tao, Sha; Engstrom, Malitta; Roux, Anne; Shea, Lindsay. (2025). Comparing the prevalence of substance use disorders between persons with and without autism spectrum disorders.. Autism : the international journal of research and practice, 29(7), 1674-1687. https://doi.org/10.1177/13623613251325282
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