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Alcohol use disorder is a condition that develops as a result of problematic alcohol use. The study examined the relationship between social anxiety and self-compassion among persons with alcohol use disorder in the three main psychiatric hospitals and an alcohol rehabilitation centre in Ghana. The study employed a correlational design and used purposive sampling in obtaining its participants. Sixty participants were involved in the study and Frequencies and Pearson's product-moment correlation coefficient were used to analyse the data. The findings revealed that social anxiety was highly prevalent among participants and moderate level of self-compassion was observed. A highly significant inverse relationship between social anxiety and self-compassion was also found. The sample size and the use of an adapted version of the self-compassion scale are considered limitations for the study. Also, persons with alcohol use disorders in the study were addicted to at least one other psychoactive substance and this was also considered a limitation of the study.
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Social Anxiety and Self-Compassion
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George Ekem-Ferguson
International Journal of Research and Innovation in Social Science
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International Journal of Research and Innovation in Social Science (IJRISS) |Volume V, Issue I, January 2021|ISSN 2454-6186
www.rsisinternational.org Page 563
Social Anxiety and Self-Compassion in Persons with
Alcohol Use Disorders in Ghana
Marie Pearl Agordzo1*, Joseph Kwarteng Ofosuhene-Mensah2, Kofi Krafona3 and George Ekem-Ferguson4
1,2,3 Department of Education and Psychology, University of Cape Coast, Ghana
4Korle-bu Teaching Hospital, Accra-Ghana
Corresponding Author*
Abstract: Alcohol use disorder is a condition that develops as a
result of problematic alcohol use. The study examined the
relationship between social anxiety and self-compassion among
persons with alcohol use disorder in the three main psychiatric
hospitals and an alcohol rehabilitation centre in Ghana. The
study employed a correlational design and used purposive
sampling in obtaining its participants. Sixty participants were
involved in the study and Frequencies and Pearson’s product-
moment correlation coefficient were used to analyse the data.
The findings revealed that social anxiety was highly prevalent
among participants and moderate level of self-compassion was
observed. A highly significant inverse relationship between social
anxiety and self-compassion was also found. The sample size and
the use of an adapted version of the self-compassion scale are
considered limitations for the study. Also, persons with alcohol
use disorders in the study were addicted to at least one other
psychoactive substance and this was also considered a limitation
of the study.
Keywords: Alcohol use disorder, social anxiety, self-compassion.
I. INTRODUCTION
lcohol is a psychoactive substance that has benefits
which cannot be overemphasized. Its use cuts across
gender, culture and race with its medicinal value reported
(Stolberg, 2006). Even though the benefits of alcohol have
been acknowledged (Dunbar, Launay, Wlodarski, Robertson,
Pearce, Carney et. al., 2016), its harmful effects have also
been documented. The harmful effects of alcohol have been
implicated in every 1 out 20 deaths in 2016 and more than 5%
of the global disease burden (World Health Organisation
(WHO), 2018). In Ghana, it has been estimated that about 1.2
million people suffer from alcohol and other drug related
problems (Ofori-Atta, Read & Lund, 2010).
Alcohol use disorder has been defined by Kranzler and Soyka
(2018) as a problematic pattern of compulsive and
uncontrolled alcohol use associated with clinically significant
impairment or distress as defined by the Diagnostic and
Statistical Manual for Mental Disorders V (DSM V). The
DSM V spells out eleven criteria and requires that a person
meets at least two out of these eleven criteria to merit the
diagnosis of alcohol use disorder. However, the severity of the
condition depends on number of criteria the person meets
(APA, 2013).
Alcohol has been found to cause neuroadaptive changes to the
brain upon continual usage (Koob & Le Moal, 2008). This
explains alcohol as a psychoactive substance that could serve
both physiological and psychological purposes for its users
(Dunbar, Launay, Wlodarski, Robertson, Pearce, Carney et.
al., 2016). One of these purposes is the anxiolytic effect of the
substance. This property of alcohol provides an avenue for
people who experience physiological or psychological
symptoms of anxiety to experience a feeling of relaxation
especially in situations that trigger anxiety.
