Like most other people, I have always enjoyed a drink. I have to confess there have been occasions when I have, perhaps, had more than I should!
What I have always understood is that a drink helps calm me down somewhat and makes me more at ease in social situations: it has helped me as someone with Asperger syndrome (AS) to feel “normal”.
What I didn’t know, as I was not [self] diagnosed until my mid-thirties however, was that this was partly due to my condition. Having a drink in social situations lessened my nerves and relaxed me in general. It also helped to provide downtime from the awareness of being “different”.
Is using alcohol a dangerous strategy for someone with AS or a useful coping mechanism?
This is one of the questions that Asperger Syndrome and Alcohol: Learning to Cope by Matthew Tinsley and Sarah Hendrickx seeks to answer. Tinsley has AS and went through a prolonged period of alcoholism, whilst Hendrickx works with adults with AS within a support project.
They have come together to combine experiences. The book works through Tinsley’s life and fall into alcoholism which, he believes, is a consequence of his AS. The following review covers some of this ground but, for the purposes of Asperger Management, focuses more on how alcohol can impact upon a person with AS in a work context.
The book starts by emphasising how, for those who find interacting or socialising difficult, the loosening effects of alcohol can be very beneficial. However, as the authors also go on to emphasise it can also be addictive. As of yet, no specific studies exist of the connection between AS and alcohol.
Matt – diagnosed at 43 – used alcohol to suppress anxiety, fear and panic and develop relationships and independence. Unfortunately, this coping strategy collapsed and resulted in serious illness.
As the authors rightly point out, the notion that alcohol helps us to cope is in our culture. For me, this certainly applies to the workplace. The book attempts to gain a wider picture of the attitudes and behaviours regarding alcohol by analysing these facets from the perspective of the autistic community.
Doing so is difficult though, as willing participants are hard to find due to their reticence about being open about their condition in general. In addition, the author’s suspect that many people don’t know they have AS, as – in part at least – the drinking hides it and “normalizes” them.
Unlike some other toxic substances, alcohol is legal, socially acceptable and accessible, so the book starts by first asking why should there be a link between AS and drink?
For many people, a strategy which begins as a simple coping behaviour becomes an addiction, meaning that it is hard to separate the original motives from the end results. This, I feel, is very pertinent from the perspective of having AS.
People in general drink alcohol for a variety of reasons; for social reasons; to change their mood; to gain acceptance; forget reality; to feel carefree and brave; to feel less anxious and afraid. In simple terms, it also stops people worrying so much. Again, all these things apply to having AS but, I feel, even more so.
Drinking is also socially expected and seen as a sign of “normal” behaviour. This means there is a degree of pressure to conform which will vary to degree depending on what type of vocation the person is undertaking.
From a work perspective, this is how incipient problems can, perhaps, begin to take shape. I have spoken a number of times in Asperger Management about the importance of socializing at work, hard as though I have often found it. Having a drink for the reasons that I outline above has helped me to effectively do this.
Among the reasons for this are that the – positive – effects (reduced anxiety, feeling at ease etc) are immediate and allow for emotional expression. However as the book points out, there is a fine line between enjoying a drink and needing.
In the book, alcoholism is defined as: “a vulnerability to alcohol that sets the alcoholic apart from other drinkers”. Secondary alcoholism is where it is a symptom of another condition; it is also described as reactive alcoholism. Q AS!
For people with AS, alcohol is used as a means of numbing sensitivity and reducing anxiety so as to satisfy the need for life to be on an individual’s terms. Matt found he needed to drink so he could do what was required of him. People with AS drink for the same reasons as many other problem drinkers, but with a different degree of necessity: i.e. to combat higher anxiety levels.
For those who have learned that the only way to avoid isolation and loneliness is to engage in a social marketplace which has rules, signs and language that they cannot read or understand, alcohol may be the only way to cope. It allows for access into the social world and the chance to practice social skills. This, in a work context, is why alcohol has always been useful for me.
However, for someone with AS drinking only delivers assistance up to a certain point, after that, it becomes damaging; the “all or nothing” mindset according to the authors makes it harder for them to moderate their drinking.
Environments which are too stressful are typically avoided by people with AS; where sensory input is too high to manage for example. If avoidance is not possible, coping strategies are put in place to cope with anxiety. The workplace is not always a protected environment in terms of avoiding anxiety and people with AS are conscious of this: this is where alcohol often then comes in.
