Treatment with psychotropic agents seemed to reduce SUD risk

Adolescents with autism spectrum disorder (ASD) seemed to have a higher risk for substance use disorder (SUD), particularly those with behavioral comorbidities or who were not treated with psychotropic agents, researchers in Taiwan reported.

In a retrospective, population-based, cohort study of participants in a national database, the adjusted hazard ratio (aHR) for SUD was 2.33 (95% CI 1.89-2.87) for the ASD group versus the non-ASD group, according to Chih-Sung Liang, MD, from Tri-Service General Hospital in Taipei City, and co-authors.

Additionally, the aHRs for alcohol use disorder and drug use disorder were 2.07 (95% CI 1.60-2.63) and 3.00 (95% CI 2.15-4.58), respectively, for those with ASD versus those without, respectively, they stated in JAMA Pediatrics.

“Moreover, compared with non-ASD controls without SUD, patients with ASD and comorbid SUD had an aHR of 3.17 [95% CI 2.69-3.89] for mortality,” the authors noted.

But treatment with psychotropic agents seemed to reduce the SUD risk in the ASD population, they added. While the findings “should remind psychiatrists and the families of patients with ASD of the importance of ASD treatment,” Liang’s group stated, they also acknowledged study limitations, including the fact that the research was based on ICD-9-CM codes, which did not allow for an evaluation of how ASD severity might be linked with SUD risk. Also, the patient population was relatively small (n=6,599) and the role of behavioral therapy and interventions was not assessed in the study.

Still, “impaired peer-group connections in ASD” may not be as protective against AUD and DUD as originally thought, noted Maria Catallozzi, MD, MCSE, of Vagelos College of Physicians & Surgeons in New York City and Sarah Ann R. Anderson, MD, PhD, of New York-Presbyterian Morgan Stanley Children’s Hospital in New York City, in an editorial accompanying the study.

On the one hand, the results are a call to action as “Families must be educated on the higher risk of development of SUD in patients with ASD and how these SUDs are different from but connected to ASD,” according to Catallozzi and Anderson.

On the other hand, there are some areas that the study could not clarify, such as whether specific drug and drug types make a difference. Catallozzi and Anderson pointed out that adolescents in Taiwan reported abusing ketamine and novel psychoactive substances most often, while marijuana and alcohol are more commonly abused in the U.S. by young people.

“The difference in trends of specific drug use has vast implications on how SUD would be managed clinically in adolescents with ASD,” they stated.

Liang and co-authors accessed the Taiwan National Health Insurance Research Database (NHIRD) for ICD-9-CM codes associated with ASD after 2000. Those patients diagnosed with SUD prior to their first visit for alcohol use disorder, or those with missing data, were excluded. Controls without an ASD diagnosis were randomly selected and matched by sex, age, and index date; a 1:4 ratio of ASD patients to non-ASD patients was established for statistical power, according to the authors.

Enrolled participants with ASD had a mean age of 11.9 and 77.2% were boys. The mean follow-up period was 8.1 years. The control group had 26,396 patients (mean age 12.1; 77.2% boys) with a mean follow-up period of 8.6 years.

Liang’s group found that comparisons between patients with ASD and controls with the same comorbidities, such as intellectual disability, attention-deficit hyperactivity disorder, epilepsy, and mood disorder, showed higher aHRs for SUD among patients with ASD (range 1.17-2.55).

Finally, aHRs for SUD in the ASD subgroups who were treated with one psychotropic agent (0.60 95% CI 0.43-0.66) and with multiple psychotropic agents (0.37k 95% CI 0.28-0.49) were significantly lower than those in the ASD subgroup with no psychotropic agents.

“These findings suggested that [psychotropic agents] may be associated with a reduction in the risk of SUD in the ASD population,” they wrote. “In other words, the risk of SUD could be reduced if patients with ASD maintain a stable condition.”

However, the authors stressed that “the association of nonpharmacotherapies, such as behavioral therapy, family therapy, and psychotherapy, with the risk of SUD requires further investigation.”

  1. A diagnosis of autism spectrum disorder (ASD) was associated with an increased risk of substance use disorder (SUD).

  2. The use of psychotropic agents for ASD was associated with a decreased risk of SUD.

Shalmali Pal, Contributing Writer, BreakingMED™

Liang reported no relationships relevant to the contents of this paper to disclose. A co-author reported support from Taipei Veterans General Hospital, the Ministry of Science and Technology, Taiwan, and the Tri-Service General Hospital Research Foundation.

Catallozzi and Anderson reported no relationships relevant to the contents of this paper to disclose.

Cat ID: 135

Topic ID: 85,135,730,135,192,144,145,925

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