Co-occurring Addictive and Psychiatric Disorders by Geert Dom & Franz Moggi

Author:Geert Dom & Franz Moggi
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

At first glance addiction and autism seem very different disorders. In some respects they even seem to be each other’s antipodes. The socially aloof naïve person with autism on one side, and the cunning, lying addicted individual on the other. But alongside these big differences some striking behavioural similarities can be found, e.g. both groups are extremely detail oriented and compulsive. Moreover both are developmental brain disorders with a strong dopaminergic component in their pathogenesis (Dichter et al. 2012). At the start preoccupations (e.g. with spinning objects) and stereotype movements (rocking, whirling, swinging: sometimes leading to trance-like state) in ASD are aimed at soothing over-arousal, stress, and anxiety. Likewise addiction often starts with taking substances or behaviours (gambling) to feel better and regulate difficult to manage tensions. Stimulation of the dopaminergic reward system by substance use or habit behaviour might not only give a “good” feeling but also help to cope with scary, stressful situations.

So are there common neurobiological characteristics to both conditions? Recent studies provide some evidence for such neurobiological overlap in the dopaminergic deregulation of the cortico-striatal-limbic loop (leading to skewed and compulsive behaviours) both in addiction and autism (Langen et al. 2011). In this respect ASD is in terms of dopaminergic deregulation at the interface of ADHD on one side, addiction on the other along with obsessive–compulsive disorder (OCD). The motor stereotypies may point to a motor component related to motor neurological disorders such as Parkinson’s disease. But this is yet small evidence in need of far more research to identify these relationships and the possible neurobiological links explaining the enhanced vulnerability to addictions in ASD.

In high functioning individuals with ASD a strong urge for social relationships emerges at puberty (Gerland 1996). But they have great difficulties in the social encounters due to their hampered empathy, lack of understanding of underlying intentions of others, and their relative incapacity to tune into other’s needs. Alcohol and drugs prove helpful in overcoming their social awkwardness and shyness. They feel less uncomfortable and more at ease in engaging in social contacts. Yet their eagerness and naïve perception of others, makes them an easy prey for abusive individuals, e.g. the drugs scene. Of interest they often feel more at home in these substance using social groups that are, strangely, remarkable functional in the sense that the have strait forward rules of conduct and many visual cues.

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