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Autism Coach

Alcohol, Marijuana, Autism and ADD/ADHD - Part 1 - Neurobiology of Self-Medication

Posted by Susan Bennett on

I became interested in use of recreational substances and autism because my children are musicians.  Although my kids don't drink  or use recreational drugs, many of their peers in the music world have autistic and ADD/ADHD traits and are heavy users of recreational drugs, including alcohol and marijuana.  After spending time with and getting to know these musicians over the years, I realized that many were suffering from moderate to severe depression; some shared they had suicidal thoughts and self-injurious behaviors.  I realized they were using alcohol, marijuana, and other illegal substances to relieve feelings of underlying depression, anxiety, anger, and post traumatic stress disorder (PTSD) .  The PTSD reflected traumas they had experienced as children, teens or young adults, including parental divorce, abuse by authority figures, and abuse by peers. 

It turns out research indicates that high-functioning young adults who are have both traits of autism and ADD/ADHD are more likely to self-medicate with alcohol and marijuana. These findings were based upon an epidemiology study of 3,080 Australian twins. These individuals did not necessarily have an autism spectrum disorder diagnosis but they scored on measurements of autistic traits.  (1)  A corroborating 2017 study, published in Sweden, suggests that people with autism who have average or above-average intelligence quotients (IQs) are more than twice as likely to become addicted to alcohol or other drugs as their peers. The risk is even higher for people who also have attention deficit hyperactivity disorder (ADHD).

Part 1 of this article discusses the neurobiology of why individuals within the autism spectrum and individuals with ADD/ADHD are more likely to self-medicate with alcohol and marijuana.

Part 2 of this article discusses natural alternatives to help people feel calmer, happier, be more focused, and overall mentally at their best without having to turn to recreational drugs.

Using Recreational Substances is a Form of Self-Medication

According to the latest research. substance abuse and addiction are widely misunderstood. Addiction is not a matter of personal weakness and failings, but rather an attempt to balance imbalanced neurotransmitters.  People self-medicate to feel the same as people who don’t have a neurotransmitter imbalance do - to  achieve a feeling of well-being, of feeling normal, which they don’t have unless they self-medicate.

Here is how addiction really works:

  1. A person whose neurotransmitters are imbalanced initially feels and/or functions better when he or she first uses a recreational substance which provide a more normal balance of neurotransmitters. There are initially positive rewards through brain chemistry for using the substance.
  2. Over time the brain and neurotransmitter system are changed by taking the substance. The amount of time it takes depends on the substance, dose, and frequency of use.
  3. The results of changes to the brain are that It takes a higher dose of the substance to feel normal.  This is called developing a tolerance for the substance.
  4. The person actually now feels worse when they go off the substance than before they started taking it in the first place.  
  5. Over time, substances further alter the brain and its neurochemistry, causing additional problems in behavior, mood, mental function, and mental health.

Neurotransmitter Levels in Autism and ADD/ADHD

The neurobalance of individuals on the autism spectrum and those with ADD/ADHD are both skewed compared to neurotypical individuals, typically with:

  • too many excitatory neurotransmitters
  • too few calming/inihibitory neurotransmitters

The main calming neurotransmitter is GABA (gamma-aminobutyric acid).  The main excitatory neurotransmitter is glutamate.

There are many theories as to why this is including exposure to toxins, a dysfunctional immune system, and genetic mutations and epigenetic changes (which genes are switched on and off).

A dysfunctional immune system may be the result of chronic viral or retroviral infections, a nutritionally depleted food supply, immunizations, environmentally and medically introduced toxins), and intestinal dysbiosis (not enough beneficial microbes in the gut producing buildling blocks for the nervous system and too many harmful microbes producing toxins).

Inihibitory (calming) neurotransitters promote:

  • elevation of mood,
  • feeling of well--being
  • focus/attention
  • improved sleep
  • robust immune system
  • feeling relaxed
  • ability to meditate and turn off internal monologue

Excessive levels of inihibitory neurotransmitters promote:

  • anxiety
  • agitation
  • depression
  • anger
  • stress
  • impulsive behavior
  • disrupted sleep
  • depressed immune system
  • feeling always vigilant - hard to relax
  • constant internal monologue that won’t shut off

Neurotransmitters, Neurons and Your Brain

Neurotransmitters are chemical messengers that are released by one neuron to communicate with the next neuron.

