Addiction Treatment Rights - Emergent Divergence

Jul 13 2023

AuDHD and cigarettes: What is the relationship?

Autism and ADHD are often reported to have vastly different relationships with regard to the smoking of cigarettes. Research suggests that among Autistic people, we see a reduced rate of smoking, while ADHDers generally report smoking more frequently (nearly half reported daily smoking by age 17). I believe, however, that a serious oversight has occurred in research regarding the co-existence of both Autistic and ADHD identities in individuals (also known as AuDHD).

I had previously highlighted that around 37% of Autistic respondents to a Twitter survey reported current or historical smoking. I discussed that this may be because Autistic people use smoking as a stim and for sensory breaks, but when we consider the overlap between autism and ADHD (estimated to be 50-70%) we start to see more reasons for why there may be increased smoking of tobacco between neurodivergent people.

ADHDers often smoke as a way to self-medicate (nicotine is a stimulant) or due to impulsivity (see this study). When we combine ADHD and Autism, we combine the risk factors for smoking cigarettes. Not only do AuDHDers need a reason to escape environments or use smoking as a stim, the nicotine helps to regulate attention.

So, when we consider research that finds Autistic people to have a lower than average prevalence of tobacco smoking, I have to question whether or not the sample was biased. At least half, if not more Autistic people are also ADHD, and therefore should be subject to the sake prevalence and risk factors for smoking as those assumed to only be ADHD.

Smoking rates are an important thing to consider in neurodivergent communities, given their link to early mortality. Autistic people face a mortality risk suggested to be 51% higher than the general population with Autistic people living an average of 16 years less than non-Autistic people. Increased rates of smoking in AuDHD demographics almost inevitably contribute to our shorter than average life span.

This raises important questions for cessation and maintenance of abstinence from tobacco in nicotine dependent AuDHDers. Substance use services are notoriously ill equipped to work with neurodivergent people; the same could be said of smoking cessation services. Most of which are run out of pharmacies in the UK with no reference to neurodivergence in NICE guidance.

As with most cases of chemical dependency and addiction, neurodivergent people are forced to find their own route to abstinence or harm reduction. This matter only becomes more complicated with the co-occurrence of multiple neurodivergent identities.

AuDHD people are often ignored in research, probably due to the complicated nature of identifying exact co-occurrence rates in a world where diagnostic criteria miss the identification of many. When we consider research into AuDHD substance use, we can appreciate that it is not a simple affair and that it would be a significant undertaking to obtain truly accurate figures.

Regardless, Autistic and ADHD people deserve a shift in research priorities, away from causative factors and genetics, towards meaningful insights into our quality of life and longevity.

Nothing will shorten our lives more than ignoring the issues that shorten our lives.

David Gray-Hammond 1 Comments

Jun 28 2023

Autism and alexithymia: The fallout for our mental health

Autism and alexithymia are two things you might see discussed in tandem quite regularly. In fact, Vaiouli and Panayiotou (2021) found a strong postive correlation beween Autistic experience and alexithymia with Kinnaird et al (2019) finding a prevalence rate of nearly 50% among Autistic people. Considering the very high rates of alexithymia among Autistic people, it is necessary to think about how this might contribute to issues in healthcare settings where professionals are largely trained in non-autistic expressions of emotion.

Alexithymia (according to the Merriam-Webster dictionary) is the inability to identify and express or describe one’s emotions. In other words, an alexithymic person experiences emotions in a way that means they struggle to attribute the internal sensations to descriptive language. It is subset of interoceptive differences which is discussed by Adkin (2023) in relation to their concept of “Meerkat Mode”.

This obviously presents issues with accessing support for our mental health. How can we explain our struggle if we can’t put it into words? Professionals often take us less seriously because if it was “that bad” we would be able to voice our suffering. Unfortunately it is not as simple as this. Even in my own experience, I often struggle to feel the difference between emotions like anxiety and excitement. Happiness and sadness also feel similar to me, and exhaustion is something I often can’t recognise until I am at the point of crisis.

