ArticleLiterature Review

The relationship between social anxiety disorder and alcohol use disorders: A critical review

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Abstract

Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.

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... Additionally, data from a 2009 national United States survey indicate that an existing diagnosis of SAD is linked with greater risk for alcohol abuse and dependence in adolescents (Conway et al., 2016). The cumulative literature on alcohol use in social anxiety indicates that while social anxiety symptoms do not necessarily predict a greater frequency or amount of alcohol use, they do connote greater risk for experiencing alcohol-related problems, such as aggression, driving under the influence, or alcohol poisoning (Morris et al., 2005;Schry & White, 2013). Given these high rates of comorbidity and the detrimental consequences of alcohol use disorders, it is important for research to probe cognitive and emotional processes that shape socially anxious individuals' decisions and perceptions surrounding alcohol use. ...
... Existing work lends support to the concept that affective forecasts could play a role in the link between social anxiety and alcohol use. Morris et al. (2005) identify that an individual's fear about social interactions appears to invoke more alcohol use than their fear of nonsocial performance situations, implying that people's predictions about the anxiolytic effects of alcohol may drive their alcohol use in social settings. Stevens et al. (2017) found that for participants with SAD, receiving real alcohol or placebo alcohol lessened their anxiety about doing a speech task. ...
... Social anxiety symptoms and alcohol use problems represent major public health burdens (Nardi, 2003;Sacks et al., 2015), and their comorbidity gives rise to various dangerous outcomes, including aggression, driving under the influence, and alcohol poisoning (Morris et al., 2005;Schry & White, 2013). Accordingly, we believe our results have several important implications. ...
Article
Background: Existing work proposes that people with higher social anxiety symptoms and sociability alcohol expectancies believe alcohol can lower their anxiety. However, studies have primarily analyzed retrospective reports, not anticipatory motives. Since predictions of future emotion (i.e., affective forecasts) strongly influence behavior, it is critical to understand how people predict alcohol will influence their anxiety. Additionally, intolerance of uncertainty (IU) is related to the use of alcohol as a coping tool, but there is a dearth of work testing whether IU influences alcohol-related forecasts. Objectives: Utilizing a novel affective forecasting task, we tested the prediction that social anxiety symptoms, sociability alcohol expectancies, and IU would relate to predictions about alcohol use. In an initial study and preregistered replication, participants imagined themselves in stressful social scenarios and forecasted how anxious they would feel when drinking and when sober. In the replication, participants also forecasted whether they would drink in the imagined scenarios. Results: Contrary to hypotheses, social anxiety symptoms and IU did not significantly predict higher forecasted anxiety across studies, nor did they predict forecasted drinking. Exploratory analyses showed that participants with higher sociability alcohol expectancies forecasted being more likely to drink, and forecasted feeling less anxious when drinking (versus being sober). Even after statistically controlling for social anxiety, the effect of sociability expectancies remained significant in predicting forecasted anxiety and forecasted drinking. Conclusions: Clinicians could consider specifically targeting sociability expectancies for alcohol use difficulties, and future research should continue utilizing affective forecasting paradigms to test links between social anxiety, alcohol expectancies, and alcohol-use problems.
... Le trouble d'anxiété sociale et le trouble de l'usage d'alcool sont deux pathologies mentales parmi les plus prévalentes, toutes les deux associées à un grand handicap fonctionnel (3)(4)(5). Leur coexistence est également très fréquente (5)(6)(7)(8)(9), comme l'illustre une étude épidémiologique en population générale (10) : la prévalence du TUA sur l'ensemble de la vie chez les individus souffrant de TAS est de 48 %. Sur la même cohorte, la prévalence du TUA à un an chez les personnes présentant un TAS était de 13.1 %, comparé à 8.5 % en population générale. ...
... Corollairement, 25 % des individus soignés pour TUA remplissaient les critères de TAS et 55 % des patients en cure de désintoxication pour une dépendance à l'alcool répondaient aux critères d'anxiété sociale d'intensité modérée. Ces résultats, bien que cohérents entre études, différaient cependant selon la population étudiée et les définitions des troubles (4). ...
... Cette relation est modérée par les motifs de consommation. Ainsi, les individus craignant les interactions sociales nouvelles, telle qu'une discussion avec des inconnus, sont plus à risque de développer un TUA que ceux craignant les situations de performance telle qu'une présentation orale (4). La peur d'être observé est aussi un élément accroissant le risque de survenue du TUA (23). ...
Article
Alcohol use disorder and social anxiety disorder are two common and disabling conditions that share a frequent co-existence. If this co-existence is well documented in epidemiological studies, less is known about the nature of this relation and on a broader perspective, between social anxiety disorder and alcohol use. The aim of this article is to bring an update to the current literature concerning these topics in a way useful for the clinical practice. If there is no validated empirical model treating the comorbidity, we underline that alcohol use disorder is often a social bonds disorder. Personal and social factors have a moderating role in these bonds. All of these variables have a major clinical impact and should therefore be take into account for any prevention or treatment measure.
... Several studies find support for this hypothesis, such that individuals with internalizing symptoms report heavier drinking (e.g. Rodgers et al. 2000;Morris et al. 2005), cannabis use (e.g. Hayatbakhsh et al. 2007;Crippa et al. 2009;Lev-Ran et al. 2014), and using for coping motivation (e.g. ...
... Metrik et al. 2016;Kenney et al. 2018). In addition, depressive and anxiety disorders are among the most co-morbid with AUD (Morris et al. 2005;Bri ere et al. 2014), suggesting that self-medication may predict any substance use and disordered use. Further, theories of AUD development suggest that internalizing symptoms are a developmental antecedent to heavier, problem drinking (Hussong et al. 2011). ...
... Keough et al. 2015;Bravo and Pearson 2017), and AUD symptoms/ negative consequences (e.g. Morris et al. 2005;Corbin et al. 2020;Waddell et al. 2021b). Therefore, future research is needed to test other person-level characteristics. ...
Article
Background Alcohol and cannabis co-use is associated with negative alcohol consequences and alcohol use disorder. However, mediating and distal effects remain largely unstudied. Co-use is associated with alcohol use disorder/negative consequences even when accounting for drinking levels and personality, suggesting that other person-level characteristics may explain relations between co-use and negative outcomes. Method The current study tested whether internalizing symptoms, strong correlates of co-use and alcohol use disorder, explained the effect of co-use on alcohol use disorder. Data from adults (N = 353,000) in the 2008–2019 National Study on Drug Use and Health (NSDUH) were used. Analyses tested whether (1) substance use profiles reduced/dissipated the effect of co-use on alcohol use disorder, (2) internalizing symptoms (anxiety, depression) reduced/dissipated the effect of co-use on alcohol use disorder, and (3) internalizing symptoms were indirectly associated with alcohol use disorder via co-use. Results When accounting for frequency/quantity of use, co-use was still associated with higher odds of alcohol use disorder. Anxiety and depression were related to higher odds of an alcohol use disorder, however, the effect of co-use on higher odds of alcohol use disorder remained. Anxiety and depression scores were indirectly associated with higher odds of alcohol use disorder via co-use. Conclusions Depressive and anxiety symptoms only accounted for a portion of the variance of co-use on alcohol use disorder, and there were indirect effects of internalizing symptoms through co-use. Future longitudinal research is needed to elucidate other person-level characteristics that drive associations between co-use and alcohol use disorder to target via interventions.
... Indeed, among individuals with an anxiety disorder, it is estimated that 20%-40% will also experience an alcohol use disorder in their lifetime [4]. When anxiety and alcohol use co-occur, symptom severity can be worse, and treatment adherence and outcomes are typically poorer compared to individuals with an anxiety or alcohol disorder alone [5,6]. ...
... Previous critical and systematic reviews have established a strong body of evidence for a relationship between anxiety and alcohol use [12,16]. These reviews have typically focused on the temporal sequencing of the anxiety-alcohol relationship [16,17]; comorbidity between a specific anxiety disorder, for example, social anxiety disorder, and alcohol use [5,[18][19][20][21]; the treatment of comorbid anxiety and alcohol use disorders [22][23][24][25]; or all of the above [12,26]. Yet, despite substantial existing research, the specific mechanisms driving anxiety and alcohol comorbidity are still poorly understood. ...
