This study explored demographic and psychological predictors of alcohol use and misuse in a high-functioning, community sample of 237 autistic adults aged 18-75 (mean = 41.92 and standard deviation = 13.3) recruited in the United Kingdom. An online survey measured demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use with the Alcohol Use Disorders Identification Test. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) and multinomial logistic regression models were used to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring significantly higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. In multivariate analysis, autistic non-drinkers were less likely to be male (odds ratio = 0.44; 95% confidence interval = 0.22-0.87) and had more autistic traits (odds ratio = 2.50; 95% confidence interval = 1.19-5.28). Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community. Lay abstract Alcohol use and misuse are associated with a variety of negative physical, psychological and social consequences. The limited existing research on substance use including alcohol use in autistic adults has yielded mixed findings, with some studies concluding that autism reduces the likelihood of substance use and others suggesting that autism may increase an individual's risk for substance misuse. This study investigated demographic and psychological predictors of alcohol use and misuse in a sample of 237 autistic adults. An online survey was used to obtain data on demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) in order to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. Autistic non-drinkers were less likely to be male and had more autistic traits. Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community.