This is a significant enough issue to face as an Autistic adult, but it happens to Autistic children as well. We regularly see Autistic people turned away from services such as CAMHS because they are in no way equipped to help us. Children are naturally less adept at describing emotions, especially the big emotions, and when you throw alexithymia in on top of that it leads to a breakdown in communication that can have life threatening consequences.

I have found myself at multiple points in my life being administered medication that I did not need because the ways I have learned to articulate my very abstract feeling emotions have been misunderstood (accidentally and willfully) by psychiatrists. We live in a world that pathologises our suffering, meaning that we can face horrific side effects to treatments that we might not have needed had professionals been culturally competent with regards to mental health in Autistic people. Tanya Adkin and I have written about the importance of competence previously (Gray-Hammond & Adkin, 2023).

I often ponder on the relationship between my early experiences of not being able to communicate my emotions effectively to professionals and my subsequent years of a drug and alcohol addiction. Honkalampi et al (2022) found a positive correlation between alexithymia and substance use, which in my opinion may indicate a mechanism behind the findings of Weir et al (2021) showing significantly higher rates of self-medicating with recreational drugs among Autistic adolescents and adults. In fact, one of the primary drivers behind my drug use was having control over my emotional experience. I would hazard a guess that drug use is so common in the Autistic community because it allows us to feel a familiar and more easily described feeling.

It is clear that alexithymia is a significant issue for not just Autistic people, but also for professionals working in healthcare and wellbeing practices. The links between alexithymia, poor access to mental health support, and risk taking behaviour are clear. It’s necessary for professionals working with Autistic people to find ways to help Autistic people articulate their emotions rather than to just ignore us or belittle our struggles.

Our lives depend on it.

References

Adkin, T. (2023). What is meerkat mode and how does it relate to AuDHD? https://emergentdivergence.com/2023/06/06/what-is-meerkat-mode-and-how-does-it-relate-to-audhd/

Gray-Hammond, D., & Adkin, T. (2023). Creating Autistic Suffering: Autistic safety and neurodivergence competency. https://emergentdivergence.com/2023/04/11/creating-autistic-suffering-autistic-safety-and-neurodivergence-competency/

Honkalampi, K., Jokela, M., Lehto, S. M., Kivimäki, M., & Virtanen, M. (2022). Association between alexithymia and substance use: A systematic review and meta‐analysis. Scandinavian Journal of Psychology, 63(5), 427-438.

Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80-89.

Vaiouli, P., & Panayiotou, G. (2021). Alexithymia and autistic traits: associations with social and emotional challenges among college students. Frontiers in Neuroscience, 15, 733775.

Weir, E., Allison, C., & Baron-Cohen, S. (2021). Understanding the substance use of autistic adolescents and adults: a mixed-methods approach. The Lancet Psychiatry, 8(8), 673-685.

David Gray-Hammond 6 Comments

Apr 16 2023

My new book on autism and addiction is now available!

I am really excited to tell you all that I ha e published a new book!

Unusual Medicine: Essays on Autistic identity and drug addiction

This book explores my personal experiences with being Autistic and addicted to drugs and alcohol. It considers my recovery and what was unique about my experiences.

Alongside this, I also bring my professional insights as a person who works with Autistic addicts. I make suggestions on basic changes to services that would make them more accessible, and how we can change societies framing of addiction.

It is currently available on Amazon in most territories, and will also soon be available from some other online retailers.

If you would like purchase a copy, see the buttons below!

UK Amazon Link

US Amazon Link

Also, don’t forget that you can subscribe to my Substack for bonus content!

David Gray-Hammond 1 Comments

Jan 15 2023

Drug-use and harm reduction: what does it look like?

When we consider harm reduction strategies for drug-users, we often think about education on the safer use of drugs. Things such as safer injection practices and “tasting the hit” to reduce accidental overdoses. While things such as safe consumption rooms and needle exchanges can reduce a lot of the surface level harms, there is a wider conversation about the factors leading to drug-use and the fall out from drug-use once it has initiated.

