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Social Anxiety and Problem Drinking: The Connection

Expectancies play a big role

Most people are intuitively familiar with the concept of “social anxiety.” Severe social anxiety is actually an official mental health diagnosis. According to the American Psychiatric Association's Diagnostic Manual (DSM-5) it is characterized by a strong and persistent fear in social or performance situations. The individual who suffers from “social anxiety disorder” fears that he or she will act in an embarrassing way or show symptoms of anxiety that will be humiliating. It's easy to see how social anxiety can have severe deleterious effects on a person's life stle, including their relationships and their careers.

What is less well known is the fact that 28% of men and women who are diagnosed with social anxiety disorder meet the criteria for lifetime prevalence of an alcohol use disorder (Psychological Medicine. 40(6):977-988, June 2010). That’s a lot of people.

What Is the Connection?

It might be tempting, given the above statistic, to conclude that simply having social anxiety is in itself enough to predispose someone to problem drinking. But as it turns out the connection is not quite as simple. Moreover, by better understanding the connection between social anxiety and problem drinking individuals and therapists alike might be in a position to reduce that risk.

A study of university students in Germany sought to explore the link between social anxiety and excessive drinking (The motive to drink due to social anxiety and its relation to hazardous alcohol use. Cludius, Barbara, Stevens, Stephan, Bantin, Trisha, Gerlach, Alexander L., Hermann, Christiane, Psychology of Addictive Behaviors, 0893164X, 2013, Vol. 27, Issue 3). While further research will be required—to determine, for example, if the reported findings apply to older adults, etc.—the results of this study point in an interesting direction.

Expectations Make the Difference

First, the researchers found that men and women who were diagnosed with social anxiety disorder tended to drink excessively mostly in situations in which drinking is more or less socially acceptable: parties, happy hours, and other similar gatherings, for example. In contrast, they were inclined to suppress their drinking in situations in which it might make them stand out.

Second, while social anxiety itself is associated with more drinking, the individual’s expectation for how drinking will affect them played a large role in how much they drank in any given situation. For example, if a man believes that drinking will make him more relaxed and sociable at a dinner party, he is more likely to drink, even to excess. On the other hand, if he is planning to go to a company picnic where he will be expected to participate in some friendly team sports, he is more likely to suppress his urge to drink if he believes it might cause him to make errors or otherwise perform poorly. A socially anxious woman who expects a couple of drinks ahead of a social event will help bring her out of her shell may take to “pre-drinking” or “frontloading” every time she goes out. Over time this can lead to the development of the alcohol use disorders that appear to affect many people who suffer from social anxiety.

What to Do?

The above results make a lot of sense. Those people with social anxiety who are most likely to develop a drinking problem are those who believe that drinking has positive, but no negative, effects on their behavior. Unfortunately, we all know some people whose behavior changes in negative ways when they drink but they don’t realize it. Family and friends are often hesitant to point this out for fear of embarrassing or even angering the person who is trying to cope with their social; anxiety. That said, men and women who understand that they have social anxiety are best off taking the time to examine their motivation for drinking: what positive effects do they believe it has, versus what if any negative effects? If they are really brave they might even ask a trusted friend if that friend has noticed how their behavior changes when they are drinking. This is very important, because no one sets out in life to develop an alcohol use disorder; rather, problem drinking is an insidious process, and its negative consequences may occur so slowly over time that the anxious drinker is not fully aware of them.

Perhaps most importantly, the socially anxious individual may be better off seeking some counseling aimed at replacing drinking with some other strategy to help him or her cope with that anxiety. There are many proven therapeutic strategies for doing this, such as role-playing (with a therapist), cognitive role-playing (by yourself), and cognitive-behavioral therapy, which involves changing thoughts, perceptions, and expectations in order to change behavior. Certain antidepressant medications, when used in tandem with therapy, can also be effective in mderating social anxiety. Availing themselves of such resources and strategies—preferably sooner than later—could just help many men and women avoid the negative physical and psychological consequences that come from chronic reliance on drinking to get them through the day.

Joseph Nowinski's most recent book is Almost Alcoholic: Is My (or My Loved One's) Drinking a Problem?

@2013 by Joseph Nowinski, PhD