A neuron or nerve cel is an electro-chemically excitable cell that processes and transmits information through electrical and chemical signals. These signals between neurons occur via synapses, specialized connections with other cells. Neurons can connect to each other to form neural networks. Neurons are the core components of the brain, spinal cord, central nervous system, and peripheral nervous system.

Long-term memories are stored throughout the brain as groups of neurons that are primed to fire together in the same pattern that created the original experience, with each component of a memory stored in the brain area that initiated it. For example, a group of neurons in the visual cortex store the sight associated with a memory, a group of neurons in the amygdala part of the brain store the associated emotion, and so on. When a memory is recalled by a person, all the different areas of the brain associated with parts of that memory (sight, sound, smell, emotion, touch) fire together to recreate that memory.

In fact, memories may be stored redundantly, several times, in various parts of the brain, so that, if one memory trace is wiped out, there are duplicates, or alternative pathways, elsewhere, through which the memory may still be retrieved.  Memories are not stored in our brains like books on library shelves, but must be actively reconstructed from elements scattered throughout various areas of the brain by an encoding process. 

Memory storage and retrieval is an ongoing process.  How our memories are stored and retrieved changes over time because of continuous changes in our neural pathways, and parallel processing of new information we take in throughout our lives.

This also means that if sensory processing is distorted, as is the case in autism, information that is taken in through the senses is stored in the brain in a distorted fashion.  This can result in making memories harder to retrieve or skewing the information that is retrieved - so that the person only receives visual information or auditory information for a memory as opposed to an integrated memory with information from all the senses. Impaired storage and retrieval of information results in slower reaction times and impairs the ability to quickly react to and make quick decisions.

Let’s take a look at two neurons connected in part of a neural network. The first (top) neuron receives signals from one or more other neurons through its dendrites. When enough dendrites are activated (typically through glutamate), a charge builds up inside the neuron sufficient for the neuron to fire (release an electical and/or chemical signal that goes down its axon to the ends of its axon (axon terminals), where the axon terminals release glutamate into an area at the end of the terminals called a synapse. The synapse is the gap between that neuron and the dendrite of the next neuron. If glutamate is released from that neuron and enough activates the second neuron fires, repeating transmission of the signal to activate to a third neuron and so on.

In terms of firing, neurons are like a gun, either they fire and transmit a neurotransmitter to one or more interconnected neurons or they don’t fire at all.

If there is enough glutamate receptors activated, the neuron fires. However if enough of the neuron’s GABA receptors are activated, this prevents the neuron from firing.

In fact there is a specialized type of neuron, an inhibitory neuron that interconnects with excitatory neurons to transmit GABA to suppress the firing of the neuron. If the inihibitory neuron does not produce enough GABA, the excitatory neuron fires too often. In this particular example an impaired receptor on the inihibitory neuron causes it not to receive a glutamate signal from the excitatory neuron (NDMA), which in turn causes it not to produce enough GABA to inhibit the neuron from firing again. Damage to neurons through over-firing is called excito-toxicity and molecules that trigger over-firing are called excito-toxins.

If a neuron over-fires, it can become damaged in various ways, including damage to the myelin sheath (the insulation that wraps along the axon of the neuron to send a signal to other neurons, resulting in weak signal transmission and leakage of the electrical through the sides of the sheath:

In a normally myelinated nerve, the message transmits quickly and with a strong electrical impulse. In a damaged nerve the signal can’t be transitted as far and moves more slowly, the net result being overall slower reaction times.

So it really is important to balance the neurotransmitters and restore the proper balance of calming neurotransmitters to excitatory neurotransmitters. Chronically over-firing neurotransmitters become damaged and this eventually can lead to neurodegenerative diseases like Alzheimer’s and Parkinson’s.

Why People Self-Medicate with Alcohol - The Upsides and the Downsides

When a person first starts drinking, it causes an increase in calming neurotransmitters and decrease in excitatory neurotransmitters, plus increase in GABA and opiates lead to an uplifted mood, and less anxiety. An person with too many excitatory neurotransmitters and not enough calming neurotransmitters temporarily feels better when drinking. This feeds into a reward system in the brain that encourages them to drink again.