Here are some of the things that, in my opinion, are important factors to consider when trying to reduce the harms from drug-use.

1. Trauma-informed practice

First, we need to stop viewing trauma through a normative lens and realise that trauma can be experienced from just about any source. As I discussed with Tanya Adkin in the Creating Autistic Suffering Series, trauma is a subjective experience.

Once we have shed our misconceptions of what constitutes trauma, we need to recognise the role that traumatic experiences play in the harms associated with drug-use. Anyone supporting people around harm reduction needs to remember that they are more than likely working with traumatised people.

2. Responsible prescribing practices

The pathologisation and subsequent medicalisation of distress has done many people a great deal of harm. For many people, myself included, it has meant trading addiction to illicit drugs for addiction to prescription drugs. In my case, prescription drugs were more dangerous than the illicit ones due to ease of access.

People don’t like to admit it, but doctors often end up being a person’s main supplier of drugs.

3. Move away from current diagnostic models in psychiatry

Distress doesn’t have to be centred as a problem in the person. In fact, I would argue that it’s necessary to externalise it by looking to the environment, and subsequent experiences of people in distress. We need to consider that if we want people to be safer in the use of drugs, we need to think about what in their life has brought them to using them.

For a good example of this, check out the power threat meaning framework.

It is also important to embrace neurodiversity models. It’s not just Autistic people that are Neurodivergent. Neurodivergence can be acquired in a number of ways, or you van be born with it. It is important, though, to recognise that “mental illness” as a concept has not improved outcomes in psychiatry in over 50 years. Recognising Neurodivergent people in distress will take you much further.

4. End prohibition

The war on drugs is a lie. It has not stopped drug use, and neither has abstinence-based education. Making drugs illegal does not stop their use, it empowers clandestine markets to exploit the distress of vulnerable people, for profit, and increases harms through the lack of regulations around purity and age restriction.

This is a non-exhaustive list. We need to have a wider conversation about racism and other bigotry, socioeconomic status, housing, access to healthcare, and myriad other factors. I do not believe I could do this justice in a short blog.

I hope that we can move into a world where we support people rather than criminalise and institutionalise them. I hope that medical professionals can take a moment to acknowledge the harm their profession has done. I hope that we can all assess our own internalised ableism towards drug-use and addiction.

We may not be able to solve this issue over night, but little by little, we can make the waves that will sweep away the old models and make space to replace them with something that works better for every one. The greatest thing we can do is have a little compassion for others who are suffering.

David Gray-Hammond 0 Comments

Jan 13 2023

Autistic drug-users and the lack of solid guidance in support services

In the UK the majority of mental health support and treatment is guided by an organisation called The National Institute for Health and Care Excellence (NICE). Their guidance sets out how each and every person treated in a clinical setting should be managed, and what treatment modalities are appropriate and inappropriate. Except there is a glaring gap in this guidance, this gap is with regards to the treatment of Neurodivergent drug-users. They have guidance on the dual-diagnosis intersection where drug-use and “severe mental illness” meet, but nothing regarding neurodivergence.

This presents a unique challenge to practitioners working in the field of substance-use; it certainly contributes to the misconception that drug-use is a non-issue for Autistic people. Of course, if it was an issue, why wouldn’t it be in the guidance?

Neurodivergent people exist at multiple intersections of race, gender, sexuality, socioeconomic status, why is it so hard to understand that we often turn to drugs in order to self-medicate the trauma of our improper society? Weir et al (2021) showed definitively that while we are less likely to report using drugs, we are more likely to report self-medicating with what can be considered “recreational substances”. This pulls the plight of Neurodivergent people into the spotlight. Where self-medication exists, the potential for escalation to addiction exists.

Without concrete guidance in place, support for those existing at this intersection of experiences is likely to continue down a path of inadequacy. Some might ask what guidance should look like, while I have some specific ideas, I believe there is a wider need for understanding of Neurodivergent experiences in service providers. Guidance can’t just be drawn up in a “one-size-fits-all” manner, clinical commissioners and others involved in treatment policy need a nuanced understanding of our experiences.

