What 75 Minutes of Video Taught Substance Use Counselors About Their Autistic Clients
Substance use disorder (SUD) treatment is extremely difficult for everyone. NIDA estimates that 40-60% of people relapse after treatment. For autistic adults, the road to recovery is often steeper still: in addition to the inherent difficulty of quitting substances, autism can pose an undue barrier to recovery, often due to providers’ lack of training in understanding and adapting to autistic needs.
Over the past year, our team at dfusion set out to understand why, and to test whether short, skill-focused videos could help SUD counselors close the treatment gap. With support from a Phase I SBIR grant from the National Institute on Drug Abuse, we built and pilot tested SkillFlix for Substance Use Counselors. The early results are some of the most encouraging we’ve seen.
Two very different stories
We started by listening. We interviewed eight autistic adults who had been through SUD treatment and held two focus groups and eight additional interviews with SUD counselors. A Community Advisory Board of autistic adults in recovery and a Professional Advisory Board of experienced SUD counselors with extensive autism expertise guided us throughout.
The autistic adults we spoke with described treatment as exhausting to navigate. Few received any accommodations, and those who did, had to fight for them. Several were labeled “defiant” for avoiding eye contact or staying quiet in group, or “aggressive” for asking clarifying questions or pushing back when an accommodation request was denied.
Providers told a different story. Many felt well equipped to work with autistic clients because approaches like Motivational Interviewing are already individualized. Yet most were largely unaware of the additional sensory, social, and communication needs autistic clients might have. That disconnect became the blueprint for everything we built next.
What we built
From that research, we mapped out 23 potential skill sets a full resource could cover, from inpatient and outpatient care to group therapy, meltdowns, and how to respond when a client discloses their autistic versus when a counselor only suspects it.
For this first phase, we focused on three of these skill sets:
- Preparing for a session with an autistic client
- Building a neurodiversity-affirming practice
- Developing a therapeutic relationship with an autistic client
The result is a library of 21 professionally produced videos (3-5 minutes each), including an introduction, totaling about 75 minutes of content. The videos follow two SUD counselors, their supervisor, and four autistic clients with a range of sensory, communication, and social needs. Every script was reviewed by both advisory boards before filming. Topics range from setting up a room for a client with sensory sensitivities to helping de-escalate a meltdown.
Putting it to the test
We recruited 12 SUD treatment professionals from the Santa Cruz County and San Francisco Bay Area region. To measure skills, each study participant met a simulated autistic client for a first individual session of up to 30 minutes. In the simulated scenario, the client had just enrolled in outpatient treatment that required both individual and group therapy. Over the session, the client presented eight challenges:
- Sensitivity to lights
- Sensitivity to sounds
- Sensitivity to touch
- Escalating stimming
- Distrust of healthcare workers
- Reluctance to attend required group therapy
- Difficulty describing emotions
- Wanting to know why personal questions were being asked
Participants then had one week to watch the SkillFlix videos. Afterward, they met a new simulated client with a different backstory and addiction, who presented the same eight challenges. The recorded testing sessions were reviewed and scored by two independent observers using an established rubric rating protocol.
What changed
Eleven of the 12 participants completed both sessions, and every one of them performed better overall after watching the videos. Across all participants and targets, 91% of responses improved.
The most striking change was in how sessions ended. In the first round, five participants’ simulated clients escalated to a full shutdown. In the second round, none did.
Confidence rose too. Ten of the 12 participants reported greater confidence working with autistic clients on the Therapist Confidence Scale. Of the two who did not improve on this scale: one had extensive, personal experience with autistic folks and was already fully confident in working with this population. The other told us:
“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.”
This kind of humility is exactly what the formative research suggested was missing. And of note, even the participant who entered the study fully confident in their ability to work with autistic folks still improved across 6 of the 8 challenges after watching the videos, performing the same for the other two.
All 12 participants recommended the resource. Several said it was the best video training they had ever taken, contrasting it with continuing education videos that felt long and boring. Another participant summed up the need:
“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.”
What’s next
This was a small, early pilot, and we’re careful not to overstate it. But it showed that short video modeling clips can teach SUD counselors concrete, observable skills, and that counselors want this kind of training.
If funded for Phase II, we plan to grow SkillFlix into a comprehensive library of roughly 200 videos and resources covering all 23 skill sets. We also plan companion videos for autistic clients, to help them understand which accommodations might support them during treatment.
Providers want to help their clients. When they understand what their autistic clients need, both sides can stop fighting the process and focus on what matters: recovery.
SkillFlix for Substance Use Counselors was supported by the National Institute on Drug Abuse of the National Institutes of Health under award number R43DA063374. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
