Improving substance-use services for autistic adults: insights and recommendations from autistic adults

Purpose: We aimed to explore autistic substance users’ experiences and their recommendations for improving substance-use services. Methods: We conducted an online cross-sectional questionnaire survey with autistic adults, either self-identifying or formally diagnosed, who reported past or current substance use. We applied reflexive thematic analysis to identify differences and similarities across their diverse narratives. Results: A total of 475 participants completed the questionnaire. Participants shared varied experiences with substance-use services, but three key themes emerged as follows: challenges with service accessibility, gaps in providers’ knowledge about autism, and the need for harm reduction practices tailored to autistic individuals. Participants provided numerous recommendations to enhance the accessibility and appropriateness of these services, emphasizing the value of personalized, inclusive, and neuro-affirming care. Conclusion: Participants recommended that substance-use services improve accessibility by incorporating autistic-led training and adopting trauma-informed, harm-reduction approaches focused on personalized care. We suggest that future research include more in-depth interviews to cocreate resources for both substance-use service professionals and autistic individuals who engage with these services.