Article
Full-text available
Background: Anxiety and alcohol use commonly co-occur. Previous research has demonstrated the bidirectional and mutually reinforcing nature of this relationship, with an increasing body of research investigating the mediating and moderating mechanisms driving this association. Within the existing mediation and moderation research, however, there have been contrasting findings and, at times, null results among some population groups. Objective: This protocol outlines a systematic review and meta-analysis aiming to synthesize and clarify mediators and moderators in the anxiety-alcohol and alcohol-anxiety relationships. Methods: Systematic searches will be conducted in the electronic databases Medline, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science to identify studies that investigated mediators and moderators of the relationship between anxiety and alcohol use, including clinical and subclinical levels. Studies that look at the relationship between anxiety and alcohol use outcomes, as well as alcohol use and anxiety outcomes, will be included in order to capture an in-depth understanding of the mechanisms driving the association in either direction. No limits will be placed on study year or study language. Included study designs will be observational studies, including cohort, cross-sectional, and longitudinal studies, and secondary analyses of randomized controlled trials reporting quantitative results. Selected studies will also have their reference lists hand-searched for other relevant papers. Study quality will be assessed with the Joanna Briggs Institute Checklists for Analytical Cross-Sectional Studies and Cohort Studies. Mediators and moderators will be narratively synthesized in line with the biopsychosocial framework, where results will be grouped into biological, psychological, and social or environmental factors. If the data are sufficiently homogeneous, a meta-analysis will be conducted with mediation and moderation analyses synthesized separately. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework will also be used to assess the strength of cumulative evidence. Results: Electronic database searches were conducted in September 2022. After duplicates were removed, a total of 7330 titles and abstracts were screened. Full-text reviewing is currently under way, with the results expected to be available by the end of 2023. Conclusions: Given the significant individual and societal impacts of co-occurring anxiety and alcohol use, this review will help clarify mechanisms linking these two concerns. Identified mechanisms, where possible, can then be targeted in prevention, early intervention, and treatment approaches to improve the outcomes for individuals experiencing co-occurring anxiety and alcohol use. Trial registration: PROSPERO CRD42023358402; https://tinyurl.com/2m2e3enp. International registered report identifier (irrid): DERR1-10.2196/48875.
... Despite plausible affective mechanisms supporting links between social anxiety and drinking, along with established correlations between clinical-level presentations, studies have produced varying findings regarding associations between social anxiety and alcohol consumption (for review, see Morris et al., 2005). Some studies find those lower in social anxiety tend to drink more when seeking relief (Tran et al., 1997), while others have found only mixed support for this idea (Booth & Hasking, 2009), and still others have reported positive relationships between high social anxiety, drinking quantity, and negative alcoholrelated consequences (Ham et al., 2016). ...
... Bresin & Mekawi, 2021;Cooper et al., 1995). Such results, however, raise questions when compared against equivocal findings regarding trait-level assessments of social anxiety and alcohol consumption (Morris et al., 2005). The present results may represent a step towards resolving this inconsistency by suggesting that Fig. 3. Graph depicting the relationship between eBrAC and social familiarity for both low and high social anxiety across both low and high levels of social familiarity "Low" and "high" social anxiety were defined as 1 SD below and 1 SD above the mean LSAS score, respectively. ...
Article
Research has identified social anxiety as a risk factor for the development of alcohol use disorder. However, studies have produced equivocal findings regarding the relationship between social anxiety and drinking behaviors in authentic drinking environments. This study examined how social-contextual features of real-world drinking contexts might influence the relationship between social anxiety and alcohol consumption in everyday settings. At an initial laboratory visit, heavy social drinkers (N = 48) completed the Liebowitz Social Anxiety Scale. Participants were then outfitted with a transdermal alcohol monitor individually-calibrated for each participant via laboratory alcohol-administration. Over the next seven days, participants wore this transdermal alcohol monitor and responded to random survey prompts (6x/day), during which they provided photographs of their surroundings. Participants then reported on their levels of social familiarity with individuals visible in photographs. Multilevel models indicated a significant interaction between social anxiety and social familiarity in predicting drinking, b = -0.004, p =.003 Specifically, among participants higher in social anxiety, drinking increased as social familiarity decreased b = -0.152, p <.001, whereas among those lower in social anxiety, this relationship was non-significant, b = 0.007, p =.867. Considered alongside prior research, findings suggest that the presence of strangers within a given environment may play a role in the drinking behavior of socially anxious individuals.
... Additionally, future research could explore the mechanisms explaining the association between hangover-related rumination and HED, such as drinking to cope with rumination, through mediational analyses. Further investigation could extend to clinical samples, especially socially anxious individuals-a group at high risk for rumination after social drinking events and for alcohol use disorder (Morris et al., 2005). ...
Article
Full-text available
Objective: We examined whether hangover-related rumination—repeatedly dwelling on negative aspects of yesterday’s drinking while hungover the following morning—predicts changes in three dimensions of heavy episodic drinking (HED) over time. Method: N = 334 emerging adults (aged 19–29) from three Eastern Canadian universities who had recently experienced a hangover completed online self-report questionnaires at baseline (Wave 1) and 30 days later (Wave 2; 71.6% retention). HED was assessed in frequency (number of HED episodes), perceptions (how participants perceived the extent of their heavy drinking), and quantity (greatest number of alcoholic drinks consumed in a single HED episode) over the past 2 weeks. Results: Levels of HED frequency, perceptions, and quantity declined overall from Waves 1 to 2. Exploratory factor analysis established two factors of hangover-related rumination: intrusiveness (unwanted thoughts about the previous night’s drinking) and regret (desire to change future drinking behavior). Structural equation models revealed that intrusiveness at Wave 1 predicted the maintenance of higher frequency and perceptions of HED at Wave 2, even as these HED measures were generally declining; regret at Wave 1 also predicted the maintenance of HED perceptions at Wave 2. Neither Wave 1 hangover rumination factor predicted changes in HED quantity at Wave 2. Models controlled Wave 1 variables, including the relevant HED outcome, overall hangover severity, total number of hangovers, generalized anxiety symptoms, sex, age, and data collection site. Conclusion: Hangover-related rumination factors are associated with the maintenance of higher HED frequency (intrusiveness factor) and HED perceptions (intrusiveness and regret factors), suggesting risk for problematic alcohol consumption.
... Prior research supports that Whites tend to consume 2-5 more drinks per month than other ethnic-racial groups in the US, with the highest consumption rates found in the Northeast and Western regions [24]. Elevated alcohol consumption may be linked to the higher prevalence of anxiety disorders and cardiac arrhythmias among Whites [25][26]. One study found that Whites are more than three times as likely to be diagnosed with anxiety and more than four times as likely to be diagnosed with posttraumatic stress disorder compared to Asians [27]. ...
... Various models on the theoretical basis for co-occurrence of SAD and AUD generally propose that, for people with SAD symptoms, the anxiolytic properties of alcohol negatively reinforce drinking (Morris et al., 2005). These models emphasizing the function of alcohol (reducing unpleasant social and emotional experiences) make sense given findings showing that the link between SAD and AUD symptoms is mediated by coping motives (i.e., drinking to cope with negative emotions; Ham et al., 2009). ...
... While alcohol is an acute anxiolytic, its long-term use can exacerbate anxiety [9], particularly during withdrawal. The type of alcohol wine, beer, or spirits may have varying effects on mental health due to differences in consumption patterns and social contexts [10]. Individuals with anxiety may use alcohol to self-medicate, potentially leading to increased consumption and dependency [11,12]. ...
Article
Full-text available
Background The relationship between alcohol consumption and mental health is complex; drinking may exacerbate anxiety, and in turn, anxiety can lead to excessive drinking. This study explores the relationship between alcohol consumption patterns including wine, beer, and spirits, and anxiety prevalence in selected 13 South American nations. Methods This study utilises secondary data spanning 29 years from 1991 to 2019 obtained from the Our World in Data database. It investigates the causal link between the prevalence of anxiety and alcohol consumption in the selected countries using the Granger causality test. Results Anxiety was found to have a unidirectional effect on wine and beer consumption in Chile, Suriname, Uruguay, and Trinidad and Tobago. Additionally, drinking alcohol consumption appears to impact anxiety levels in Brazil. Argentina demonstrates a bidirectional relationship between anxiety and all three types of alcohol consumption, with similar patterns observed in Brazil (wine and beer), Chile (spirits), and Paraguay (spirits). Conclusion No significant causal relationships for alcohol consumption patterns were found in other nations. The identified Granger causal links follow four distinct directions in this study. These findings provide valuable insights for policymakers, governments, and international investors for informed decision-making regarding regulation and policy tools.