The book then usefully investigates other, similar conditions to demonstrate that certain traits are not confined solely to those with Asperger, and how alcohol impacts on them.
Social anxiety disorder is one such recognized condition. Though it is different to AS insofar as it is not lifelong condition, there are similarities in outcome: isolation, anxiety, low self-esteem and avoidance of social situations.
Another related condition is Avoidant Personality Disorder (APD) which shows significant overlaps with social anxiety. APD is thought to be harder to shift and is more severe: it has persistent feelings of tension and fear, feelings of inferiority and inadequacy, avoidance of contact with people in any context for fear of social failure, inadequacy or rejection.
Both of the central traits in these conditions – anxiety and lower self worth – are inherent in AS and alcohol as a palliative is used by those affected to contain them.
Alcohol will also affect cognitive processing and can cause damage to the frontal lobe due to its toxicity. When under the influence of drink it becomes harder to read facial expressions for example meaning that the negative effects of alcohol on AS may be more pronounced. Other emotional, non-verbal behaviour may also be impaired such as processing social information.
These effects are another reason why being fully aware of the effects of excess alcohol is useful from an AS perspective – especially in a work context.
The next point made is I feel important: to keep the [alcohol] issue in context. The Mental Health Foundation reports that the “co-existence of alcohol problems and mental health are very common” in general. Many people “self medicate” their mental health problems using alcohol and studies suggest that “social phobia is an important factor in the development of alcoholism” in general. This, I believe, applies widely in the context of the world work.
The book then provides some interesting insight into research into related fields and individuals and possible links between AS and alcohol. There is, for example, some evidence to suggest that autism is connected to addiction (BVan der Gaag, 2006) and that AS can add a compulsive facet/quality to social drinking and “encourage isolated drinking ungoverned by normal social conventions”.
Ostrander believes that alcoholism is a condition for individualists and loners who get a sense of early in their lives that they are alone in the world. This prevents them from gaining emotional release through relationships with others. In other words, those with AS are not the only ones’ using alcohol for reasons other than general enjoyment.
However, though alcoholism applies to many people outside the spectrum also who use it to manage the anxiety associated with social situations for confidence reasons, the greater difficulties experienced in this area by those with AS means that the subsequent higher anxiety levels lead many to experience social anxiety disorder. Consequently, studies suggest that, as a result, people with Asperger have an above average chance of developing alcoholism.
The book’s background analysis then goes deeper into alcohol related problems which, like many psychological issues, are thought to develop in childhood.
Children with AS use intellect rather than instinct to manage situations as they struggle to make sense of what is going on in general. This results in physical and mental tiredness.
In the case of Matt, alcohol made him “normal” and led him to get drunker than others. However, he didn’t appreciate that others’ didn’t experience the extreme impact on life that he did as a result and could integrate relatively easily socially and I the ever-changing world around them. Drinking alcohol also helped Matt conform to peer expectations and socially integrate: it helped him associate with the former which, at work, was a useful – and important – requirement.
However, as is well documented, alcohol can exacerbate the negative effects of AS if taken to extremes: engaging in undesirable activities and doing stressful things as a result; trying to work out the needs of another person, compromising the need for solitude, dealing with conflict, curtailments to individual freedoms, rules, boundaries and permitted behaviour, managing a relationship on top of other pressures all become, at best, more difficult if the negative effects of alcohol are being felt.
When these apply to work based relationships, the effects can be potentially volatile and this is where the book becomes very insightful and useful from a work perspective.
Matt’s serious drinking began upon entering the world of work. The stress of trying to be social at work meant that his drinking increased. Drink was used to cover up feelings of guilt and inadequacy. “I” [he] felt fine about things if they were alcohol induced but others’ would “not” be able to see there was a problem and he would not consider things from their perspective.
There were other effects for Matt. Failing to have sufficient time out or solitude led to “overload” from the demands of [working] life. Turning to alcohol was an answer and an easy one. Being drunk also gave him the courage or “permission” to do things he thought he ought to do but was unsure about – it acted as an anaesthetic.
There is one chapter that specifically analyses the work context: Employment and Alcohol in the Workplace.
Here the difficulties encountered by those with AS in areas like team working/empathy, accepting authority regardless of ones own view, social understanding, environmental factors, changing structures, oral instructions or understanding what is said, poor social skills, being assertive or accepting criticism positively are outlined. All of these I can obviously relate to.