This understanding can only come from co-production of material guidance. Autistic and otherwise Neurodivergent people need to be involved in the generation of guidance and policy. Having worked in service user involvement models, I have seen first hand the vital impact that the voice of those affected has on steering policy.

The truth is that many people writing guidance and policy have little to no experience of the real world effects of drug-use, let alone the real world impacts that drug-use has on Neurodivergent people in particular. Most of them are still rooted deeply in medicalised ideas of neurodivergence. Their are broad issues to consider.

Drug-use is intrinsically linked to socioeconomic status and further marginalisation. When you consider that only 22% of Autistic people are currently in any form of employment in the UK (Office for National statistics, 2020), not to mention the number of us existing in the court and judicial system; Neurodivergent young people represent a particularly large portion of youth offending populations (Day, 2022). We are 7 times more likely to be permanently excluded from mainstream education (Gill et al, 2017), representing 44% of all permanent exclusions (Vibert, 2021).

It seems as though Neurodivergent young people exist on a school to self-medication to prison pipeline, and that is assuming the drugs don’t end their lives before they have begun. The guidance is not only needed, it needs to consider all aspects of life that are contributing to it. We cannot claim that we are engaging in harm reduction while such things are happening. Let us not forget the horrifically traumatic experiences that Autistic people face (Gray-Hammond & Adkin, 2021). It’s a perfect storm for drug-use and addiction. We need guidance from official governing bodies.

It’s vital to mention that neurodivergence doesn’t end at 18. Neurodivergent young people turn into Neurodivergent adults. We need support and guidance across all age groups.

Until NICE and other clinical governing bodies work with Neurodivergent populations to produce guidance that is fit-for-purpose, we will continue to see the premature death and imprisonment of Neurodivergent people who are doing nothing but trying to survive in a system that sets them up to fail. We need guidance across all settings, but especially clinical ones.

Please sign this petition regarding the lack of NICE guidelines

References

Day, A. M. (2022). Disabling and Criminalising systems? Understanding the experiences and challenges facing incarcerated, neurodivergent children in the education and youth justice systems in England. Forensic Science International: Mind and Law, 3, 100102.

Gill, K., Quilter-Pinner, H., & Swift, D. (2017). Making the difference: Breaking the link between school exclusion and social exclusion. Institute for Public Policy Research.

Gray-Hammond, D & Adkin T (2021) Creating Autistic Suffering: In the Beginning there was trauma. Emergent Divergence

Office for National Statistics (2020) Outcomes for disabled people in the UK: 2020

Vibert, S. (2021). Briefing: Five things you need to know about SEN in schools: February 2021.

Weir, E., Allison, C., & Baron-Cohen, S. (2021). Understanding the substance use of autistic adolescents and adults: a mixed-methods approach. The Lancet Psychiatry, 8(8), 673-685.

David Gray-Hammond 0 Comments

Dec 20 2022

Rat Park: Addiction misunderstood

Johann Hari did a lot for the popularisation of the rat park experiment. This person’s now infamous Ted Talk flung open the conversation that perhaps, just maybe, addiction was not biological in origin. While this attempt to depathologise human experience was admirable, both sides of this argument miss a vital cornerstone that bridges so many gaps in our understanding of addiction.

Rat park suggested that the reason the rats preferred drug-laden water was because of the lack of a meaningful social environment. While I will argue that this certainly plays a role on the perpetuation of addictive behaviours, there is more to be considered.

There have been various retorts, but in my opinion, we need to discuss one thing in particular. We need to talk about trauma.

It doesn’t matter what kind of privilege you have in this world, trauma can set off a domino effect, leading you down a path towards addiction. I am yet to meet any addict who was not trying to hide from pain. Some might argue that not all addicts are traumatised, but I would respond by saying that we need to ditch the normative ideas of what trauma is.

Anything can be traumatic, trauma is relative to the Self, not the external observer.

