Addiction and Neurodiversity

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It is time to stop treating neurodiversity as an optional addition

To the alcohol and other drug sector of Aotearoa New Zealand,

I am writing to ask a difficult question:

Why has the alcohol and other drug sector not yet made the full pivot required to embrace neurodiversity?

This is no longer a question of whether there is enough evidence to start the conversation.

The evidence is already here.

In 2024, the New Zealand Drug Foundation published Neurodivergence and Substance Use, examining the relationship between ADHD, autism, substance use and addiction in Aotearoa New Zealand. The report found significant barriers to diagnosis and treatment and concluded that many AOD services are not designed around the needs of neurodivergent people.

The report itself recommends:

- tailored AOD treatment for neurodivergent people;
- neurodiversity training for the addiction workforce;
- better screening for ADHD and autism;
- increased access to diagnosis;
- community-based and peer support;
- neurodiversity-informed harm reduction;
- increased research; and
- approaches that are equitable, culturally safe and appropriate for Māori.

So the question is no longer whether neurodiversity matters to addiction services.

The question is:

What is the sector going to do about it?

Neurodivergence cannot remain a footnote to addiction

For too long, substance use has been approached primarily through the lens of the substance itself.

But for some neurodivergent people, substance use can be intertwined with sensory overwhelm, emotional regulation, impulsivity, executive-function difficulties, social isolation, masking, trauma, untreated ADHD or autism, and attempts to cope with an environment that was never designed for them.

The Drug Foundation's report describes people using substances to self-medicate or cope with symptoms and identifies significant barriers to accessing appropriate neurodivergence and addiction support.

That should fundamentally change how the sector thinks about prevention and treatment.

If we only ask:

"Why are you using this substance?"

we may miss the more important question:

"What need is the substance helping you meet?"

And then:

"What neuro-affirming supports could help meet that need more safely?"

Diagnosis cannot be the only gateway to understanding

There is another enormous problem.

Many people entering addiction services will not have a formal ADHD or autism diagnosis.

Some may never have been assessed.

Some may have been missed because they are women.

Some may have learned to mask.

Some may have been incorrectly diagnosed with other conditions.

Some may be unable to afford a private assessment.

And some may have spent years being told that their difficulties were behavioural, motivational or characterological rather than recognising the possibility of neurodevelopmental differences.

The Drug Foundation has identified diagnosis cost, wait times, stigma and system navigation as barriers. It also highlights the underdiagnosis of ADHD and autism, particularly among groups including women.

Therefore:

A person should not have to arrive at an addiction service with a piece of paper proving their neurodivergence before receiving neurodiversity-informed care.

Services need to become capable of recognising possible neurodivergence without requiring a diagnosis as the price of entry.

We need a sector-wide pivot

This should not be the responsibility of one organisation.

It should become a sector-wide transformation.

I am calling on Aotearoa New Zealand's alcohol and other drug sector to establish a National Neurodiversity and Addiction Transformation Programme.

That programme should include:

1. Neurodiversity-informed AOD services

Every AOD service should assess whether its environment, communication, intake procedures, group programmes and treatment models are accessible to ADHD, autistic and otherwise neurodivergent people.

2. Mandatory workforce education

Addiction professionals should receive meaningful training about ADHD, autism and other forms of neurodivergence, including how neurodivergence can present differently in women and adults.

3. Neuro-affirming screening

Services should be able to identify possible neurodivergence and make appropriate referrals without treating neurodivergence as a behavioural problem.

4. Integrated treatment

People should not have to navigate completely separate systems for addiction, ADHD/autism, mental health, trauma and disability support.

The systems need to communicate.

5. Neurodiversity-informed harm reduction

Drug checking, needle services, outreach and harm-reduction education should be designed so that neurodivergent people can actually access and use them.

Sensory environments, communication differences, processing time and accessible information matter.

6. Lived-experience leadership

Neurodivergent people with lived experience of substance use must be involved in designing, governing and evaluating services.

Not simply consulted after the decisions have already been made.

7. Better data

We cannot fix what we refuse to measure.

Aotearoa needs better data about the intersection between neurodivergence, addiction, alcohol use, drug harm, treatment access and outcomes.

8. A specific focus on women

The sector must address the historical invisibility of neurodivergent women.

Women can reach adulthood without recognition of ADHD or autism, while accumulating years of trauma, substance use, mental-health diagnoses and interactions with health and social systems.

The absence of a diagnosis does not mean the absence of neurodivergence.

This is also a safeguarding issue

Neurodiversity cannot be separated from safety.

When a person has difficulty communicating, recognising unsafe situations, regulating overwhelming emotions, navigating relationships or accessing appropriate services, those differences can affect vulnerability to harm.

That means neuro-affirming addiction treatment should not simply be about improving treatment completion rates.

It should be about preventing harm and creating safer lives.

This is why I am working on a broader neuro-affirming safeguarding project.

Part of that work involves examining how systems, including the media, health services, disability services and social services, understand neurodivergent people.

We cannot build effective safeguarding systems while continuing to misunderstand the people those systems are supposed to protect.

The sector has an opportunity to lead

The addiction sector has already demonstrated that it can challenge stigma.

It has challenged the idea that people who use drugs are simply making bad choices.

It has promoted harm reduction.

It has advocated for health-based approaches.

The next step is to apply that same willingness to challenge assumptions to neurodiversity.

Because if addiction services continue to operate primarily around neurotypical assumptions, some neurodivergent people will continue to fall through the gaps.

And when people fall through those gaps, the consequences are not theoretical.

They can include untreated neurodevelopmental needs, escalating substance use, preventable health harms, stigma, exclusion and repeated interactions with systems that misunderstand what is happening.

Don't wait for another generation

The NZ Drug Foundation's report already provides a starting point.

Its recommendations include tailoring AOD treatment, training the workforce, improving screening, expanding community support and developing better evidence.

The sector does not need another decade of discussion before beginning.

It needs implementation.

It needs accountability.

It needs neurodivergent people at the table.

And it needs to recognise that neurodiversity is not a niche issue sitting beside addiction services.

For many people, it may be part of the story of how they arrived there in the first place.

So I am asking Aotearoa New Zealand's alcohol and other drug sector:

Will you pivot?

Will you redesign services around the people who have historically been missed?

Will you train the workforce?

Will you listen to neurodivergent people with lived experience?

Will you invest in prevention rather than waiting until crisis?

Will you treat neurodiversity as a core component of addiction policy rather than an optional specialist interest?

Because the evidence is already telling us something important:

We cannot build an effective addiction system while leaving neurodivergent people outside the design of that system.

The time for acknowledging the gap is over.

Now is the time to close it.

Liz Wilkinson ☮️

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