... The meta-analysis revealed a moderate to strong negative association between the presence of psychiatric comorbidities and quality of life, with an overall effect size of -0.67. This finding reinforces the conclusions of previous studies that have documented a significant decline in life quality for individuals with both AUD and psychiatric conditions [28] . Specifically, the impact of depression and anxiety on quality of life was more pronounced than that of PTSD or bipolar disorder. ...
... Table 2.1 reproduced with permission from Stapinski et al. (2015) evidence suggesting important bidirectional connections between anxiety and AUD (Anker & Kushner, 2019;Smith & Randall, 2012;Stewart et al., 2016). Anxiety disorders are consistently associated with self-reported use of alcohol to self-medicate or cope with their anxiety (Cooper et al., 2014;Morris et al., 2005). For people with social anxiety, alcohol can be conceptualized as one of many "safety behaviors" (avoidance strategies) used in an attempt to prevent feared social outcomes (Piccirillo et al., 2016;Wong & Rapee, 2016). ...
Chapter
Social anxiety disorder (SAD) and alcohol use disorder (AUD) are prevalent disorders that often co-occur. SAD onset typically precedes that of AUD, and co-occurrence of the two disorders is associated with greater symptom severity than either condition alone. This chapter reviews current evidence about psychological treatment of co-occurring SAD and AUD. While people with co-occurring SAD-AUD can benefit from single-disorder cognitive behavioral therapy (CBT) approaches (either AUD-focused or SAD-focused), treatment efficacy and long-term outcomes are negatively impacted by the co-occurring disorders. Two alternate treatment models have been tested for co-occurring SAD-AUD: (i) dual-focused treatment, and (ii) integrated treatment. In one of two trials, dual-focused CBT for SAD and AUD resulted in worse outcomes, potentially due to the demands of engaging in two separate treatments. By contrast, integrated SAD-AUD treatment involves a synthesized therapeutic protocol (delivered by one therapist) to address SAD, AUD and the inter-connection between these disorders. To date, two trials have found that integrated CBT for co-occurring SAD-AUD improved outcomes compared to AUD-focused treatment. The remainder of the chapter provides a comprehensive overview of the therapeutic strategies and clinical application of integrated CBT for co-occurring SAD and AUD. A clinical vignette illustrates the treatment, common challenges, and provides example worksheets and therapeutic dialogue.
... One possible explanation for this could be that these individuals use alcohol to temporarily decrease discomfort during socialization and therefore are more likely to engage in social activity. 35 While this increased engagement in social activity may be modestly related to improvements in physical QOL, we do not expect that comorbid AUD is causally linked to long-term improvements in physical health for those with SAD. Contrary to our hypotheses, comorbid agoraphobia, specific phobia, panic disorder, and GAD were not associated with decreased physical QOL. ...
Article
Objective: Social anxiety disorder (SAD) is a prevalent and debilitating psychiatric disorder that is associated with impairments in functioning and detrimental outcomes such as suicide, poor physical quality of life (QOL), and overall mental health. The goal of the present study was to examine the past year comorbidities of DSM-5 SAD among a large nationally representative sample of US adults (N = 36,309) and to examine correlates of physical QOL and overall mental health among individuals with past-year SAD (N = 980). Methods: The study utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to examine diagnostic correlates of SAD as well as how symptoms and features of SAD are related to QOL using survey-weighted regression analyses. Results: We found that comorbid depression, anxiety disorders, posttraumatic stress disorder, and borderline personality disorder were positively associated with SAD. Further, presence of these disorders was also associated with poorer mental health among those with SAD. We also found that specific feared situations (eg, eating and drinking in public) and social anxiety symptoms (panic attack and avoidance) were linked to both forms of QOL (all ps <0.01). Conclusion: The present findings highlight that SAD is comorbid with other impairing disorders and that these comorbidities, specific feared situations, and SAD symptoms are related to worse QOL in individuals with SAD.
... Depending on the threshold of diagnosis, the prevalence of social anxiety in college students range from 10 to 33.4 % (Melkam et al., 2023;Meng et al., 2021;Reta et al., 2020;Russell and Shaw, 2009). Several studies have found that individuals with SAD are at increased risk of developing secondary mental health difficulties, such as depressive symptoms (Beesdo et al., 2007;Hamilton et al., 2016), alcohol dependence (Black et al., 2015;Morris et al., 2005), substance abuse (Buckner et al., 2008), and suicidal ideation (Buckner et al., 2017). ...
... Social anxiety disorder, or social phobia, is one of the most frequent mental disorders in the world, after depression and alcohol abuse (Davidson, Hughes, George, & Blazer, 1993Kessler, et al., 1994;Kessler, Stang, Wittchen, Stein, & Walters, 1999;Lecrubier, Wittchen, Faravelli, Bobes, Patel, & Knapp, 2000;Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996;Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992;Stein, Walker, & Forde, 1994;Weinstock, 1999), with which, in turn, it has high comorbidity (Chartier, Walker, & Stein, 2003;Erwin, Heimberg, Juster, & Mindlin, 2002;Fehm, Beesdo, Jacobi, & Fiedler, 2008;Fogler, 2005;Ham, & Hope, 2005;Lampe, Slade, Issakidis, & Andrews, 2003;Merikangas, & Angst, 1995;Morris, Stewart, & Ham, 2005;Swinson, 2005;Weinstock, 1999;Yonkers, Dyck, & Keller, 2001). Social phobia is highly comorbid with other anxiety disorders (e.g., panic disorder, agoraphobia, specific phobia) or other mental disorders. ...
... However, most studies found no positive association between social anxiety and frequency of participation in games (George et al., 2019;Mulligan et al., 2016) with some even finding a negative association (Ham et al., 2010). These results can be interpreted considering the global lower participation of socially anxious individuals in socializing events (Burke & Stephens, 1999;Morris et al., 2005;Myers et al., 2003). ...
Article
This systematic review explores the prevalence and impact of Drinking Games (DG) among college students. DGs involve social drinking with the goal of heavy alcohol consumption and are associated with risky behaviours. The review aims to quantify the relationship between DG participation, alcohol consumption, and negative outcomes. It also investigates gender moderation and unexplored motivational factors for DG engagement. Following PRISMA guidelines, 34 studies were included after screening 317 records. The studies comprised n = 34,197 participants and were analysed for various variables, including gender dynamics, motivations, and associated negative consequences. Gender convergence in DG participation was noted, emphasizing the importance of gender-specific interventions. Participants were aware of risks but often perceived negative outcomes as a badge of honour. Motivations for DGs were linked to social interaction and a sense of belonging. Personality traits like sensation seeking and identification with college drinking culture played significant roles in DG engagement and outcomes. The review underscores the need for targeted interventions to address shifting perceptions of negative consequences and consider personality traits when designing preventive measures. It also highlights the significance of gender-specific strategies. However, variations in DG measurement and possible selection bias among heavy drinkers participating in DGs remain limitations. This systematic review provides insights into DG prevalence and its link to negative outcomes among college students. The findings stress the importance of tailored interventions and further research to mitigate risk factors and promote healthier drinking behaviours in this demographic.
... Negative reinforcement, a similar construct, is also active during earlier alcohol use patterns, whereby patient behavior can be shaped by the escape or avoidance of an aversive stimulus (40). For example, a person with social anxiety may discover that the unpleasant worry in their social situations is reduced by alcohol (41), thus leading to future alcohol use in that setting. As use increases, reward thresholds increase (decreasing reward) when alcohol is withdrawn (42). ...