So, yes, a lack of a meaningful social environment can play a big role in addiction, but I do not believe that is what pulls people into the grasp of active drug addiction. It is what keeps them feeling as though they have no way out. That in itself is a traumatic experience which leads to increased drug use.

This is why we need to constantly be aware of the structures and people that comprise our environments. These components are what scaffold us into active addiction. We respond to our environment, yes, but the factor from that environment that plays the largest role is trauma, not sociality.

David Gray-Hammond 1 Comments

Oct 15 2022

I’ve launched my own business! DGH Neurodivergent Consultancy!

For a while now, it has been a dream of mine to make Autistic knowledge sharing my career. I love the Autistic community, and want to help improve the environments thar we exist in. That is why I am happy to announce DGH Neurodivergent Consultancy.

Launching this business will help me keep my writing and online activism free and accessible on the Emergent Divergence platform, while allowing me to work towards a better world for Autistic people, and have enough money to turn the radiators on at home this winter!

If you think you could benefit from my experience, please visit my new website for more information.

A final note, emergentdivergence.com isn’t going anywhere, this is a home for my writing that I intend to keep going for many more years.

David Gray-Hammond 3 Comments

Jul 20 2022

Addiction doesn’t strip us of our humanity

Trigger Warning: This article contains discussion of addiction, death, metaphors around death, dehumanisation, and mistreatment.

What defines us as a human?

Is it rhetorical ability? Emotional experiences? Perhaps the tools we use?

I would argue that one of the defining characteristics of our humanity is our ability to to recognise humanity in others, or perhaps more specifically, our ability to deny the humanity of others. Thanks to years of colonialism, warfare, and eurocentric beliefs, we have developed a strange sort of morality. This morality is what we use to ordain or deny a person or object as human/human-adjacent.

Unfortunately, when you are an addict, human-adjacent would be a big step up in how the world sees you. For as long as we have existed, we have been ignored, spoken over, driven out of our homes, and killed. This because contemporary spins on normative morality posit that to be an addict, is to be a monster. We are beyond help and reason.

We are what you fear your children will become.

The truth is that all judgements on addiction come from a place of moral relativism. Addiction is only seen as a moral failing because of cultural attitudes towards the behaviour associated with addiction. Fundamentally, it is seen as a moral failing, rather than a response to trauma and unmet support needs. If we could move society to a more “trauma-informed” culture, it is likely that attitudes towards addiction would alter quite significantly.

This isn’t to say that addiction doesn’t represent a risk to others. As addicts, we find ourselves doing things we never imagined or wanted ourselves doing. The lengths that one might go to in that desperation can lead to some truly awful consequences. To put it another way; we still have to take ownership of our shitty behaviour, whatever the reason. However, we also require some level of compassion. Compassion can go a long way one the journey to recovery.

Sadly, compassion doesn’t go all the way. We still need professional input from those who know how to deconstruct the circumstances of addiction, and help the person to rebuild their life. We need to build a life where it is easier not to engage with our addiction. This is made ever more difficult by the defunding of services that work to do such things. Besides that, we need to recognise that heroin, crack, and alcohol, are not the only substances that need attention from services. The world of addiction grows more complicated by the day, especially since the dawn of novel psychoactives.

Considering the future, we need to build a world where it is not necessary to become addicted to survive. A world where if we do become addicted, we are not shunned to the outer edges of our community. We need people to stop acting like addicts choose to be addicts. Addiction knows no boundaries, it can come for anyone.

Deconstructing societal and cultural attitudes will take a long time. Things like decriminalisation are important, but if done badly could actually reinforce moral judgements of substance users. For this reason, we need further longitudinal data looking at other countries that have done such things, seeing where the positives and the pitfalls lie.

It’s vital that we do this work, because moral judgement and “not in my neighbourhood” attitudes are literally killing addicts. The world has blood on its hands, and it doesn’t even realise it.

Addicts deserve their humanity.

