The Link Between Cannabis, Autism, and Psychosis

This newsletter discusses the connection between cannabis, autism, and psychosis.

Many of our clients use cannabis or products like CBD and THC to help with all sorts of health issues, and for some, it brings real relief. That's why it's so important for us to understand what the science says about the risks, especially when it comes to mental health and the developing brain.

Here’s what the research is telling us: people with Autism Spectrum Disorder (ASD) seem to be more sensitive to the effects of cannabis and THC. Cannabis can interfere with the brain’s systems for thinking, emotion, and perception, which are the very same systems that are affected in psychotic disorders like schizophrenia. Schizophrenia is a chronic brain disorder in which a person might experience hallucinations (visual, auditory, tactile, olfactory) or have strong beliefs that aren't based in reality, known as delusions (e.g., believing that the government can hear their thoughts). For a person with ASD, using cannabis can unfortunately increase their risk of developing psychosis.

Some studies suggest this might happen because cannabis can affect how certain genes related to autism express themselves, making the brain more vulnerable to changes that could lead to psychosis down the road.

Some clients with ASD say that using cannabis actually helps reduce their symptoms. The challenge is that, right now, there’s very little scientific proof that cannabis is an effective treatment for autism. We also have to remember that for young people, cannabis use can have a lasting impact. The teenage years are a critical time for brain development, and using cannabis during this period can have long-term effects on learning, memory, and emotional regulation.

High levels of THC can make someone more likely to struggle with learning and memory, have trouble managing their emotions, and even experience psychotic symptoms. The research is becoming clearer that for people who already have neurodevelopmental conditions like ASD or an intellectual/developmental disability, cannabis use can significantly raise the risk of developing a full-blown psychotic disorder.

This is why we, as providers and caregivers, need to be extra vigilant. People with ASD or I/DD may:

*   Be more neurologically sensitive to psychoactive substances.

*   Struggle to describe what they’re feeling or experiencing internally.

*   Already deal with anxiety, rigid thinking, or different ways of perceiving the world.

*   Have less insight into the early warning signs that their mental health is declining.

Because of these factors, the first signs of cannabis-related psychosis can be easy to miss. They might be subtle, mistaken for a person's usual behaviors, or just brushed off as part of their autism.

Keep an eye out for these early warning signs:

*   Becoming more paranoid, fearful, or suspicious.

*   Developing new beliefs that are illogical or disconnected from reality.

*   Talking to or responding to things that aren't there.

*   Big changes in sleeping, eating, or daily routines.

*   Suddenly becoming emotionally flat, withdrawn, or agitated.

*   Seeming more confused, disorganized, or having trouble with familiar routines.

Any quick or major change from someone's typical behavior should be noted and shared with their clinical team immediately.

It's not your job to diagnose psychosis or to tell clients to stop using cannabis. Instead, our role is to:

*   Observe and document any changes in behavior and mental state.

*   Keep the lines of communication open and non-judgmental.

*   Share any concerns with supervisors, behavior specialists, and doctors.

*   Encourage families and guardians to talk about cannabis use with the client’s medical team.

*   Focus on evidence-based strategies that help with emotional regulation and safety.

The best way to approach this conversation is with curiosity and concern, not confrontation. Remember, for many of our clients, using cannabis is a way of trying to self-medicate and find relief.

Cannabis is more common and socially accepted than ever, but we can't ignore the research that points to real risks for people with ASD and I/DD. Being informed gives us the power to step in early, reduce potential harm, and advocate for safer, more effective supports. It takes all of us (caregivers, therapists, doctors, and families) working together to ensure our clients receive the thoughtful, compassionate, and appropriate care they deserve.

Citation: Bortoletto R, Colizzi M. Cannabis Use in Autism: Reasons for Concern about Risk for Psychosis. Healthcare (Basel). 2022 Aug 16;10(8):1553. doi: 10.3390/healthcare10081553. PMID: 36011210; PMCID: PMC9407973. 

Samantha Easton, Clinical Director, Miren Behavior