Article
Alcohol use disorder (AUD) remains a significant public health concern, affecting around 5% of adults worldwide. Novel pathways of damage have been described during the last years, providing insight into the mechanism of injury due to alcohol misuse beyond the direct effect of ethanol byproducts on the liver parenchyma and neurobehavioral mechanisms. Thus, the gut-liver-brain axis and immune system involvement could be therapeutic targets for AUD. In particular, a change in gut microbiota composition and function, especially bile acid homeostasis, and these changes can improve after alcohol cessation. Alcohol can also directly disrupt intestinal and blood-brain barriers. Activation of the immune system can be triggered by intestinal barrier dysfunction and translocation of bacteria, pathogen-associated molecular patterns (such as lipopolysaccharide), cytokines, and damage-associated molecular patterns. These factors in turn promote liver and brain inflammation and progression of liver fibrosis. Other involved mechanisms include oxidative stress, apoptosis, autophagy, and the release of extracellular vesicles and miRNA from hepatocytes. Potential therapeutic targets include gut microbiota (probiotics and fecal microbiota transplantation), neuroinflammatory pathways, as well as neuroendocrine pathways, e.g.: the ghrelin system (ghrelin receptor blockade), incretin mimetics (GLP-1 analogs), and the mineralocorticoid receptor system (spironolactone). In addition, support with psychological and behavioral treatments is essential to address the multiple dimensions of AUD. In the future, a personalized approach considering these novel targets can contribute to significantly decreasing the alcohol-related burden of disease.
... Consequently, a lack of trust in the persons present hinders social interactions. An influence of alcohol consumption on perceived trustworthiness is suggested by the fact that social anxiety is both associated with an increased prevalence of alcohol use disorder (AUD) and negatively associated with trust and perceived trustworthiness regarding presented faces [9][10][11][12][13]. Consequently, it is assumed that socially anxious individuals consume alcohol, partly because this increases their trust in interaction partners and, as a result, facilitates social interaction. ...
Article
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Background Alcohol consumption to facilitate social interaction is an important drinking motive. Here, we tested whether alcohol influences trust in others via modulation of oxytocin and/or androgens. We also aimed at confirming previously shown alcohol effects on positive affect and risk-taking, because of their role in facilitating social interaction. Methods This randomized, controlled, within-subject, parallel group, alcohol-challenge experiment investigated the effects of alcohol (versus water, both mixed with orange juice) on perceived trustworthiness via salivary oxytocin (primary and secondary endpoint) as well as testosterone, dihydrotestosterone, positive affect, and risk-taking (additional endpoints). We compared 56 male participants in the alcohol condition (1.07 ± 0.18 per mille blood alcohol concentration) with 20 in the control condition. Results The group (alcohol versus control condition) × time (before [versus during] versus after drinking) interactions were not significantly associated with perceived trustworthiness (η ² < 0.001) or oxytocin (η ² = 0.003). Bayes factors provided also substantial evidence for the absence of these effects (BF 01 = 3.65; BF 01 = 7.53). The group × time interactions were related to dihydrotestosterone (η ² = 0.018 with an increase in the control condition) as well as positive affect and risk-taking (η ² = 0.027 and 0.007 with increases in the alcohol condition), but not significantly to testosterone. Discussion The results do not verify alcohol effects on perceived trustworthiness or oxytocin in male individuals. However, they indicate that alcohol (versus control) might inhibit an increase in dihydrotestosterone and confirm that alcohol amplifies positive affect and risk-taking. This provides novel mechanistic insight into social facilitation as an alcohol-drinking motive.
... At the same time, if people were to drink-to-cope only when their experience of negative affect is maximal, these infrequent instances might not be captured by daily observational studies, but rare yet highly salient events may be enough to shape people's perceptions of their drinking behaviors. For example, epidemiological studies consistently indicate comorbidity between social anxiety disorders and AUDs (Morris et al., 2005), which might indicate that people use alcohol as a coping strategy in highly distressing moments. ...
Article
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Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.
... So far, many studies proved clear tendencies to abusing alcohol in a group of patients with depression or anxiety disorder, which are much than in a control group. [3,5,34] According to the National Co-morbidity Study, lifetime prevalence rates of AUD among patients with social anxiety disorder were 24% compared to a group without anxiety disorder where it rated 14,19% [35]. It means, that alcohol abuse is a consequence of anxiety disorder. ...
Article
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Introduction Over past decades the number of patients suffering from psychiatric disorders all around the world is constantly increasing. Thank to general awareness and less stigmatization people seek for specialist’s help more willingly. Recently, one of the most common diagnoses has been anxiety disorder and many of them also tend to abuse alcohol. So far, scientists have focused mostly on alcoholism as a consequence of anxiety disorder, due to patients’ predilection to addictions. However, ethanol can also trigger anxiety itself. Aim of the study The aim of this study is to summarize the current state of knowledge on the role of alcohol in anxiety disorder development and its pathomechanisms. Material and methods This article is based on available publications in Pubmed and Google Scholar databases. Conclusions Excessive alcohol consumption may lead to the development of anxiety disorder in some patients, as well as, many other psychiatric disturbances. However, further research must be done to find out precise pathomechanism responsible for those states.
... Social anxiety enhances the risk of developing AUD and reduces the use of protective behavioural strategies [177]. Virtually all psychiatric disorders that manifest in adulthood are associated with enhanced risk of AUD, such as depression [178], bipolar disorders [179], anxiety disorders [180], PTSD [181], schizophrenia [182], BPD [183] and ADHD [184]. There is also high comorbidity between chronic pain, alcohol abuse and AUD [185]. ...
Article
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Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.
... First, content validity was established by reviewing the published literature to derive appropriate item content to ensure adequate and representative coverage of the construct (Crano et al., 2015). Specifically, the items were derived by inspecting the relief-based items of previously validated alcohol measures (see Table 1) and reading systematic reviews about the relief effects of alcohol use (Åkerlind & Hörnquist, 1992;Baum-Baicker, 1985;Carrigan & Randall, 2003;Grant et al., 2009;Greeley & Oei, 1999;Morris et al., 2005;Roehrs & Roth, 2001;Sayette, 2017;Zale et al., 2015). Second, the items aimed to capture the utilitarian relief effects desired by alcohol users. ...
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Several major alcohol theoretical frameworks postulate that people consume alcohol to attain relief from negative states. These relief experiences are consistent with the classification of alcohol as a central nervous system depressant and may reinforce drinking behaviors that sustain the addiction cycle. The present research developed and validated a multidimensional questionnaire to assess the relief effects and experiences attributed to alcohol consumption in adult drinkers. In Study 1 (N = 380), an initial set of questionnaire items representing an array of alcohol relief effects was administered, and exploratory factor analysis (EFA) was performed. A correlated four-factor structure consisting of psychological relief, interpersonal relief, sleep relief, and physical relief was exhibited. In Study 2 (N = 531), confirmatory factor analysis cross-validated the four-factor structure. In tests of convergent, discriminant, and criterion-related validities, the four alcohol relief subscales evidenced differential correlations with subscales of alcohol expectancies and alcohol affect and correlated with higher drink frequency, drink quantity, and alcohol problems. Furthermore, the overall alcohol relief scale incrementally explained alcohol use and problems beyond positive and negative alcohol expectancies and alcohol affect. The Alcohol Relief Questionnaire (ARQ) advances the conceptualization of relief as a multidimensional construct stemming from self-medication with alcohol. The measure and its subscales may be used to inform etiology, prevention, and treatment of alcohol use and misuse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... Our finding that higher social tension reduction motives were related to fewer negative consequences for those high in social anxiety is harder to explain. Much prior work demonstrates that social anxiety is positively related to alcohol use and related consequences (e.g., Black et al., 2015;Morris et al., 2005;Schry & White, 2013;Villarosa-Hurlocker & Madson, 2020). Some studies have also shown that the associations between social anxiety and alcohol outcomes are partially explained by one's drinking motives, but prior research has focused on the four-factor structure of the DMQ-R and on coping motives in particular (Ham et al., 2007;Schry & White, 2013). ...
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This study reexamined the factor structure of drinking motives using 205 unique items from 18 drinking motives scales with the inclusion of social tension reduction motives, which have been largely neglected in the literature. A new scale was created and compared with the Drinking Motives Questionnaire-Revised (DMQ-R) to predict alcohol use/problems. Young adults (N = 1,049) completed questionnaires assessing drinking motives and alcohol use/problems. A subset (N = 368) of participants completed a 6-month follow-up. Hierarchical factor analyses informed the creation of a four-factor (i.e., coping, social, enhancement, and social tension reduction) scale (i.e., the Young Adult Alcohol Motives Scale [YAAMS]). In general, the YAAMS performed similarly to the DMQ-R in predicting concurrent and prospective alcohol consumption (i.e., typical drinking quantity and frequency) and alcohol problems (i.e., Alcohol Use Disorder Identification Test [AUDIT] and Brief Young Adult Alcohol Consequences Questionnaire [B-YAACQ] scores), but there were some notable differences, including that the novel social tension reduction scale of the YAAMS was particularly relevant in predicting drinking frequency in those with social anxiety. Results suggest that drinking motives can be described by multiple factor structures and predict alcohol-related outcomes.