Though I personally have never experienced difficulties at work as a direct result of alcohol in relation to these or other areas, I can relate to a key point the text then makes: the importance of gauging the limits of alcohol use at work to get the balance n its use right.
As the authors say, this is difficult: drinking impairs performance and affects colleagues. However, from my perspective, I do believe that learning how to use alcohol moderately in a work context, such as social occasions, can be a very useful tool for someone with Asperger syndrome.
If controlled and used appropriately, it can I believe provide the relaxant that enables social situations to be faced with confidence and also enables one to engage confidently with others. The crucial caveat, of course, is that there is no over-indulgence that leads to a lowering of the guard and detrimental aspects to appear such as inappropriate discourse.
According to the charity Alcohol Concern, work related stress is a major cause for drinking above safe limits. Common causes of stress at work include: ambiguity, overload, change, lack of clarity and lack of security – all issues that someone with AS would have difficulty coping with. Here within lie the danger signs.
Drinking after work is an accepted norm for many people who use it as a relaxant and a chance to unwind. For Matt, it was simply part of his overall strategy for getting through the day; having a drink enabled him to feel “normal”.
When he took on a new demanding job, however, his drinking escalated until it overwhelmed him. He was made redundant, partly because of the alcohol, which came as relief. He knew it was becoming impossible for him to do the job properly and consume the amount of alcohol he needed to keep the withdrawal symptoms at bay. He also knew he needed help, but felt unable to ask for it.
His drinking was without thought for the consequences of other people as the alcohol precluded communication. He also knew he would not have been able to keep the job, if he had not used alcohol to give him the tools to do so.
At some point therefore there comes a time when drinking is no longer a “choice” but a “need” because of addiction. This is the point Matt reached and the central, important, vital lesson that I feel people with AS need to be aware of in relation to alcohol and everyday work.
How does one know when this point is being approached?
According to the book there are many signs that may indicate an increasing reliance on alcohol: ensuring that it is always readily available, short temper and irritability if devoid of it, using it as a casual relaxant and social lubricant, excessive consumption, genuine difficulty in coping without it for any length of time – nausea, sweats, shakes, drinking in secret and continuing to do so even after it has caused significant problems.
From my personal perspective, I have never reached this stage. I have always been a moderate drinker and able to control my consumption.
From a work perspective there are a number of methods I deploy to ensure that drinking does not impact negatively in my working life. I try generally not to drink during the week for example, and, at work functions, pre-condition myself to limit what I am going to have. Having water available alongside the alcohol is another invaluable technique/discipline
The real problems for Matt with alcohol started when he commenced a new job which proved inappropriate. Whilst subsequently unemployed his drinking accelerated. As Matt was to discover, there comes a point when alcohol is no longer an effective means of managing anxiety for the individual. In his case the ability to work and function at an acceptable level became too noticeable to ignore, even though he was not immediately prepared to admit it. Eventually, however, a point is reached when it cannot be ignored.
For people with AS there is the additional difficulty of appreciating the severity of the situation due to the impaired ability to engage in abstract thought and imagine events which have not yet happened. According to the authors, there may be no amount of forewarning from others that can convince them of an impending situation that they are not experiencing.
The book then makes the important point of how, with an individual with AS and alcoholism, the latter must be treated within the confines of the AS personality. Drinking may have been a very efficient coping strategy. People with AS drink for a very good reason: it is in some cases the only way they know how to exist in the world. Removing the protective layer against the confusions and expectations of a social world may unearth high levels of anxiety and depression.
Managing anxiety must go hand-in-hand with the withdrawal of alcohol as the AS perspective of the AS alcoholic may be different to the NT alcoholic. An AS alcoholic needs to learn how to cope with the world whilst being under the hold of alcohol as the desire to return to using alcohol will be very strong.
This is where the book touches for the first time on identifying supports which are not alcohol related to address the underlying causes that prompt people with AS to engage with alcohol in the first place. For example, a programme of social skills may be required to enable the person to feel more confident about social situations i.e. Cognitive Behavioural Therapy.
Whatever method selected (rehabilitation, CBT, Alcoholics Anonymous) the more an individual engages with the support available the better his chances of staying off alcohol. For me, this resonates with the need for someone with AS to overcome the general unwillingness to ask for help and seek assistance. It is pertinent advice.
