Over the past decade, a growing body of research has challenged prior beliefs about whether substance use disorder (SUD) is a significant problem among people with autism spectrum disorder (ASD), showing that SUD is growing in that group. According to the most recent data, about 7% of people with autism had a substance use disorder in 2016, compared to 1.75% in 2012. 

LDI Fellow Steven Marcus and colleagues published the first national study to use Medicaid data to compare substance use-related clinical outcomes among people with and without autism.  The team found that people with autism had higher rates of overdose and hospitalization and lower use of SUD services than their neurotypical peers. Marcus notes that the findings show “the substance use and mental health service needs of autistic people may not be adequately addressed, leaving this large and growing population at greater risk for poor outcomes.”

Medicaid’s Role in Autism and Substance Use Services

The study examined Medicaid claims from 2016 to 2020 for more than 50,000 people with autism and SUD and compared them with a control group of beneficiaries with SUD only. Medicaid is the largest behavioral health insurer in the U.S. and covers people diagnosed with both autism and SUD. The program pays for services that support people with autism, SUD, and co-occurring conditions, but states have significant flexibility in how they implement those services. States most often administer SUD services separately from services for people with autism.

Higher Risk of Overdose and Hospitalization

The research showed that overdose, hospitalization, and the concurrent use of benzodiazepines and opioids were more common among autistic people with SUD compared to neurotypical people with SUD. Among those with SUD, about 13% of those with autism had experienced an overdose in the past four years, compared with about 9% of the control group. 

Almost half (49%) of the group with SUD and autism were hospitalized during the same period, compared to 29% in neurotypical people with SUD. People with autism used benzodiazepines almost twice as much as the control group. 

The authors note that the disproportionately severe outcomes among people with autism may be due to the high rates of benzodiazepine use, limited access to or effectiveness of evidence-based SUD treatment for people with autism, or the life stressors experienced by this population.

Lower Use of SUD Services

The analysis showed that nearly all SUD-related services were used less often by Medicaid enrollees with SUD and autism than by the control group. The use of medication-assisted treatment (MAT), the most evidence-based treatment for SUDs, was more than three times higher among people with SUD who did not have autism than among those with autism. Psychotherapy was one of the few service types used more often by people with autism.

The authors note that these differences may reflect a lack of evidence-based adaptations of recommended SUD services for people with autism or insufficient clinician training in diagnosing and treating this population.  Additionally, the siloed administration of Medicaid SUD and autism services may make it more difficult to deliver care in an integrated way.

Need for Evidence-Based Treatment for People with Co-Occurring Autism and Substance Use Disorder

The authors note that the analyses likely underrepresent the number of people with both autism and SUD because SUD is disproportionately underdiagnosed among autistic people. 

Rising rates of SUD among people with autism, along with high rates of overdose and hospitalization, highlight the need to develop evidence-based treatment options that address the complex needs of people with co-occurring autism and SUD.

---

The study, “Substance Use Disorder Outcomes and Treatment by Autism Status in Medicaid Enrollees With Substance Use Disorder,” was published in Autism Research on July 16, 2026 by Victor Lushin, Lindsay Shea, Jonas Ventimiglia, Ming Xie, and Steven Marcus.

---

Author

---