... However, some research investigating coping motives among older adolescents and undergraduates has yielded discrepant findings, whereby coping motives were not found to predict higher alcohol consumption and related problems (Bradizza et al., 1999;Perkins, 1999;Read et al., 2003). To account for these inconsistent findings and combined with evidence that depression and anxiety may be differentially associated with certain patterns of alcohol use (Graham et al., 2007;Morris et al., 2005), a five-factor motives model has been proposed differentiating between drinking to cope with anxiety and drinking to cope with depression. Using this modified model, Grant et al. (2007) found that coping-depression motives were associated with drinking quantity, while coping-anxiety motives were directly related to alcohol-related problems among undergraduates. ...
Article
Evidence demonstrates an association between symptoms of attention-deficit/hyperactivity disorder (ADHD) and alcohol outcomes, though mechanisms underlying relations are unclear. Given that drinking motives (coping-anxiety, coping-depression, enhancement, social, and conformity) appear to serve as a mediator through which other factors influence drinking behavior, the current multi-site study examined the relation between ADHD symptoms and alcohol outcomes through motives. Past-month drinkers completed online measures assessing ADHD symptoms, alcohol use and problems, and drinking motives. A multiple-mediator model found inattention symptoms were: 1) positively associated with coping-depression, which positively related to alcohol use, which positively related to alcohol problems; 2) positively associated with enhancement motives, which positively related to use, which positively related to problems; and 3) positively associated with coping-anxiety, which negatively related to use, which positively related to problems. No indirect relations via motives were found for hyperactive-impulsive symptoms. Findings highlight unique associations depending on ADHD symptoms and specific drinking motives.
... Findings within the category of social rejection and acceptance exhibited mixed findings, with social anxiety and gay rejection sensitivity emerging as the most common predictors within this category. Studies of social anxiety demonstrated significant positive associations with alcohol consumption in both experimental and observational work, which is consistent with past reviews (Morris et al. 2005;Oliveira et al. 2018). Interestingly, studies regarding gay rejection sensitivity suggested it may not function as a direct predictor of alcohol consumption, but rather it may amplify the effects of stigma. ...
Article
Social connection consists of both the presence of and perceived closeness in social relationships. Perceptions of connection are thought to be particularly important in the development and treatment of excessive alcohol use. However, no review has delineated existing work regarding the prospective associations between perceived social connection and alcohol use and related problems. Therefore, the current study synthesized and qualitatively organized this area of research in order to inform theoretical models, clinical care, and future research. A Boolean search resulted in 2,356 articles and 70 met inclusion criteria, which consisted of a repeated measures design and the presence of a perceived social connection predictor variable and alcohol-related outcome variable. Study design features, methods of measurement, and main effects were extracted from included articles. Most studies used an observational design with an average follow-up period of 1.5 years. Variables related to perceived social connection were organized into four categories: perceived support, emotional intimacy, social rejection and acceptance, and social behaviors. Perceived support and intimacy were the most common predictor variables. Results suggested that perceptions of support, acceptance, and intimacy in close relationships may be salient vulnerability factors and/or intervention targets for excessive alcohol use and related difficulties. The findings also revealed gaps in the literature with regards to sample diversity and study design that warrant attention in future empirical work.
... Anxiety Morris et al. (2005) clearly confirmed the comorbidity between anxiety disorder and alcohol use disorders and pointed to inconsistencies in demonstrating causality or even directionality of the relationship. As a possible explanation of the direction, they mentioned the specific characteristics of the patient (gender, tendency to drink, and others), which can be used to improve treatment processes. ...
Chapter
Alcohol is an easily available legal substance that has the most significant negative consequences of all substances due to its frequent occurrence in society, as well as due to social acceptance. It is well-known that alcohol use reduces cognition and is harmful to mental health. This underlines the importance of addressing the link between mental discomfort and alcohol use. Depression and stress often go hand in hand with increased alcohol use. It is possible to talk about alcohol abuse as a consequence of stressful life situations and depressive symptoms. On the other hand, drinking alcohol can lead to stressful situations in the lives of individuals and mental disorders such as depression. Stress may be a critical driver of comorbidity between mental disorders and alcohol use disorder. Educating society about the negatives and risks of alcohol plays an important role in achieving mental health objectives.
... At the same time, if people were to drink-to-cope only when their experience of negative affect is maximal, these infrequent instances might not be captured by daily observational studies, but rare yet highly salient events may be enough to shape people's perceptions of their drinking behaviors. For example, epidemiological studies consistently indicate co-morbidity between social anxiety disorders and alcohol use disorders (Morris et al., 2005), which might indicate that people use alcohol as a coping strategy in highly distressing moments. ...
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Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people do not drink more often on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance were estimated to consume more alcohol, but not to consume more alcohol on days they experience higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. Based on our findings, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.
... In another study by Vielva & Iraurgi [45] it was found that participants who had high confidence to resist drinking were more likely to keep abstinent for six months. Also, findings from Merikangas, et al., [46] and Morris, et al. [47] have suggested that alcohol use disorder and social anxiety do not merely coexist but interact. The interaction could mean treatment of a single disorder in the comorbidity is likely to impair the success of that treatment. ...
... SOCIAL ANXIETY is associated with alcohol-related problems (Morris et al., 2005). People with social anxiety disorder (SAD) are two to three times more likely to develop an alcohol use disorder (AUD) than the general population (Kushner et al., 2000). ...
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People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences—namely positive social experiences—that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.
... For example, studies show that hazardous alcohol use and regular cannabis use are associated with poorer recovery among psychiatric patients (Bahorik et al., 2016;Bahorik et al., 2017;Bricker et al., 2007). Substance use can interact negatively with psychopharmacological treatment (Worthington et al., 1996) and may directly interfere with psychological treatment, for instance when alcohol is used as a safety behavior among people with social anxiety disorder (Morris et al., 2005) or when cannabis is used for emotion regulation of posttraumatic stress (Bonn-Miller et al., 2011). Importantly, suicidal ideation and suicide are particularly common among patients with combined substance use problems and psychiatric problems (Davis et al., 2008;Yuodelis-Flores and Ries, 2015). ...
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Background Research shows that alcohol and drug use among mental health clients is common and has the potential to negatively impact treatment outcomes. Internet-delivered cognitive behavior therapy (ICBT) as a treatment for anxiety and depression is on the rise, but little is known about the prevalence of alcohol and drug use among clients and how this use affects treatment completion and outcomes. Objective The objective of the current study was to explore the prevalence of alcohol and drug use among clients in ICBT for depression and anxiety, and to investigate the impact of alcohol and drug use on treatment completion and symptom outcomes. Material and methods Data was collected from 1155 clients who participated in two randomized ICBT trials for depression and anxiety, conducted in a routine care clinic. Thirty-five individuals reporting severe substance use when applying to the trials were excluded. Demographic variables, and alcohol and drug use were measured at screening, and measures of depression and anxiety were administered at pre- and post-treatment. Results Four out of five clients reported having used alcohol in the past year, while one in five reported having used drugs in the past year. Around a third of clients had reported either problematic alcohol use, drug problems, or both. The analyses showed that drug problems, and combined alcohol and drug problems were negatively associated with treatment completion, but neither alcohol nor drug use had an impact on depression and anxiety outcomes. Conclusions Alcohol and drug problems are likely to be present among a large proportion of patients using ICBT for anxiety and depression. This may not be a barrier to treatment benefit, at least when those with severe alcohol and drug problems have been excluded.
... Social anxiety disorder (SAD) is a prevalent and disabling disorder characterized by intense fear of being scrutinized or negatively evaluated by others in social situations (American Psychiatric Association [APA], 2013). SAD is the fourth most commonly diagnosed psychological disorder in the United States (Kessler et al., 2005) with onset typically occurring in adolescence and assuming a chronic course even following treatment (Morris et al., 2005). SAD has significant public health costs including increased workplace absenteeism, lower worker productivity, and unemployment (APA, 2013;Stuhldreher et al., 2014). ...
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Objective Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder. Design This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes. Results We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors. Conclusion We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.