HOWEVER, regular heavy drinking rewires the brain and causes the brain to make glutamate receptors more excitable and reduce the production and reception of mood-elevating neurotransmitters when this person is NOT drinking. This causes a regular drinker to feel irritable, depressed, angry, have trouble thinking things through when they are not drinking.

The primary downside of drinking is that heavy alcohol use kills off your brain cells. New neurons normally are constantly generated from neural stem cells. In alcohol binge-drinking however, both the proliferation of neural stem cells and the survival of neurons produced from the stem cells during alcohol exposure are decreased. Brain cells are damaged and fewer are replaced. Imaging studies also have revealed substantial reductions in the volumes of many brain structures in alcoholics, particularly the prefrontal cortex and cerebellum. Luckily, prolonged periods of abstinence appear to promote at least partial recovery of these structural deficits in the brains of alcoholics. The prefrontal cortex is critical for impulse control and decision making.  Addiction research indicates that a heavy drinker who is quitting needs to have other responsible people with the best interests of the alcoholic in mind make decisions for them for the better part of a year until their brain has a chance to recover.

Chronic alcohol leads to alterations in the GABA systems. For example, in some brain regions, alcohol affects the expression of genes that encode components of the GABAA receptor, resulting in less GABA being produced when not drinking.

Acute alcohol administration also suppresses glutamate-mediated signal transmission in the central nucleus of the amygdala, an effect that is enhanced following chronic alcohol exposure. Alcohol affects glutamate transmission most likely by altering the functions of both NMDA receptors and metabotropic glutamate subtype 5 receptors (mGluR5). These glutamate receptors are rewired due to heavy drinking, resulting in hyperexcitability and craving during alcohol withdrawal. Because alcohol normally reduces glutamate activity, the brain adapts to chronic alcohol exposure and maintains a “normal” state by increasing glutamate activity. When alcohol is withdrawn, heightened functionality of glutamate receptors makes neurons excessively sensitive to excitatory glutamate signals, resulting in hyperexcitability.

Here is a more detailed diagram on how a person becomes addicted which also involves increased production of dopamine and opiates, both of which elevate mood. Addiction impacts an area of the brain called the nucleus acumbens, which plays a role in the processing of seeking rewarding experiences and avoiding unpleasant experiences - and also in acting impulsively and fear. It also involves the emotional processing center of the brain, the amygdala.

figure 1

Changes in the activity of the reward circuit mediating the acute positive reinforcing effects of alcohol and the stress circuit mediating negative reinforcement of dependence during the transition from nondependent alcohol drinking to dependent drinking. Key elements of the reward circuit are dopamine (DA) and opioid peptide neurons that act at both the ventral tegmental area (VTA) and the nucleus accumbens and which are activated during initial alcohol use and early stages of the progression to dependence (i.e., the binge/intoxication stage). Key elements of the stress circuit are corticotropinreleasing factor (CRF) and norepinephrine (NE)-releasing neurons that converge on γ-aminobutyric acid (GABA) interneurons in the central nucleus of the amygdala and which are activated during the development of dependence.

Marijuana and the Endocannabinoid System in the Brain

Neurons in the brain have cannabinoid receptors which are involved in modulating our perceptions of pain, appetite, mood, memory, motor learning, and the immune system. Canninoid receptors are found in the brain, central nervous system and peripheral nervous system.

Marijuana appears to have both positive benefits and potential negative impacts and research is indicating that much of this  has to do two primary components of marijuana that act upon the endocannabinoid system in the brain and nervous system:

  • cannabidiol (CBD) - a non-psychoactive component) that does not get you high 
  • tetrahydrocannabidinol (THC) - the psychoactive component that does get you high

The dendrite (transmission receiving end) of many neurons can produce cannabinoid molecules to inhibit the axon it is receiving transmissions from- so that neuron does not fire as frequently:

Cannbinoid Receptors in Synapse - Edited.jpg

In the diagram above, the neuron on top is transmitting glutamate through one of its axons to a dendrite of another neuron (below). signal the next neuron below through the synapse (gap) between the two neurons. through its dendrite

