Background: Autism spectrum disorders (ASD) are complex, highly heritable neurodevelopmental diseases characterized by individuals with a combination of behavioral and cognitive impairments. These include impaired or diminished social communication skills, repetitive behaviors, and restricted sensory processing or interests. Patients with ASD are vulnerable to the development of substance use disorder, and the use of psychotropic agents for autism is associated with a decreased risk of substance use disorder. Around one-fifth of youth (20%) of young people aged 14–26 with substance use disorders had SRS-2 scores indicative of prominent ASD traits as rated by parental reports. ASD traits are associated with a trend towards more severe SUD presentations but not psychopathology. Recent advances in brain imaging and sustained efforts towards identifying the genetic and neurobiological substrates of social impairment in ASD, including characterization of mouse models, have revived the exciting field of opioids and social behavior. These studies have provided the demonstration that, among factors of the opioid system, μ receptors are the key substrate for the control of social behavior. A trend towards more severe SUD presentations is connected with ASD characteristics, but not psychopathology. Traditional SUD-directed psychotherapies may not be as effective for young persons with pronounced ASD characteristics. Given the specific demands of the community, it is imperative to create an effective, program-wide screening for ASD in order to clarify prevalence data and to start developing integrated ASD-SUD treatment protocols.

Autistic traits, Opioid Use Disorder (OUD)