... Average number of hours of play may not be a strong indicator of problematic play, rather time of day (e.g., daytime play rather than being at work or school) may be considered a better outcome variable (Triberti et al., 2018). Finally, the AS personality predicted decreased average weekly hours of video game play, which is consistent with the substance use literature, which has identified a negative association between the AS personality and substance consumption (Morris et al., 2005). ...
Article
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The Substance Use Risk Profile Scale (SURPS) identifies four personality dimensions related to reinforcement-specific patterns of substance use. Gaming literature has identified similar personalities and game-related reinforcement properties as core risk factors of problematic play. Given similarities, we investigated whether the SURPS model could be confirmed in a recreational video game playing population as a predictive model of problematic gaming. We recruited participants through gaming forums and Amazon Mechanical Turk to complete an online survey that focused on the SURPS and indicators of problematic gaming. Confirmatory factor analysis indicated that the SURPS is a valid instrument measuring four distinct personality dimensions with minor modifications. Regression analyses did not confirm all four at-risk personality dimensions as predictors of problematic play. The Impulsive personality was a significant predictor of lifetime frequency and problematic gaming, whereas the Hopelessness personality was a significant predictor of time spent playing. Future studies will need to assess this model using outcome variables grouped based on reinforcement-related gaming taxonomy.
... The use of alcohol when faced with such situations may become negatively reinforcing: encouraging individuals with social anxiety disorder to turn to the substance whenever they experience anxiety symptoms. The tendency to use alcohol as a coping mechanism for social anxiety, however, can come with a hefty price tag: a number of large scale studies have reported a high rate of comorbidity between social anxiety disorder and alcohol use disorder (Morris, Stewart, & Ham, 2005). ...
... Several models explain this strong relationship and typical order of onset, including the (a) tension reduction (Conger 1956), (b) stress response dampening (Sher and Levenson 1982), and (c) self-medication (Khantzian 1997) models. These models all propose that alcohol serves as a mechanism by which those with social anxiety can acutely reduce their feelings of anxiety, ultimately placing them at risk for excessive drinking and AUD development (Morris et al. 2005). The self-medication model (Khantzian 1997) differs from the other two models in that it does not focus specifically on alcohol's anxiolytic effects, but rather on both alcohol's anxiety-and depression-reduction effects (Collins et al. 2018). ...
Article
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Research suggests drinking motives and drinking context mediate the relation between social anxiety and alcohol problems. Study 1 examined coping with anxiety motives (CAM) and coping with depression motives (CDM) as distinct mediators in a self-report cross-sectional study of 263 undergraduate drinkers. CDM mediated the relation between social avoidance and alcohol problems (indirect effect = 0.07). Study 2 included drinking contexts and motives as mediators in a single model and included an additional coping with social anxiety drinking motive (CSAM) mediator in a self-report cross-sectional study of 189 undergraduate drinkers. Undergraduates with high levels of social avoidance drank for both CDM and CSAM, which in turn predicted heavy drinking in risky contexts (indirect effects = 0.09–0.16); however, drinking motives, rather than risky contexts, largely mediated the relation of social avoidance to alcohol problems (indirect effects = 0.08–0.14). Taken together, these results suggest that CDM and CSAM independently mediate the relationship between social avoidance and alcohol problems and might serve as useful intervention targets.
... Consuming alcohol to cope with aversive emotional states may prevent successful coping strategies, which may lead to further adverse consequences. If social situations and anxious feelings repeatedly precede alcohol use and the rewarding effects of anxiety reduction, these situations and outcomes may become conditioned stimuli to signal the drinking response before encountering a social situation or when feelings of anxiety arise (Morris, Stewart, & Ham, 2005). ...
Article
Comorbid social anxiety and alcohol use disorders (SAD-AUD) in the community and the complex interactions that occur between these disorders have emerged as a significant clinical, public health, and research issue. The authors examined (a) the rates of comorbid SAD-AUD, (b) the impact of comorbid SAD-AUD on outcomes targeting social anxiety disorder, and (c) the effect of pretreatment alcohol consumption and alcohol use before, during, and after social situations on a composite measure of social anxiety in 172 adults presenting with social anxiety disorder. There was low incidence of AUD in this sample of individuals with SAD. Results indicated that alcohol consumption did not lead to worse social anxiety symptoms; however, alcohol use before and during social situations was associated with more severe social anxiety symptoms. These findings suggest that the function of alcohol use may be more important than the overall level of alcohol use and has implications for treatment.
... due to the higher percentage of NMI having experienced >10 alcohol intoxications (Table 1), compared to the other SP subgroups. Among adults with SAD, alcohol is often used to reduce social anxiety symptoms (Carrigan and Randall, 2003), and alcohol use disorders typically co-occurs with SAD (Morris et al., 2005). Also among adolescents, an association between self-reported social anxiety symptoms and coping motives for drinking alcohol has been reported (Blumenthal et al., 2010). ...
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Social anxiety is highly prevalent in adolescents and is often associated with great individual suffering and functional impairment. Psychiatric comorbidity is common and further adds to this burden. The purposes of this study were: (1) to describe the occurrence of diagnosed and self-reported social anxiety among 8,199 Norwegian adolescents aged 13–19 years who participated in the population-based Young-HUNT3 study (2006–2008); (2) to examine associations between sociodemographic characteristics and different subgroups of social anxiety; and (3) to describe the psychiatric health comorbidities among adolescents diagnosed with social anxiety disorder (SAD). In total, 388 (5.9%) of the adolescents screened positive for SAD and were invited into a diagnostic interview, performed by professional nurses, using Anxiety Disorders Interview Schedule for DSM IV: child version (ADIS-C) (response rate = 54.6%). A SAD diagnosis was indicated in 106 individuals (50% of the interview subjects), and more than two-thirds of the adolescents diagnosed with SAD had one or more comorbid psychiatric disorders. Higher mean scores of self-reported social anxiety symptoms, poor self-rated health, sleep problems, poor family economic situation, low physical activity, and having sought professional help within the last year were associated with higher odds of being in the screening positive subgroup. Screening positive subjects who did not meet for a diagnostic interview did not differ notably from the rest of the screening positive group in terms of these sociodemographic characteristics. Based on our results and the fact that individuals with social anxiety often fear interview situations, the use of ADIS-C, screening questions and self-reports seem to be sufficient when aiming to identify epidemiologically representative cohorts of adolescents at risk of social anxiety.
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The current study aims to explore Substance use, Depression, Social Anxiety and Academic Achievement among University Students. The observation of substance use, Depression, Social Anxiety and educational Achievement is so essential in this cutting-edge era. The sample for the present study of 225 (95 male and 130 female) changed into decided on from exceptional universities the purposive sampling technique. A correlational research design and convenient sampling technique were to measure study variables. Adult, Academic Performance Rating Scale, depression and social anxiety scale used where to check substance use, and Drug Use Questionnaire (DAST 28) were applied. The observed findings suggest that a large tremendous courting among materials makes use of, melancholy, social tension among university students. Multiple linear regression and t-tests on sample analyses for inferential facts were additionally done to check the hypotheses. The findings confirmed a large sample uses drugs and faces mental health issues but a value of (-1.01) shows a small distinction between male and female substance use. Similarly, the t-value of-1.04 suggests a small distinction between male and female depression levels. The p-value of 0.298 showed that this distinction isn't statistically large. No distinction was found in depression ranges among male and female university students. The t-value of-1.43 represents a distinctly small distinction in social anxiety rankings among male and female students. The consequences suggest largely terrible courting among substance use and educational achievement among university students. Results additionally suggest depression and social anxiety are terribly correlated with academic achievements. Findings found that there are no large variations between male and female university students in phrases of substance use, depression, social anxiety and educational performance amongst university students. The consequences found that substance use of are slight tremendous large predictor of depression among university students. The study focuses on the significance of addressing substance use, melancholy, and social anxiety among students to enhance their academic overall performance and well-being.
