Adapting Drug and Alcohol Therapies for Autistic Adults

Background: Autistic people may be at a higher risk of drug and alcohol misuse than the general population. Autistic people, however, are under-represented within drug and alcohol support services. This is the first survey of drug and alcohol therapists' perceptions of current service provision for autistic clients and recommendations for reasonable adjustments that therapists can make to enhance successful outcomes. Methods: We conducted an online survey of 122 drug and alcohol therapists, exploring therapists' demographics, training and experience with autistic clients, approaches and adaptations used with autistic clients, and therapists' confidence with autistic clients. Within two focus groups, 11 members of the autistic and broader autism (e.g., family members, professionals) communities reflected on the reasonable adjustments reported by therapists. Results: Most therapists had autistic clients and most therapists had received no autism-specific training. Alcohol misuse was the most common presenting issue, and most therapists reported that treatment outcomes were less favorable for autistic clients than for other groups. Therapists perceived that barriers to successful outcomes were (1) a lack of autism-specific training, (2) a need to adapt therapy for autistic clients, and (3) a lack of shared perspective between the therapist and the autistic client. Previous research has identified a range of reasonable adaptations and, when asked, therapists were moderately confident in their ability to deliver these. Members of the autistic and broader autism communities coproduced guidance detailing how therapists can best adapt their practice for autistic clients including how to structure sessions and the language to use within sessions. Conclusion: This study highlights a need for practical and theoretical training for drug and alcohol therapists to support successful adaptation to current service provision for autistic clients and to develop a shared perspective on the desired aims and outcomes of the therapeutic process. Autistic adults may be at greater risk for consuming drugs and alcohol to harmful levels compared with nonautistic adults. Autistic adults seeking support for drug and alcohol use report that treatment programs for reducing drug and alcohol use do not meet their needs. This study aimed to look at the skills, experience, and confidence of drug and alcohol therapists in working with autistic adults and what adaptions they are making to support autistic service users. Through an online questionnaire, the researchers asked 122 drug and alcohol therapists about their experiences with autistic clients (such as what issues they presented with), their autism training, and any perceived barriers or adaptations made to their service. Researchers also asked the therapists how confident they were to work with autistic clients and how successful their treatment was when compared with other client groups. Through two focus groups, the researchers then asked members of the autistic and broader autism (e.g., family members, professionals) communities to reflect how the reasonable adaptions reported by the therapist could be most effective for the autistic community. Most therapists had autistic clients and most therapists had received no autism-specific training. Alcohol was the most reported misused substance that therapists working with autistic adults encountered. Most therapists also reported that treatment outcomes were less favorable for autistic clients than for other groups. Therapists identified lack of training as a barrier to providing support for autistic adults. Therapists suggested that a one-size-fits-all approach was not helpful for this group and most were moderately confident that they would be able to deliver adapted therapy to autistic clients. Members of the autistic and broader autism communities developed guidance for therapists to implement effective adaptations for autistic clients. This was the first survey of drug and alcohol therapists regarding their service provision for autistic clients. The findings highlight the need for therapists to be trained in how to adapt support and treatment to meet the individual needs of autistic clients. One limitation of this study is the convenience sample. This may limit how we can generalize the findings. By asking specifically about autistic clients, we may have biased responses from therapists who have worked with autistic adults. The findings from this study highlight that treatment programs for drug and alcohol misuse do not consider the needs of autistic adults. However, they also suggest that various approaches and adaptions can be made to support autistic clients. In addition to supporting adaptions made by therapists, the guidance developed could be a useful framework for autistic clients to discuss their session-support needs with therapists. Future research should look at the effectiveness of these adaptions in improving treatment outcomes for autistic clients.