In the first episode of a two-part SSA podcast, Rob Calder talks to Professor Julia Sinclair, Chris Torry, Professor Sam Chamberlain, and Dr Janine Robertson from the Substance use, Alcohol and Behavioural Addictions in Autism (SABAA) project. With expertise and experiences spanning research, diagnosis, treatment, and lived experience, they offer a unique commentary on the similarities between behaviours associated with autism and addiction, and the challenges and opportunities these present for treatment services. [21 minutes]

There are several points of potential overlap between autism and addiction, including similar traits or patterns of behaviour. In this podcast episode you will hear about the need for practitioners to take a broad view, and be able to ask whether a particular behaviour is associated with a substance use problem or mental health problem, or could be a core feature of autism. As the SABAA team share, one of the barriers to this may be professionals not knowing enough about other conditions.

[Editorial note: Following the lead of the SABAA project this article uses identity-first language, but acknowledges that there is no universally-accepted way to describe autism.]

Julia Sinclair is Professor of Addiction Psychiatry in the Faculty of Medicine at the University of Southampton, and honorary consultant in alcohol liaison at University Hospital Southampton. She spoke about the perception that there aren’t many people in the substance use treatment population with autism, which may in part arise from autism not being considered during the assessment process: “Within autism assessment services, people are being specifically asked that question about their substance use. Within substance use disorder services, the question is not being asked, and if it is asked there is perhaps a lack of trained specialists within addiction services that might be able to pick up that this is a problem.”  Julia also identified that there may be a lack of awareness within addiction treatment services that some types of treatments are difficult for autistic people to engage with. This is particularly the case for psychological therapies in group settings, which are a mainstay of addiction treatment.

Chris Torry is autistic and has worked in addiction treatment services for many years. He expanded on this critical issue of why some treatment services can be difficult for autistic people to access: “Treatment structured around group work can be really difficult for some people because it’s overwhelming or stressful. The sensory environment can be really unpleasant. Lots of fluorescent lights and noise and lots of people interacting in sometimes intense and difficult to process ways.”

Sam Chamberlain is Professor of Psychiatry at the University of Southampton, and Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust. He talked about how treatment services for behavioural addictions are at an earlier stage of development in the UK than those for substance addictions, but why both may face similar challenges in terms of how well they can respond to the needs of autistic people: “One issue is that many clinicians may not be familiar with autism. Other clinicians, for example, who are familiar with autism, may have no training in behavioural addictions or substance use disorders.”

Janine Robinson is a Consultant Clinical Psychologist and a specialist in the field of autism in adults. She spoke about the threads that connect autism and addiction, and illustrated the potential functional role of alcohol in social settings for autistic people, whether or not alcohol also has a negative impact on their life: “I spoke to somebody a few months ago, when diagnosing them with autism, and they described their alcohol use, which they were a bit worried about. They said it wasn’t so much that they preferred drinking when they were out socialising, it was more that when other people were drinking they were more honest, and they were more direct in their communication.”

[The second part of this interview can be found at this link]