Social anxiety is a type of anxiety disorder described by the
Diagnostic and Statistical Manual for Mental Disorders V to
be marked with fear or anxiety about one or more social
situations in which the individual is exposed to possible
scrutiny by others (APA, 2013). The individual fears he or she
may act in a way or show anxiety symptoms that will be
embarrassing and humiliating. Social anxiety has been found
to have comorbidity with alcohol use disorder and as such
common among people with alcohol use disorder (Clarke &
Sayette, 1993: Kushner, Abrams & Borchardt, 2000: Randall,
2000: Schellekens, De Jong, Buitelaar & Verkes, 2014). The
World Health Organisation (2019) report on harmful use of
alcohol indicated that persons with alcohol use disorders who
have comorbid anxiety disorders are likely to relapse during
the first three months of treatment.
In Africa and specifically Ghana alcohol was used as an
expression of masculinity and was consumed by the affluent,
people who had status and were of a high social class in
society (Akyeampong, 1995). In recent times, this trend has
changed significantly. The marketing of alcoholic beverages
has seen a spike in media advertisement. This is due to the
absence of an implemented national policy on alcohol (WHO,
2011). Commercials in the media portray alcohol as a need
with celebrities and high profile personalities playing major
roles. Currently, there are variety of these alcoholic beverages
on the Ghanaian market and each portrays its potency without
disclosing the long term effects. These drinks are also
relatively more affordable than most soft drinks on the market
(Barry, Johnson, Rabre, Darville, Donova & Efunbumi, 2015).
These, coupled with the upsurge of numerous bars and spots
has seen the easy availability of the substance and lot of
patronage by even the unemployed youth.
Similar to most psychological conditions, alcohol use disorder
is not a mere national problem but a global issue (Fisher,
Bang & Kapiga, 2007). However, in Ghana, alcohol use
A
International Journal of Research and Innovation in Social Science (IJRISS) |Volume V, Issue I, January 2021|ISSN 2454-6186
www.rsisinternational.org Page 564
disorder is often viewed as a moral problem and people in this
situation are often judged based on social values and are
perceived to have weak morals. The moral definition of the
condition often makes society critical of such persons with
labels such as ‘korinsani, dantorlor’ (literally meaning
drunkard) among others used to describe them. However, the
underlying cause of the condition includes mental health
related issues such as anxiety and depression (Appiah,
Danquah, Nyarko, Ofori-Atta & Aziato, 2017: Oppong-
Asante & Kugbey, 2019).
In the face of the challenges posed by definition of alcohol use
disorder in Ghana and the critical attitude towards alcohol use
disorder within the Ghanaian context, there is a need for
people with alcohol use disorder to find strategies to cope
with their situation. This is particularly because their
condition is one that is often looked upon generally with
disdain. One of these strategies is to develop self-compassion.
Neff (2004) opined that self-compassion is an emotional
regulation strategy where people accept themselves in an
understanding, kind and humane way. This enables people
suffering various forms of psychological distress to view their
negative state in a positive light.
Neff (2009a) reported a link between self-compassion and
psychological health including happiness, conscientiousness,
optimism, decreased anxiety, depressive symptomology and
rumination. According to Neff self-compassion is the ability
to treat oneself with kindness, recognising one’s shared
humanity and being mindful when considering one’s negative
aspects. This eventually acts as a buffer against anxiety (Neff,
Kirkpatrick & Rude, 2007). Neff (2003a: 2003b) further
indicated being self-compassionate makes it less likely to use
alcohol to cope with anxiety.
Even though a few studies such as Akyeampong (1995) found
social anxiety to exist among persons with alcohol use
disorders in Ghana, there is the need to investigate the
prevalence of social anxiety among persons undergoing
treatment for alcohol use disorder. This is necessary because
relapse is common among such people (Appiah , Boakye,
Ndaa & Aziato, 2017) and social anxiety has been implicated
as a cause (World Health Organisation, 2019). There is also
the need to find out the prevalence of self-compassion among
these persons. This has become necessary as these people
would be integrated into communities after treatment with less
expectation of relapse and self-compassion could be beneficial
for such purpose (Neff, 2003a: 2003b). Knowledge from the
findings from this study would be beneficial to both
researchers and practitioners in the field of substance
disorders. Also, findings from the study would help the
Mental Health Authority and Drug Rehabilitation Homes
include appropriate and effective psychosocial skills into
treatment regimens to avoid relapse.
II. METHODS
Design and setting
The study adopted a correlational design. This allowed for the
relationship between social anxiety and self-compassion to be
established among a clinical sample of persons with alcohol
use disorder. Data for the study was collected from Ankaful
Mental Hospital, Accra Psychiatric Hospital, Pantang Mental
Hospital and House of Saint Francis, a rehabilitation centre
where patients were receiving treatment.
