I worked as a co-occurring specialist for 5 years. I can’t remember an instance where I received any training in autism and linkage to SUD. I would definitely take part in a training that helps expand my knowledge and understanding of the link between SUD and Autism.” SUD Counselor
Despite misperceptions about autism and substance use, about 1 in 3 autistic adults might experience some level of substance use disorder (SUD), and substance use counselors are not always equipped to work effectively with neurodiverse clients. SUD counselors might not know if a client is autistic and the client themselves might not know. Symptoms of autistic stress, communication differences, and reactions to sensory sensitivities can also lead providers to label clients as “defiant” or “resistant to treatment.” The goal of SUD treatment is to work with clients to help guide them in their own recovery but a lack of training in identifying and reacting to neurodiverse clients’ needs can weaken the effectiveness of treatment. SUD Counselors want to help their clients, and closing this training gap around neurodiverse clients can help them be more effective.
SkillFlix© for Substance Use Disorder Counselors Working with Autistic Clients
To address this training gap, dfusion along with Dr. Laura Graham Holmes of Hunter College at CUNY, developed a prototype of SkillFlix for SUD Counselors Working with Autistic Clients, a video library designed to teach SUD counselors how to:
- identify and react to symptoms of autistic stress
- adjust communication strategies with different clients
- mitigate sources of tension
- create treatment plans that cater to neurodiverse needs
Development
“ I’ve seen short-term success, but, like with most of our clients, a lot of relapse… It’s really hard to treat because of some of the neurodivergent behavior or thoughts…So I’m really eager to learn and see how we can better assist those clients.” SUD Counselor
We interviewed and conducted focus groups with both SUD counselors and autistic adults who have experience in SUD treatment. We also collected feedback from our Community Advisory Board and Professional Advisory Board of SUD about the knowledge and training gaps for SUD counselors, how they manifest during treatment, and how they can be addressed.
An important theme that emerged was that ‘mistreatment’ of autistic clients did not come from a lack of care for the client, but more from an ignorance of autistic folks’ behaviors and needs. This often increases the burden on autistic clients because in addition to their recovery, they have to advocate for themselves and educate their counselors. This combination could increase dropout and relapse rates.
“All of the accommodations that I received were a result of my initiation… The counselor recently told me, she now understands that there is a difference between people just causing commotion versus somebody who is like, on the surface seemingly being difficult when they’re just trying to get their needs met…That there’s a difference in how people are engaging. She said that like, she would be labeling all of these people as ‘defiant’ or just being like, ‘aggressive.’” -Autistic Adult who received inpatient SUD treatment
For the prototype SkillFlix video library, we filmed 20 microskill videos that range from 2 to 8 minutes, with approximately 70 minutes of content across 3 foundational skills.
- Build a neurodiversity affirming practice
- Prepare for a session
- Develop a therapeutic relationship
Evaluation
“This was this best video type training that I have ever taken. At my work, we used [a different online training platform] and it was often boring, too long, and not very thorough.” – SUD counselor
To evaluate the effectiveness of the SkillFlix Video Library, we recruited twelve SUD counselors to take part in a study. Participants completed simulated client intake sessions with an actor portraying an autistic SUD client. The actors were instructed to exhibit four specific sensory sensitivities (tactile issues, noises, bright lights, and distressed stimming) and address four common issues for autistic clients during the conversation (group therapy, trust in the healthcare system, difficulties elucidating emotions, and wanting to understand ‘why’ sensitive topics are discussed).
The counselors then watched the videos over the course of a week and completed a second simulated client intake session with a different actor portraying a different autistic client, still addressing the eight issues. The simulated sessions were recorded and each of the eight issues were scored on a scale of 1-10.
Across all participants and targeted skills, 93% of skills improved after viewing the SkillFlix Videos, and all participants improved in at least 6 of 8 skills! And every participant recommended SkillFlix for SUD Counselors.
Bridging the Gaps
SUD counselors want to be there for their clients, and autistic folks in treatment want to recover. Fundamental misunderstandings of how others interact with the world can make forming, growing, and maintaining a therapeutic relationship difficult. We’re encouraged by the results from this prototype, and we look forward to building a full resource that will address the entire scope of SUD treatment including inpatient and outpatient methods, group therapy, recognizing and mitigating distress and more! We have started to build a great tool to bridge a treatment gap and we look forward to expanding it!
“I now have a better understanding of how complex and nuanced therapeutic process can be with folks on the spectrum. I have so much more room for growth of knowledge and insight into this clientele, that I still believe I am capable of offering great therapy, but feel humbled.”
SUD Counselor
About the Author
Izzy Schieber, PhD, is a research associate at dfusion. With a PhD in Behavioral Psychology and certificates in Public Health and Sustainable Development Practice, Izzy focuses on developing behavioral interventions that can be implemented and sustained in real-world settings. She has 15 years of experience working directly with individuals with intellectual and developmental disabilities (IDD), as well as 14 years of research experience in behavioral health, behavioral pediatrics, behavior economics, mHealth development, sexual health, and problem behavior. Her approach is rooted in behavior analysis and implementation science to design both interventions that support behavior change and systems that can sustain those changes.