ADAPT: Development and Pilot Feasibility Trial of a Substance Use Disorder Prevention Intervention for Autistic Adults

Autistic adults experience elevated rates of substance use disorders compared with the general population. We developed Alcohol and Drug Choices for People on the Autism sPecTrum (ADAPT), a six-session, psychoeducational, online, group-based intervention grounded in harm reduction and self-determination theory, co-created and co-facilitated by autistic and nonautistic people. This pilot feasibility trial evaluated feasibility, acceptability, and preliminary efficacy. Forty autistic adults interested in gaining control over their substance use enrolled in a waitlist control trial (17 active intervention, 23 waitlist control). We facilitated weekly meetings to deliver ADAPT via Zoom. The research team assessed feasibility through recruitment, retention, and attendance metrics, and acceptability through satisfaction ratings and qualitative interviews. We met the following feasibility benchmarks: 40 participants enrolled, 88% of active intervention participants attended at least five of six sessions, and the intervention achieved 87.5% retention. Participants rated the intervention highly ( M = 8.16/10) and experienced improvement in coping skills and depression symptoms, but no significant changes in substance use. Participants reflected on process and content elements that worked well and that we could improve. Opportunities for improvement included a longer intervention with more options for community-building among attendees and including more information about what is known and unknown about autism and substance use. ADAPT is a feasible and acceptable intervention for autistic adults seeking to gain control over substance use. Participants showed improvements in knowledge, coping skills, and mental health symptoms. Future research should examine longer-term follow-up, strengthen motivational components, and validate outcome measures for autistic populations.