Participants
This study received ethical clearance from the University of
Cape Coast Institutional Review Board. There were sixty (60)
participants obtained through purposive sampling for the
study. Sixteen (16) participants were obtained from Ankaful
Mental Hospital, six (6) from Accra Psychiatric Hospital,
twenty-one (21) from House of Saint Francis Rehab and
seventeen (17) from Pantang Mental Hospital. Each
participant in the study had to meet the requirements of an
inclusion criteria to be enrolled in the study. The criteria
detailed that a participant of the study should be clinically
diagnosed of alcohol use disorder from the clinical facility
without drug induced psychosis and should be in treatment for
at least a week.
Measures
To measure social anxiety, the Social Interaction Anxiety
Scale (SIAS) by Mattick and Clarke (1998) was adopted. The
instrument is a 20 item questionnaire on a 5 point Likert scale
ranging from ‘not at all’ to ‘extremely’. Mattick and Clark
found a strong internal consistency of ɑ = 0.84 in both clinical
and undergraduate samples. The Cronbach alpha for the scale
in the sample for this study was ɑ = 0.92. The scale has three
categorisations based on the scores obtained. The first
category involved people with normal level of anxiety with a
score of below 34, the second category involved persons who
obtained a score ranging from 34 to 42 and they were
categorised as social phobics while a score of 43 and above
indicated social anxiety.
In measuring self-compassion, the Self-Compassion Scale
developed by Neff (2003a) was adapted. The original
instrument consists of 26 items on a 5-point Likert scale
ranging from ‘almost never’ to ‘almost always’. It has six
facets that determine the presence or absence of self-
compassion. The facets are self-kindness, self-judgement,
common humanity, isolation, mindfulness and over
identification. The Self-Compassion scale used in this study
was an adaption of the original 26 items to a 23 item.
Cronbach alpha of the 23 item scale was found in the study to
be 0.7.
The items ‘When times are really difficult I tend to be tough
on myself’, ‘when I’m feeling down, I tend to feel like other
people are probably happier than I am’ and ‘when I fail at
something that is important to me, I tend to feel alone in my
International Journal of Research and Innovation in Social Science (IJRISS) |Volume V, Issue I, January 2021|ISSN 2454-6186
www.rsisinternational.org Page 565
failure’ were deleted. For the purpose of this work, the scale
had three categorisations, scores that were one standard
deviation below the mean were indicative of a low self-
compassion. Those that were one standard deviation above the
mean were also indicative of a high self-compassion, any
score that lied within the low or high self-compassion values
were indicative of a moderate self-compassion.
Table 1: Sample characteristics (N =60)
Demographic
N
Sex
Male
56
Female
4
Age
Below 30 years
23
31-40 years
24
41-50 years
7
51 years and above
6
Marital Status
Single
42
Married
12
Divorced
2
Separated
4
Duration in Treatment
Below 4 weeks
4
5-6 weeks
5
7-8 weeks
2
9-10 weeks
2
11-12 weeks
15
13 weeks and above
32
Religion
Christian
55
Muslim
4
Traditional
1
aSample include 60 inpatients receiving treatment for alcohol use disorder
Table 2: Mean and Standard Deviations of Variables n = 60
SD
Social Anxiety
11.39
Self-Compassion
11.15
Score of the participants on the social anxiety scale indicated
that majority of them experienced high social anxiety and
moderate self-compassion. The percentage distributions for
the social anxiety and self-compassion are represented on
figures I and II respectively. Figure I shows that 55 % of the
participants had social anxiety.
Figure I: Percentage Distribution of Social Anxiety
Figure II: Percentage Distribution of Self Compassion
The relationship between social anxiety (as measured by
Social Interaction Anxiety Scale) and self-compassion (as
measured by Self-Compassion Scale) was investigated using
the Pearson product moment correlation co -efficient.
Preliminary analyses were performed to ensure no violations
of assumption of normality, linearity and homoscedasticity.
There was a moderate significant negative relationship
between social anxiety and self-compassion, (r = -.44, n = 60,
p < 0.01), with high levels of social anxiety associated lower
levels of self-compassion. This implies that social anxiety is a
significant factor that influences self-compassion.