Here is anther mechanism by which cannanoid receptors can promote calming neurotransmitters and help to prevent excito-toxicity. Endocannabinoid receptor activation can increase the output of GABA, leading to inhibition of excitatory glutamates, reducing levels of anxiety, using a CB1 receptor at the end (terminal) of a of GABA producing neuron:

(A), Under normal condition, the equilibrium between excitatory and inhibitory transmission provides an appropriate emotional reactivity. (B), Stressful experiences leads to an unbalance between excitatory and inhibitory transmission. (C), The overexcitation induced by stressful stimuli triggers CB1 receptor downregulation exclusively on GABAergic terminals, which eventually modifies the balance between GABAergic and glutamatergic CB1 receptor activation by endocannabinoids. (D), This long-lasting CB1 receptor downregulation on GABAergic terminals leads to a persistent increase in the strength of GABAergic inhibition of the glutamatergic transmission.

Conflicting Research on Marijuana Benefits vs Risks

There is much conflicting research on whether marijuana is beneficial or harmful, just as there is conflict on whether or not to legalize it.  Below I have discussed some of the pros and cons of marijuana as indicated by current research.

Downsides of Marijuana

Although marijuana does not have the severe withdrawal symptoms of opiates and alcohol, it can also be addictive. 

Studies have shown that 9 percent of cannabis users, regardless of how often they get high, develop an addiction to the drug. Among daily users, 25 to 50 percent develop an addiction.

Genetic makeup plays a part in how the individual reacts to the psychoactive THC component of marijuana.  Just as with alcohol, some people are more susceptible to becoming addicted to marijuana.

Withdrawal symptoms from marijuana include:

  • sleeping problems
  • anxiety
  • irritability
  • feeling of unease or disatisfaction (dysphoria)

Here are some other downsides:

  • Poorer verbal memory amongst people who smoked every day for 5 years or more. (Research is also suggesting that CBD oil in marijuana is neuroprotective and prevent memory problems created by the psychoactive THC. So strains with less THC and more CBD are preferable. CBD oil may actually slow down the progression of Alzheimer's.)
  • An increase in traffic fatalities are linked to marijuana states where it is legalized.  Reaction time, judgement, and concentration are impaired with use.  Driving while high doubles the risk of a car crash.
  • Combining marijuana and alcohol is problematic.  Impairment of reaction time, judgement, and concentration while driving is dramatically increased when combining even a small amount of alcohol with marijuana.
  • Some individuals become more anxious, paranoid.
  • Adulterated marijuana may have unanticipated side effects and/or do harm.
  • Increased risk of schizophrenia - delusions, hallucinations, disordered thinking, especially in individuals with a genetic predisposition to psychosis.  It is not yet clear if marijuana increases psychosis or people with a predisposition to psychosis are more likely to use marijuana.
  • Tolerance - long-term use can result in downregulation of cannabinoid receptors.

Upsides of Marijuana

We are not condoning the use of marijuana, but research is indicating it has positive health benefits:

  • Can reduce incidence and frequency of seizures
  • Can reduce symptoms of depression and elevate mood
  • Can reduce symptoms of anxiety in low doses - low doses of THC beneficial; while higher doses can have the opposite effect
  • Can reduce anger and aggression
  • Can improve sleep
  • Can diminish symptoms of Post Traumatic Stress Disorder
  • Can help reduce use of opiods
  • Can help to reduce use of alcohol
  • Can lead to reduced use of Anti-Depressants
  • Can reduce chronic pain
  • Can help with muscle spasms
  • Does not harm lung capacity and may improve it
  • Decreases eye pressure in glacoma
  • The CBD component may be anti-cancer, prevent cancer from spreading, or slow it down
  • CBD component may slow the progression of Alzheimer's disease by blocking the enzyme that makes amyloid plaque
  • Eases pain of multiple sclerosis
  • Lessens side effects of treating hepatitis C and increases treatment effectiveness
  • May help with inflammatory bowel disease
  • Relieves rheuamtoid arthritis pain
  • Lessens obesity and decreases insulin resistance
  • Reduces tremors in Parkinson's
  • CBD component is neuroprotective - may protect the brain after a stroke
  • Reduces pain and nausea from chemotherapy and stimulates appetite

Using Marijuana and/or Its Active Ingredients Safely With Minimal Negative Side Effects

The impact of marijuana on a person often their genetic make-up, just as alcohol consumption and how a person will react to it also has a genetic component. 

