Table 3.

Clinical recommendations – important factors in therapy for ASD and SUD.

Therapy course and structure  Therapy for this group is more complex than simply following a manual.  The therapy has to be more detailed and thorough; length of sessions and duration of treatment usually need to be increased.  To optimise predictability for the patient, sessions should, as far as possible, be at a fixed time each week.  It is important to discuss the likely duration of intervention at the beginning of the therapy.  The therapy has to be structured, direct, and concrete, and supplemented with written guidance.  Written plans, notes, and/or homework assignments are an essential adjunct to therapy.  The use of a motivational interview is useful for making a plan for treatment and outcome.  Psychoeducation about ASD characteristics and how they may impact on each individual is important.  Stability is vital – changing therapist is very challenging for patients.  Ending treatment is difficult because the patient may feel rejected.

Therapist characteristics  Therapists should have previous experience of conducting CBT.  It is preferable for the therapist to have had have previous experience of working with individuals with ASD.  Therapists have to be persevering and patient and recognise that they may feel incompetent in dealing with the challenges of autism. They may also experience a strong emotional commitment to their patient.  Flexibility and creativity are vital therapeutic techniques.

Patient characteristics  Some patients believe that they are drug experts although they seldom are.  Some patients stop using drugs immediately although this can imply a health risk.  Most patients have a challenging communication style and may take control over the sessions.

Collaboration/external support  Some patients will need more support than can be provided in an outpatient clinic.  Supervision by experienced clinicians is vital, as is collaboration with colleagues.  The therapist should be able to support the patient after ending the therapy – and offer follow-up sessions as needed.  It is crucial to establish collaborations with other relevant services and with the family.  It is important to help the patient establish relationships with local support professional before ending therapy.  Most patients need help with more than SUD; housing, employment, social contacts, etc.

ASD, autism spectrum disorder; CBT, cognitive behavioural therapy; SUD, substance use disorder.