Interestingly, the correlation co-efficient (r2) between social
23.3
21.7
55
0
10
20
30
40
50
60
Normal
Social
Phobia
Social
Anxiety
percentage
Normal
Social Phobia
Social
Anxiety
15
71.7
13.3
0
10
20
30
40
50
60
70
80
Low sc
Moderate
sc
High sc
Percentage
Low sc
Moder
ate sc
International Journal of Research and Innovation in Social Science (IJRISS) |Volume V, Issue I, January 2021|ISSN 2454-6186
www.rsisinternational.org Page 566
anxiety and self-compassion was 0.19 which implies that
social anxiety helps to explains nearly 19% of the variance in
participants score on self-compassion.
Table 3: Relationship between social anxiety and self-compassion
1
2
1. Social anxiety
-.44**
2. Self-compassion
**correlation significant at 0.01
III. DISCUSSION
That majority of the participants were males and this finding
is consistent with the assertion of APA (2013) and
Akyeampong (1995) who argued that alcohol use disorder is a
male dominated condition and was used express power
especially for Ghanaian man respectively. Again, males are
expected to play major roles in their various families, societies
and communities compared to their female counterparts.
Magazine (2004) found that men are more likely to drink
heavily because drinking helps them to ignore responsibilities
especially domestic roles while women have also been found
to be less likely to drink because they are saddled with greater
domestic responsibilities (Ahlstrom, Bloomfield & Knibbe,
2001). Drinking may therefore hamper their efficiency in
carrying out the enormous demands and responsibilities they
must perform on a daily basis to run the home.
It must also be mentioned that the Ghanaian culture frowns on
female alcohol use especially when a female develops an
alcohol use disorder. Although women have been found to be
alcohol users with some having alcohol related problems in
Ghana (Agoabasa, 2012), cultural
expectations which frown on women alcohol use, limits
female drinking. Despite female occasional and low dose
drinking being permissible; females are subjected to severer
judgement when they develop alcohol use disorder.
Furthermore, women also go through periods of pregnancy
and child delivery at certain periods in their lives. These
periods are known to be very crucial and exposures to alcohol
have been found to have detrimental effects on the child
(WHO, 2016). This could possibly explain the gender
difference observed in the study.
It was found that younger persons were more implicated than
the elderly. Over 78% of the respondents were less than 41
years. This finding was similar to that found by Adu-Mireku
(2003) and Doku, Koivusilta and Rimpala (2012) as they
called the condition a growing concern in Ghana and said
concerted efforts was needed to curb the situation. This trend
was an emerging problem observed by the World Health
Organisation in 2011. They found that Ghanaian college
students ranked third in Africa for problematic alcohol use on
the continent. The WHO report was more disturbing as it
implicated persons in college who are expected to know the
devastating effects of alcohol and lead the campaign to
educate Ghanaians on the addictive nature of the substance
and the possible harm it causes in the long term.
It was again observed that most of the respondents in this
study were single compared to the married, divorced and
separated respondents. The distribution was a reflection of a
finding by Schonbrun, Zach, Stuart & Strong (2011). They
asserted that marriage was a buffer against alcohol use
disorder. Beig single is a state that could render one
vulnerable to alcohol use as the support married people may
obtain from their spouses in times of psychological distress
would be absent for these individuals. This could account for
the high frequency of single persons being implicated in the
condition. In addition to this, since the condition is morally
defined in the Ghanaian context, it is possible that people may
not want to marry with individuals perceived to have weak
morals.
The demographic data also provided information on
participants’ religion. A report from Ghana Statistical Service
(2013) indicates that most Ghanaians are religious and
indicate to state to be either Christians (71.2%) or Moslems
(17.6%) or the African Traditional Religion (5.2%). In a
similar sense, most of the respondents in the study were
Christians. This could be due to the greater proportion of the
Ghanaian populace being Christians. In addition to this,
Islamic religion compared to the Christian religion strongly
forbids the use of alcohol. It is also possible that the sufferers
of the condition in the Islamic religion may not want to
disclose their state in order to preserve their identity and
integrity as Moslems.
The study found that majority of the scores of participants
indicated social anxiety. This is supported by studies on
alcohol use disorder and social anxiety which indicate that
alcohol use disorder and social anxiety are usually comorbid
disorders (Kushner, Abrams & Borchardt, 2000; Clarke &
Sayette, 1993). Akyeampong (1996) also reported in his study
in Ghana that most people with social anxiety are highly
likely to use alcohol especially for the relaxing effects that
alcohol provides. It is also possible that persons with alcohol
use disorders have high social anxiety as a reaction to the
cultural outlook on the condition in Ghana.
