There’s been a huge amount of debate and discussion in recent years about neurodiversity. Here, we explore what it is and why it matters when we’re thinking about how to reduce alcohol harm.

All of us see the world in different ways. In the past, some of those differences have been seen as difficulties or disabilities, but in the 1990s Australian sociologist Judy Singer and others popularised the term “neurodiversity” with the aim of increasing acceptance and inclusion of people who experience and interact with the world in different ways.

What is neurodiversity?

Being “neurodiverse” or “neurodivergent” is often defined in contrast to being “neurotypical”: the way most people think and feel. A lot of things can be classed as “neurodiverse” but most commonly the term refers to the autism spectrum and to attention deficit and hyperactivity disorder (ADHD).

You may also have heard the term “Asperger’s Syndrome”. This was used from 1992 to 2019 to refer to some people on the autism spectrum but is no longer in use.

The autism spectrum

People on the autism spectrum – who often describe themselves as “autistic people” – experience the world in ways that are characterised by:

• Differences in processing information and interacting socially. It’s often the case that an autistic person takes longer to process new information, and/or that they miss some social cues.
• Restricted and/or repetitive interests and behaviours. This sometimes manifests as a passionate interest in a particular subject or hobby.
• Greater sensitivity to noise, touch, and light – meaning that autistic people may be uneasy in noisy, crowded, or chaotic spaces.

It was sometimes thought that autistic people were less likely to drink alcohol, given the loss of control it can bring. However, the ever-growing genre of 'autism autobiographies' has revealed that many autistic adults do use alcohol, and that they often use it to cope with the stresses of being autistic in a neurotypical world. Alcohol can become part of the “masking” some autistic people do to fit in with others.

Research undertaken for us by the Centre for Applied Autism Research (CAAR) at the University of Bath found that autistic people are just as likely to experience alcohol problems as anyone else, but that when they do, they often find that alcohol treatment services aren’t set up in ways they can access. The researchers at CAAR produced a list of practical steps that alcohol treatment services can take to become more autism-friendly:

• Above all, understand autism: That means understanding autistic strengths – such as honesty and attention to detail – as well as some of the potential problems, such as social anxiety.
• Be prepared: Make sure the autistic person you are supporting knows what to expect and who they’ll be seeing. Ask them what they need.
• Be consistent: Give them a regular slot, if possible with the same person every time.
• Be explicit: Always explain why something is happening.
• Be clear: Use plain language and avoid metaphors, jargon and acronyms. If you’re discussing emotions, do that in terms of lived experience, not simply labels.
• Involve a family member, partner or advocate in sessions: This can help, but only if agreed with the autistic person, who should remain in control.

We hope that these adjustments will not be too much of a stretch for services that are already taking a person-centred approach. As Prof Mark Brosnan at CAAR puts it, “Autism-friendly is everyone-friendly”.

ADHD

According to official statistics, 3% to 4% of adults in the UK have attention deficit and hyperactivity disorder (ADHD) and men are three times more likely to be diagnosed with it than women. It’s usually diagnosed in childhood, and the sex difference in diagnoses may be due to boys showing more signs of disruptive behaviour that people notice, whereas girls more commonly show inattentive behaviour that gets overlooked. Rates of diagnosis of ADHD have risen greatly in recent years. The reasons for this are not clear but it may be that ADHD is becoming better recognised.

The charity ADHD UK give the following list of signs and symptoms of ADHD:

• Difficulty paying attention to details, and being easily distracted.
• Trouble organising tasks and activities.
• Avoiding tasks that require mental effort over a long period of time, and losing things necessary for tasks and activities.
• Talking excessively and interrupting, and not seeming to listen when spoken to.

These are behaviours that many of us show from time to time but the will occur more frequently and persistently in someone with ADHD. Assessing whether anyone’s pattern of symptoms is ADHD requires a medical diagnosis.

There is some evidence that people with ADHD are more likely to experience problems with alcohol. This may well be for the same reasons that some autistic people find themselves drinking to excess – in world that makes few allowances for neurological differences, it can be very tempting to use alcohol to try to cope with that stress. However, as DJ Andy Mac has described in his blog for us about his experiences, although he used drinking to manage his anxiety, “alcohol sits terribly with some of the classic symptoms of ADHD, such as impulsivity and disrupted emotional functioning”.

Andy Mac’s choice, in the end, was to give up alcohol altogether. Not everyone with ADHD will feel the need to do that, but all of us can benefit from keeping our drinking moderate. You may find these tips for cutting down and our reviews of low and no alcohol drinks helpful in doing that.

Just like autism, ADHD can also be seen as a source of strength and some people with ADHD find they can:

• Hyperfocus on a topic or activity, enabling them to become very knowledgeable or productive.
• Do well in a crisis that demands their full attention.
• Use their tendency to be distracted to explore creative approaches to problems.

As in the case of autism, these are strengths it may be possible for alcohol treatment services to work with when helping someone overcome an alcohol problem.