Article
Background: There is a lack of consensus among researchers on the association between shyness and substance use. This may be due to unexamined modifiers of this association, such as childhood victimization. Objective: The purpose of this study was to examine if experiencing different types of victimization (emotional, physical, sexual, and poly-victimization) modifies the association between shyness and substance use outcomes in adults. In this study, we performed moderation analyses to investigate whether victimization moderates the association between shyness and substance use/abuse. Data came from the National Comorbidity Survey Baseline (NCS-1; 1990-1992) and the Collaborative Psychiatric Epidemiological Surveys (CPES; 2001-2003). Substance use outcomes included were binge drinking, tobacco use, other drug use, and DSM-III-R (NCS-1)/DSM-IV (CPES) classifications of alcohol and drug abuse. Results: Results from NCS-1 supported a moderating role of childhood victimization on the relationship between shyness and tobacco use only, specifically for emotional (p = .031) and physical (p < .001) victimization, and poly-victimization (p < .001). Results from CPES showed a moderating role of lifetime sexual abuse for binge drinking (p = .017), other drug use (p = .028), and alcohol abuse (p = .004). For both datasets, the associations between shyness and substance use outcomes were stronger when there were no victimization histories. Conclusion: These findings give insight on the complexity of the interaction between shyness and victimization. Future research could focus on mechanisms, such as cognitive processes, that may contribute to interactions between shyness and victimization history on substance outcomes.
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Background Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition that heavily impacts social functioning and quality of life. Though efficacious treatments exist for SAD, remission rates remain elevated and a significant portion of those affected do not access effective treatment, suggesting the need for additional evidence-based treatment options. This paper presents a protocol for an open-label pilot study of MDMA-assisted therapy (MDMA-AT) for social anxiety disorder. The study aims to assess preliminary treatment outcomes, feasibility and safety, and psychological and physiological processes of change in the treatment of SAD with MDMA-AT. A secondary aim includes the development of a treatment manual for MDMA-AT for SAD. Method The outlined protocol is a randomized, open-label delayed treatment study. We will recruit 20 participants who meet criteria with moderate-to-severe social anxiety disorder (SAD) of the generalized subtype. Participants will be randomly assigned to an immediate treatment (n = 10) or delayed treatment condition (n = 10). Those in the immediate treatment condition will proceed immediately to active MDMA-AT consisting of three preparation sessions, two medicine sessions in which they receive oral doses of MDMA, and six integration sessions over approximately a 16-week period. The delayed treatment condition will receive the same intervention after a 16-week delay. Our primary outcome is SAD symptom reduction as measured by the Liebowitz Social Anxiety Scale administered by blinded raters at post-treatment and 6 month follow up. Secondary outcomes include changes in functional impairment, feasibility and safety measures, and novel therapeutic processes of change including shame and shame-related coping, belongingness, self-concealment, and self-compassion at post-treatment. Exploratory outcomes are also discussed. Discussion The results of this pilot trial advance the field’s understanding of the acceptability and potential effectiveness of MDMA-AT for social anxiety disorder and provide an overview of relevant therapeutic mechanisms unique to SAD. We hope findings from this protocol will inform the design of subsequent larger-scale randomized controlled trials (RCT) examining the efficacy of MDMA-AT for SAD. Clinical trial registration https://clinicaltrials.gov/, NCT05138068.
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Objectives: The aim of this study was to investigate the prevalence of hazardous drinking (HD) and its association with sociodemographic factors, smoking, social anxiety, self-esteem, and ego-resiliency in medical students. Methods: A total of 408 medical students were included in this study. Data were collected by self-administered questionnaire , and HD was assessed by Alcohol Use Disorder Identification Test (AUDIT). The HD and non-HD group were defined using the AUDIT score 10 for male and 6 for female as a cutoff , respectively. Multiple logistic regression analyses were carried out to examine the impact of sociodemographic factors, smoking, social anxiety, self-esteem, and ego-resiliency on HD. Results: A total of 192 participants (47.1%) were identified as having HD. Frequency of smoking and the severity of social anxiety were significantly higher in HD group than non-HD group. Meanwhile, the levels of self-esteem and ego-resiliency were significantly lower than HD group than non-HD group. In multiple logistic regression, smoking was associated with a higher risk of HD, whereas ego-resiliency and age were associated with a lower risk of HD. Compared to the high level of subjective socioeconomic status, both middle and low level were associated with a lower risk of HD. Conclusions: HD among medical students was quite common and associated with smoking, ego-resiliency, age, and level of subjective socioeconomic status. Strong efforts to improve smoking cessation and ego-resiliency, as well as education for HD in medical schools, is needed to reduce the harmful effects of alcohol.
Chapter
Physiological height vertigo is a visually induced destabilization of stance and locomotion accompanied by individually various amounts of strong anxiety and vegetative symptoms at the sight of towers, ladders, buildings, a cliff, or a mountain ridge. In Anglo-American countries, the term “height vertigo” is unusual; instead “fear of heights” or “acrophobia” is used, which in psychiatric nomenclature are classified as a variant of specific phobias in accordance with the criteria of the “Diagnostic and Statistical Manual of Mental Disorders” (American Psychiatric Association 2013). These language-specific terms require a clear definition for medical and scientific use with respect to the susceptibility and the severity of the condition.
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Background: Social Anxiety Disorder (SAD) is associated with pervasive functional impairments and chronicity. Romantic relationship functioning and quality for individuals with SAD has been previously explored but existing studies have not been synthesised. Aims: This scoping review charted existing literature regarding the quality and functioning of romantic relationships for people with SAD and high sub-clinical social anxiety (SA). Methods: The review used a scoping approach to explore the current evidence base relating to SA, romantic relationship quality and functioning. Articles published in English after 1980 that reported either clinical or high sub-clinical SA were eligible. Double screening, data extraction, quality assessment, and thematic analysis of studies was conducted. Results: 50 studies from 46 articles were identified, involving a range of community, college, adolescent, and clinical samples. Thematic analysis identified four themes; Relationship Quality, Satisfaction and Commitment; Communication and Self-Disclosure; Conflict, Social Support and Trust; Intimacy, Closeness and Sexual Satisfaction. Conclusions: The review highlights that evidence relating to romantic relationship functioning for individuals with SAD and high sub-clinical SA is heterogeneous, with relationship initiation in particular relatively under-explored. Further research is required to elucidate key constructs and interpersonal processes related to relationship functioning, and to inform treatment approaches with this group.
Chapter
Die meisten Schwindelformen und vestibulären Syndrome des Erwachsenen können sich ebenso in der Kindheit manifestieren, weshalb wir in diesem Kapitel die spezifischen Punkte der richtungsgebenden Anamnese, Befunde, Verläufe und der Therapie beim Kind hervorheben. Die Beschreibung der Beschwerden ist bei Kindern jedoch – je nach Alter – weniger präzise als bei Erwachsenen. Auch hängen die Untersuchungsbefunde der Gleichgewichtsfunktion und Okulomotorik bei Kindern (Devaraja 2018) stärker von der konzentrierten Mitarbeit ab.
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Using ecological momentary assessment (EMA), we assessed momentary patterns of alcohol and cannabis co-use in college students and whether state-level and baseline reports of anxiety varied based on type of substance(s) consumed. Students (N=109) reporting regular cannabis use completed a baseline assessment and two-week signal-contingent EMA, with three random prompts/day. At each EMA instance, we categorized instances of substance "usage" as: 1) no use, 2) cannabis-only, 3) alcohol-only, or 4) co-use of alcohol and cannabis (i.e., reports of alcohol and cannabis use within the same prompt). Using temporal sequenced data, we explored how state-level anxiety varied before and after usage type using multiple multilevel structural equation models (MSEMs) and whether baseline factors (general anxiety, social anxiety, and sex) influenced the relation between usage type and state-level anxiety. Participants were 63.3% White, 58.7% female, used cannabis near-daily, and commonly reported co-use. Models examining whether usage type predicted subsequent state-level anxiety were predominantly significant, with the majority of relationships being more pronounced for participants with higher baseline general anxiety. In examining whether momentary state-level anxiety predicted usage type, in instances when participants reported higher levels of momentary anxiety, they were more likely to report no use compared to co-use and cannabis-only, with sex moderating some of the relationships. Social anxiety did not moderate any of the within-person associations between state-level anxiety and usage type. This study provides preliminary evidence that report of momentary anxiety varies based on substance type. Future research is needed to establish co-use related synergistic effects and correlates.