It was also observed that majority of respondents scored
within the moderate range for self-compassion. This is an
indication of respondents’ empathy and kindness they
demonstrate towards themselves in spite of their condition. In
Ghana, chronic medical and psychological conditions
including alcohol use disorder have been given definitions
such as the supernatural which placed the individual at the
mercy of the ‘gods’ or a deity. In a study by Agoabasa (2012)
it was found that some persons with alcohol use disorder in
Ghana believed that a pot had been deposited in their belly
which called for the continual use of the substance. A spiritual
explanation as this makes it easy to empathise with oneself
and treat oneself with more kindness and concern as the
persons with alcohol use disorder perceive themselves as
International Journal of Research and Innovation in Social Science (IJRISS) |Volume V, Issue I, January 2021|ISSN 2454-6186
www.rsisinternational.org Page 567
victims of the condition. In another study by Appiah, Boakye,
Ndaa and Aziato (2017), they found spiritual explanations
being offered to the cause of substance abuse. This further
provides possible explanation to the moderate self-
compassion observed in the study.
A negative correlation between social anxiety and self-
compassion was observed in the study. A similar findig was
made by Werner, Jazaieri, Goldin, Ziv, Heimberg and Gross
(2012). They found that persons with social anxiety disorder
reported significantly lower scores on self-compassion than
healthy controls. In another study by Potter, Yar, Francis and
Schuster (2014), it was found that self-compassion negatively
correlated with social anxiety. Self-compassion has been
found to involve how an individual thinks of himself
considering his/her humanity and making allowances for
error. Self-compassionate thoughts and behaviours are
regarded to be positive and enhancing and they shield an
individual from engaging in counterproductive thoughts as a
result of being critical on oneself.
According to Leary, Tate, Adams, Allen and Hancook (2007)
people diagnosed of suffering from anxiety are often
cushioned against feelings of anxiety when they tend to be
self-compassionate even though they may keep the anxiety
provoking situations in focus. This result was found after their
subjects recalled an event that involved failure and
embarrassment. They found that after a treatment involving
self-compassionate meditation, these persons reported less
negative affect. In a recent study by Blackie and Kocovski
(2017) they found that social anxiety as measured by social
interaction anxiety scale and self-compassion as measured by
self-compassion scale were negatively correlated. These
studies suggest that self-compassion provided a buffer against
the feeling of social anxiety disorder and was similarly
reported in this study.
People experiencing social anxiety are often preoccupied with
self-defeating thoughts which lies parallel to those in self-
compassion. Having mentioned this, it is worthy to note that
even though the Ghanaian culture is lenient with alcohol use,
it frowns on people with alcohol use disorder. Such persons
are often considered as moral failures and social misfits.
These individuals are likely to respond based on this cultural
and societal judgement and tend to be critical of themselves,
eventually avoid instances that puts them in the public space
for fear of being negatively evaluated. This puts such persons
at risk of developing social anxiety disorder and consequently
uses alcohol or possibly relapses. In the absence of the skill of
being self-compassionate, this phenomenon hampers the
efforts of both the patients and the clinicians or counsellors as
relapse becomes inevitable.
Based on the high prevalence of social anxiety observed from
the results of the study and the effect of social anxiety on the
success of treatment and relapse prevention, it is necessary
that clinicians and counsellors attending to people with
alcohol use disorder inculcate self-compassion meditation
skills in the treatment regimen. This is to act as a cushion for
these persons especially after treatment in order to limit the
occurrence of relapse.
IV. CONCLUSIONS
Alcohol use disorder is a condition that develops as a result of
problematic alcohol use which has far reaching psychological
consequences on the individual and society. Our study found
a high prevalence of social anxiety to exist among persons
with alcohol use disorders in Ghana, with moderate levels of
self-compassion. The study further found a significant
negative relationship between social anxiety and self-
compassion among persons with alcohol use in Ghana.
Considering the high prevalence of social anxiety observed in
the findings of this study, the study recommended that self-
compassion meditation exercises are included in the treatment
of persons with alcohol use disorders. It is also recommended
that further studies be conducted to find the influence of social
anxiety on self-efficacy to resist alcohol among persons with
alcohol use disorders in Ghana.
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