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Self-Medication Can Lead to Dependence

Those With Anxiety Disorders Twice as Like to Be Alcoholics

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Updated December 16, 2003

Individuals with social anxiety disorder are not simply shy. They are pained at the thought of being scrutinized, and have an extreme fear of looking foolish to others. Findings published in the December 2003 issue of Alcoholism: Clinical & Experimental Research indicate that they may also deliberately drink alcohol in order to cope with social interaction, and avoid social situations where alcohol is unavailable.

"Social anxiety disorder can keep people from enjoying social events and often interferes with their jobs, especially when they are required to speak to a group as part of their work," explained Suzanne E. Thomas, assistant professor of psychiatry at the Medical University of South Carolina and first author of the study. "Besides avoiding situations where they might be evaluated, many individuals with social anxiety disorder [also] use alcohol to cope."

Thomas noted that although reports vary, the average lifetime prevalence of alcoholism among individuals with social anxiety disorder is 20 percent; that is, one in five develops alcoholism at some point in their lifetime. This compares to about a 10 percent lifetime prevalence of alcoholism in the general population, or, one in 10.

For this study, Thomas and her colleagues examined 46 study participants (26 females, 20 males), evenly divided into two groups with similar demographic variables and alcohol use: 23 had high social anxiety, and 23 "controls" were not socially anxious.

All participants were asked about their use of alcohol as a coping mechanism, the practice of avoiding social situations if alcohol were not available, and the degree of relief attained by drinking alcohol. Participants were also asked about using alcohol during 11 specific situations: four were considered "social interactions," such as meeting people for the first time, and seven were "performance" events, such as giving a speech to a group.

"We found that drinking to relieve social discomfort was a common practice in both groups, but that individuals with high levels of social anxiety use alcohol for this purpose more often, and they would drink both in anticipation of and during social situations," said Thomas. "Also, more individuals with high social anxiety avoid social situations if alcohol is not available. Lastly, they experience greater relief from anxiety in social situations than do individuals who are not highly anxious."

Thomas added that individuals with high levels of social anxiety did not experience full relief from their symptoms by using alcohol, but perhaps just enough to enable them to endure being in a social situation. "Individuals with high social anxiety do not use alcohol indiscriminately," said Thomas, "they may drink to cope with social-interaction situations, like meeting people for the first time, but not in performance-type situations, like giving a talk in front of a group, which they also fear."

Darlene H. Moak, a psychiatrist and assistant professor at the Medical University of South Carolina, said that this ability to discriminate between situations when alcohol use is acceptable or not warrants further research.

"This finding suggests that utilizing a single anxiety-provoking experience such as giving a speech in front of a group may not be the best way to study the relationship between social anxiety and alcohol use. Individuals with social anxiety seem to learn that drinking before and during performance events is, in fact, counterproductive in that it can lead to increased anxiety due to poor performance."

"Our study shows that people with high social anxiety do drink alcohol specifically to relieve anxiety more than controls," added Thomas. "It does not, however, address whether they drink more alcohol in general than controls, which should be the case if the self-medication hypothesis were completely correct."

The self-medication hypothesis proposes that some people use alcohol or other drugs because they experience relief from existing psychiatric or emotional problems. Consequently, the substance is used repeatedly, and for some people, leads to chronic use in order to manage mood or anxiety.

"Although alcohol is commonly used as a social lubricant," said Thomas, "that doesn't mean that a person who uses alcohol to feel comfortable in social situations is likely to become an alcoholic. We would argue that people with high social anxiety who use alcohol repeatedly to relieve their stress may come to rely on it as their primary coping strategy, and research suggests that such people are at risk for alcoholism. However, not all socially anxious individuals use alcohol to cope. What makes these individuals different from those who do is a fruitful research area."

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