I was diagnosed with Autism Spectrum Disorder (ASD) at 50, in the middle of a breakdown. I also haven't touched cocaine or heroin in sixteen years. For a long time those were two separate stories in my head. They aren't anymore.
So, was I self-medicating? I don't know for sure, and I'm wary of anyone who claims to know that about their own past with total certainty. But I've had to ask myself the question. And the research says it's a fair one. A 2021 study from Cambridge of more than 2,000 adults found autistic people were, overall, less likely than non-autistic people to drink regularly or binge. But among those who gave a reason for using drugs, autistic people were nearly nine times more likely to say they used to manage their behaviour, and about three times more likely to say they used to manage mental health symptoms.
Less using, overall. But when we do, it's more often medicine we prescribed ourselves.
What does self-medicating even mean?
It means using a substance to fix a feeling you don't have another tool for. Anxiety, sadness, overload, the sense that you're on the wrong frequency from everyone else. You don't call it that at the time. At the time it's just the thing that works.
The trouble is it works on a loan. The relief is borrowed against tomorrow, with interest.
What might drugs have been doing for an autistic brain nobody had named?
This is where I can only speak for me, and even then, carefully.
For fifty years I didn't know why I was "weird." The tics, the habits, the obsessions, the passions that ate whole months. I could run a room full of people and then go home feeling like nobody in it had met me. I masked so hard and so long that I didn't know I was doing it. (I wrote about how masking broke me.)
When you live like that, anything that turns down the volume is going to feel like a miracle. The autistic people in that Cambridge study said much the same thing in their own words. They used to manage their behaviour, and to manage their mental health.
I've wondered if some of it, for me, was about making rooms full of people bearable. About quieting the noise in my own head long enough to feel normal. I've also had to admit it was just fun, at first, and I won't pretend otherwise. Both things can be true. That's what makes it so hard to untangle.
Does a late diagnosis change recovery?
For me it changed the story, which changed a lot.
For years the only explanation I had was a moral one. Weak. Bad at life. That kind of shame is fuel. It's one of the things people use over.
A diagnosis didn't excuse anything. I still did what I did. But it gave me a second explanation sitting next to the first one: maybe I was a person with a brain nobody had explained to me, using the only tools I could find. That's a lot easier to work with than "I'm just bad." You can build new tools for a brain. You can't build much on self-hatred.
It also matters for treatment. If you're autistic and nobody knows it, some advice won't fit. "Go to more meetings, call people, get out of the house" is good advice, and also exhausting in a way that's hard to explain if you're the one in the room who's masking the whole time. Knowing what you are lets you ask for help that fits. More on that tangle in dual diagnosis and in why a good night out wipes me out.
Should I get assessed if I think this is me?
Maybe. If you're in recovery and you've always felt wired differently, it's worth thinking about. I wrote about being diagnosed autistic at 50, and about whether it was worth it at my age.
Two cautions. First, don't use "maybe I'm autistic" as a reason to delay dealing with the substance use. Both can be worked on at the same time. Second, the line between autism, ADHD, trauma, anxiety and the effects of the drugs themselves gets blurry when you're still using or recently stopped. A good clinician will want to know your history, and some things are easier to see once you've had some time clean.
If you're physically dependent on anything, opioids especially, get medical help before you stop. Don't do withdrawal on your own.
A book that hit close to home
Gabor Maté spent years as a doctor in Vancouver's Downtown Eastside, treating people the rest of the city stepped over. I lived and worked in Vancouver for years, which is part of why this one landed.
In the Realm of Hungry Ghosts
Gabor Maté
My take. A Vancouver doctor who treated people the rest of the city stepped over. Compassion first. Hit close to home.
Good to know. His 'trauma causes all addiction' model is debated by researchers. Read it as one lens, not the whole truth.
His big idea is that addiction grows out of pain, often early pain, and that the right response is compassion. Researchers argue with him on how far he takes the trauma part, and they have a point: read it as one lens, not the whole truth. But on the compassion part, I think he's right.