Identifying situations where problems may occur – or “triggers for usage” – are also investigated. In a work context, a number of these can be readily identified: regular after hours drinking, formal social occasions like industry conferences or when senior management are present and watching.
The book then discusses the long-term strategy of changing ones thinking and ways of perceiving problems (social events will be anxiety provoking – not), so that the real , underlying concerns are challenged and addressed.
Outside stresses like money worries need to be removed before they have the chance to overwhelm. One work example for me, is not taking on tasks at work that are too demanding or for which the individual is insufficiently prepared.
The authors then look at diagnosis and assert that an official AS diagnosis may not be necessary for some adults; simply knowing themselves is all they need. The same point, for me, applies to alcohol. Being aware of its benefits, whilst guarding against its dangers, has enabled me to use it in a controlled fashion to my own advantage.
For those who already have become overly reliant on alcohol, some useful advice is provided. Firstly, how support networks are hugely beneficial in helping to overcome loss of the soothing effects that alcohol provides.
To help him do so, Matt admirably identified alternative activities. He started studying for example. For him, disclosing his diagnosis was also beneficial – he was given help. When the MA degree he signed up for and needed to complete in a year was something he was not mentally prepared for and so unable to undertake, he withdrew which provided ameliorative relief.
This approach, for me, was one of the most encouraging lessons of the book. If something is not right for you – don’t do it! Instead of forcing yourself to do something that is making you unhappy or miserable, choose a different direction – and avoid the possible recourse to drink.
In the past Matt would probably have carried on the same course – supported by alcohol. Life needs to be on your own terms to protect yourself against the stress that leads to drinking.
Since Matt stopped drinking his AS traits have come more to the fore. He is less focused and more easily distracted by anything that catches his interest. He does sometimes “freeze” when confronted with a problem. However, to avoid anxiety he no longer uses alcohol but permits himself to fail and does not harangue himself if he does.
Care needs to be taken in this area when coming off alcohol in relation to other people. From a work perspective, this point, I feel, should be considered – and accommodated – even more carefully when dealing with colleagues. As is the next point from a work perspective: that is important not to put oneself in any situation where there is a risk of returning to drinking behaviour. Excessive work demands or responsibilities, tolerating bullying, having an insufficient support network etc. All very useful advice.
Inevitably, and very importantly, the text then turns to socialising, friendships and social situations. The key point made here that it is important to try and find the level of social interaction that is right for you, regardless of what others or society say is “normal”. For me this is all so pertinent in the world of work and having AS.
People with AS find groups difficult and prefer to meet on a one-to-one basis – true. The more people present, the greater the level of non-verbal communication and social cues that need to be fathomed – correct. A drink, of course, can help overcome these issues for us.
I liked the suggestion of identifying one or two trusted people who can guide the person (about drinking too much socially). This provides invaluable support and mitigates the risk of being misunderstood or perceived as being rude.
Today, Matt doesn’t socialize after work in certain ways – like going to the pub. He does though watch films with colleagues before going off and doing his own thing afterwards. I thought that this was very sensible advice and accords with satisfying the essential need to socialise with work colleagues but in a safe, alcohol free context.
The book finally addresses the professional support & strategies available for someone with AS if they do succumb to excessive alcohol consumption.
Unfortunately, as is often the case, the authors believe that the quality of support available is varied and intermittent. When seeking assistance, it is important to try and identify a professional who is aware of the characteristics of AS and the overlap between it and alcohol.
Every person with AS interprets their condition differently and there is no one-size-fits-al strategy that will work for everyone. An individualistic, person centred approach is required and this means working with a mainstream professional from the area of alcohol addiction who is not knowledgeable about AS may be inappropriate.
The book finishes with the conclusion – like I do – that alcohol can help manage the anxiety inherent in AS to some degree. However, the possibility that someone can be autistic and alcoholic needs to be recognised and fully understood.
I think that the key message that emanates is one of awareness. If you are fully conscious of the way that alcohol can impact, then each individual can develop their own strategy for incorporating and managing it within their lifestyle. This alone makes the book a very worthwhile read.
Perhaps total abstinence is, however, a better solution? As Matt asserts “It is never too late to change your life and your addiction”. Well done to him.
Asperger Syndrome and Alcohol: Drinking to Cope? – Matthew Tinsley & Sarah Hendrickx
Jessica Kingsley Publishers
ISBN: 978 – 1 – 84310 – 609 – 8