If it is legal in your state and you decide to try marijuana or a marijuana-derived product:

  • Avoid marijuana that has extremely high levels of THC.  The extremely potent marijuana is more likely to cause symptoms of anxiety, paranoia, and possibly symptoms of psychosis in genetically susceptible individuals.
  • Use strains of marijuana that have a high level of CBD.
  • Use strains a citrus fragrance such as lemon or lime.  Resesarch indicates that strains that contain fragrant oils such as limonene which smells like citrus can contribute to improved mood, stress relief. Limonene also has antifungal properties, antibacterial properties, and may help to relieve heartburn and gastric reflux, and improves absorption through membranes in the respiratory system and digestive tract.
  • Avoid finished products or adulterated products that may other additives that are harmful.  Seek out organic natural and gluten and casein free.

Food Can Also Be Addictive and Disrupt Neurological Development

The reward centers in our brain that positively react to opiates, such as cocaine and heroin, also react to foods that produce opiates as by-products of digestion. 

In autism, maldigested gluten and casein proteins form opiates that pass through the blood brain barrier, flooding the brain with opiates. Excessive levels of opiates rewires the brain and can result in an addiction and craving for foods that produce these opiates, such as cheese, noodles, and pizza.  Excessive levels of opiates in young children who maldigest gluten and casein disrupts neurological development.  Removal of gluten and casein from the diet can temporarily result in opiate withdrawal symptoms, but the vast majority of children benefit from being put on a gluten and casein free diet.

Ingredients in foods that excite the neurons can also be addictive - those that produce more glutamates. These include monosodiumglutamate (MSG) that is a flavor inhancer in processed foods and is otten hidden as an ingredient on labels as "natural flavoring."  Many other artificial ingredients also result in excito-toxicity in the brain which is why it is important to use as few processed foods and convenience foods as possible (especially fast food and gas station food) - to keep the diet as organic and natural as possible.

Overgrowths of yeast in the intestinal tract through excessive consumption of sugar and refined carbohydrates can also result in the yeast overgrowth producing alcohol in the intestinal tract.  Alcohol consumption also disrupts neurological development in young children.  

Generally individuals on the autism spectrum and with ADD/ADHD benefit from an organic, natural, low-sugar, low-carbohydrate ketogenic or specific carbohydate diet that is also gluten and casein free.

Activities Can Be Addictive

Many activities can also rewire the brain's reward and trigger addiction, including computer activities, sexual addiction issues, and gambling. 

Safer Ways to Balance Neurotransmitters and Feel Good

The reward system in our brain is necessary for our survival. Our brain rewards activities that promote our health, well being and survival.  

Problems arise when specific substances or activities that reward the brain create a dependence on these substances or activities that cause harm.

Part 2 of this article discusses nutritional approaches to rebalance neurotransmitters naturally to obtain and sustain a natural feeling of being at one's best both mentally and physically without harmful side-effects. 

Part 2 - Safer Alternatives to Balancing Neurotransmitters and Feeling Good


  1. ADHD Symptoms, Autistic Traits and Substance Use and Misuse in Australian Twins -
  2. HIdden Link between Autism and Addiction -
  3. Neurobiology of Alcohol Dependence -
  4. Young autistic adults vulnerable to alcholism
  5. Astrocytes and microglia in autism -
  6. Endocannabinoid System in guarding against fear, anxiety, stress.
  7. Modulating the endocannabinoid system in human health and disease -
  8. Regulation of Physical MIcroglia-Neuron Interactions.
  9. The Human Memory.
  10. The Endocannabanoid system in anxiety, fear, memory and habituation -
  11. Getting High on the Endocannabinoid System -
  12. Health Benefits of Marijuana -
  13. Addiction write-up on Wikipeida - amazingly informative.
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