David Gray-Hammond 2 Comments

Jul 10 2022

Back to the corner: Psychoactive drug use, my Autistic experience

Some 4(ish) years ago, my debut blog post on this website was Standing on the corner: Where autism and addiction meet shortly covered by Recovery services as an Autistic adult. Back then My writing was merely an attempt to scream into the void, offloading my frustrations. Little did i know that in 4 years, my articles would have garnered over 25,000 views, and that people would ask me to go places and do things. I was also pretty surprised to discover that for the most part I don’t mind going places and doing things.

With that in mind, I decided it’s time to take another crack at this one, seeing if 4 years of experience makes for an improved experience for you, my wonderful readers and followers.

So here we are.

I’m David. Born Autistic at the dawn of the 1990’s. My life was pretty standard for what you’d expect of a truamatised, psychotic, recovering addict. So let’s consider where this particular part of my journey started.

October 2008.

My long term relationship came to an end (mutually, but still painful none-the-less). On that very same day, I had a peculiar experience. I heard a number of voices calling my name, but it seemed that it wasn’t the people around me that were doing so. Interestingly, this was the day of my first ever cigarette as well. Hindsight tells me that the fact that my first cigarette led to me smoking an entire pack in a number of hours should have been a huge warning for what was coming. Sadly, hindsight isn’t good for much, and I have a traumatised AuDHD brain that at the time was going through what some might term a “prodromal phase” for the psychotic condition I would later be diagnosed with.

Over the next week I discovered that smoking cannabis really helped my growing paranoia and auditory disturbances chill the f*ck out, and that when drank a litre of vodka, I just didn’t give a sh*t. Just a note here for anyone who can’t see what’s coming; drug-use and trauma is a volatile mix. Some people use psychoactives safely and medicinally their whole lives, with no real negative outcomes. I on the other hand came to resemble one of those warning videos your school would have shown you about the dangers of peer pressure and drug-use.

So, naturally I did what any normal AuDHD’er would do when they discovered something that makes them feel good. I did it again. And again, and again, ad infinitum. Each time I used, my consumption grew. Each new environment I entered I would break down another boundary in my life. First it was cannabis, then alcohol, and I figured that since these two weren’t the dangerous and hellish things my school had made them out to be, perhaps other psychoactives would be okay as well. Side note: this is why using scare tactics and abstinence based approached to stop young people from getting high is f*cking irresponsible, because when they find out they’ve been lied to, they don’t truat you on ANYTHING.

My time at university can be summed up by quoting myself “I don’t think you’ve ever seen me this high, have you?” and the phrase said to me most often “How the f*ck are you still alive?”. You see, I hadn’t noticed it, but I was taking drugs by the shed load. I was out of my mind on pretty much anything I could get. It’s easier to list the drugs I haven’t used than the drugs I have used; To date, I’ve never used “street” heroin, or crack cocaine. More on this in a moment.

What this meant was that when I ran away from my environment, making the 300 mile journey back to my mother’s house, I swore I would never use again. After all, I had nearly died on a couple of occasions, and found myself on the radar of what one might describe as “less than savoury people”.

Autistic Substance Use Survey 2022

Below is a survey on Autistic people and substance use. The aim is to collate data anonymously on the use of drugs and alcohol in the Autistic community, and use that data to write a report that will be published on this website.

The hope is that these insights may help Autistic people better advocate for themselves with regard to this topic.

None of the questions are mandatory, but the more that you can answer, the more data we will have to look at.

David Gray-Hammond 1 Comments

Creating Autistic Suffering: Interoceptive stimming or “challenging behaviour”?

TW: Discusses Challenging Behaviour, Disordered Eating, Sex and Related Activities, Self-Injury, and Victimisation Recently David posted an infographic about interoceptive stimming. This proved to be a very popular topic and we felt it necessary to expand on this more via this series. In our experience working directly with Autistic individuals experiencing various levels of distress and crisis, what is often conceptualised as "behavioural" can be attributed to interoceptive self-stimulation.

Category Archives: Addiction Treatment Rights