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Objectives Social anxiety disorder (SAD) and alcohol use disorder (AUD) are highly comorbid and this comorbidity is associated with poorer clinical outcomes. Integrating exposure-based treatment for SAD into the context of typical AUD treatment programs should improve engagement and treatment outcomes for this population. Methods After initial development of a fully integrated, intensive outpatient program (IOP) for individuals with comorbid SAD and AUD, patients with SAD and AUD were recruited from a community-based SUD specialty clinic (N = 56) and randomized to either (a) usual care (UC), consisting of the evidence-based Matrix Model of Addiction IOP; or (b) the Fully Integrated Treatment (FIT) for comorbid SAD and AUD IOP. Participants were assessed on indices of social anxiety and alcohol use. Results By the 6-month follow-up, those in FIT showed superior improvement to UC on number of drinking days in the past 30 days and social anxiety severity at follow-up, but there were no differences between groups on quantity of alcohol consumed on drinking days. Alcohol-related problems improved in both groups, with no statistically significant differences. Within-group improvement was observed in FIT (but not in UC) on drinking to cope with social anxiety and avoidance of social situations without alcohol, but between-group effects were non-significant. In sum, the integrated treatment of SAD and AUD led to greater reductions in both the frequency of drinking and in social anxiety symptoms than usual care. Conclusions Targeting social anxiety in the context of AUD treatment is a promising approach to improving the treatment of this common comorbidity.
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El objetivo fue evaluar la validez del constructo y la confiabilidad de la Escala de Ansiedad Social para Adolescentes. Se trató de un estudio de corte instrumental, y diseño transversal. La muestra es no probabilística, accidental y por cuota; incluyó 677 estudiantes de escuelas oficiales, nivel medio y medio superior, edad (x = 14.8 años, de = 1.5), 56.3% mujeres. La validación aparente y de contenido por jueces expertos confirmó que las instrucciones son claras y el lenguaje comprensible para los participantes. La consistencia interna obtenida por la sas-a fue α = 0.85; el análisis factorial exploratorio arrojó tres factores con valores propios mayores a uno, que explicaron 55.9% de la varianza total. Con un intervalo de cuatro semanas entre aplicaciones, se obtuvo la confiabilidad test-retest, r = 0.78, p < 0.01. Finalmente, se establecieron las normas percentilares para tamizaje de los participantes. La sas-a es una medida válida y confiable, adecuada para utilizarse en adolescentes escolarizados de la Ciudad de México.
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Alcohol use disorders (AUD) often co-occur with anxiety and depressive disorders, and anxiety often drives relapse during alcohol abstinence. Optimal AUD pharmacotherapies may thus need to target both excessive alcohol intake and elevated anxiety. (−)-OSU6162 (OSU) is a monoamine stabilizer that attenuates alcohol-mediated behaviors in both preclinical and clinical settings. However, OSU’s effect on anxiety-like behavior following long-term drinking remains unknown. To this end, we utilized a genetic rat model that exhibits increased anxiety- and depression-like behaviors (Flinders Sensitive Line; FSL) and their controls (Flinders Resistant Line; FRL). Using the novelty suppressed feeding (NSF) test, we evaluated anxiety-like behaviors (1) at baseline, (2) following long-term voluntary drinking and after 24 h of alcohol deprivation, and (3) following OSU administration in the same animals. At baseline, FSL animals displayed significantly elevated anxiety-like characteristics compared to FRL. Compared to alcohol-naïve animals, long-term drinking significantly reduced anxiety-like behaviors in FSL, without any significant effects in FRL animals. Compared to vehicle, OSU administration significantly reduced anxiety-like behaviors in alcohol-naïve FSL and long-term drinking FRL animals. While there was no significant difference in alcohol intake between FSL and FRL, OSU attenuated alcohol intake in both strains. Conclusively, in addition to the compound’s previously identified ability to suppress alcohol-mediated behaviors, OSU may also possess anxiolytic properties, warranting further clinical evaluation in both AUD and anxiety disorder settings.
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K. Abrams, M. Kushner, K. Medina, and A. Voight (2001) showed that alcohol attenuates social anxiety symptoms in socially phobic individuals. This article examines whether social anxiety symptoms can lead to increased alcohol use in this same population. Forty-four individuals with social phobia attended 2 laboratory sessions, spaced 1 week apart, in groups of approximately 10. Participants underwent a social anxiety challenge during 1 session and a control task during the other. Half of the sample self-administered alcohol immediately before, and half immediately after, these 2 activities.As predicted, participants consumed more alcohol following the anxiety challenge than following the control task; however, the opposite pattern was evidenced for drinking following the 2 activities. These findings add to an understanding of why social phobia and alcohol problems tend to co-occur.
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Using an in vivo manipulation, this study examined whether alcohol outcome expectancies (AOEs) vary across environmental settings. Two hundred twenty-one undergraduates were randomly assigned to 1 of 4 conditions in which environmental context (an on-campus bar vs. a laboratory) and instructed phase of intoxication (“just enough to begin to feel intoxicated” vs. “too much to drink”) were manipulated. AOEs were assessed with a revised version of the Effects of Alcohol Scale (L. Southwick, C. Steele, A. Marlatt, & M. Lindell, 1981). Compared with participants tested in the laboratory, individuals exposed to the on-campus bar expected greater alcohol-related stimulation/perceived dominance and pleasurable disinhibition. Women expected more behavioral impairment during the latter stage of intoxication. These findings highlight the importance of ecologically valid research in this area, as well as cue-exposure assessment and treatment approaches.
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The clinical manifestations of social phobia were studied in a carefully diagnosed sample of 21 social phobics. Social phobia was found to be a chronic and pervasive condition affecting a variety of life areas and producing significant emotional distress. In a second study, individuals with a diagnosis of social phobia or avoidant personality disorder were compared using a subsample of socially phobic subjects and a sample with avoidant personality disorder. Although physiological reactivity and cognitive content were essentially the same for both groups in a number of situational tasks, those individuals with a diagnosis of avoidant personality disorder were found to be more sensitive interpersonally, and exhibited significantly poorer social skill than did the social phobic subjects. The results are discussed in relation to Diagnostic and Statistical Manual of Mental Disorders, third edition, criteria for social phobia, the significance of social phobia as a clinical syndrome, and the research and treatment implications of the difference found between individuals with a diagnosis of social phobia and those with avoidant personality disorders.
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The best method currently available for predicting adolescent alcohol consumption is to use the significant relationship that has been found between this variable and demographic/background variables. To assess the theoretical and practical utility of adolescent alcohol expectancies, the present authors pitted these expectancies against important demographic/background variables in the prediction of adolescent drinking. This comparison required 3 procedural steps: (a) factor analytic derivation of 3 adolescent drinking styles, (b) multiple regression prediction of these drinking styles using demographic/background variables, and (c) assessment of the predictive power of alcohol expectancies. Ss were 1,580 12–19 yr olds. Results show that expectancies (as measured by the Alcohol Expectancy Questionnaire for Adolescents) at least equalled and even added to the predictive power of the background variables. Specifically, Ss who drank in a frequent, social manner expected alcohol to enhance their social behavior, whereas Ss who reported alcohol-related problems expected an improvement in their cognitive and motor functioning. Results suggest assessment and treatment strategies for high-risk adolescents and indicate a possible mediator of adolescent drinking problems. (27 ref)
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In Exp I, male nonalcoholics (aged 21–30 yrs), considered to be at heightened risk for alcoholism on the basis of high scores on the MacAndrew Alcoholism Scale (MAC), were found to show much more pronounced reduction of their cardiovascular and affective responses (as measured by the Mood Adjective Check List) to stress when they consumed alcohol (1 g/kg) than did their low-risk controls. In Exp II, with 82 Ss, a similar finding for cardiovascular responses to stress was observed when risk was predicated on the basis of low scores on the Socialization (S) scale of the California Psychological Inventory (or on the basis of combined risk on both the MAC and S scale). Results indicate that outgoing, aggressive, impulsive, and antisocial individuals who are identified by these measures may find alchohol consumption particularly reinforcing by virtue of their obtaining a greater amount of alcohol's stress-response-dampening (SRD) effect when they drink. An etiological model of alcoholism that incorporates individual differences in the SRD effects is proposed. (58 ref)
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The article which follows this introduction was originally published as a Special (Cover) Article in the American Journal of Psychiatry in the November, 1985 issue, the same month in which the First International Drug Symposium, sponsored by The Bahamas Ministry of Health and The Embassy of the United States of America, was convened to discuss the rock-cocaine epidemic in the Bahamas and other Caribbean Islands. Based on my article, I was invited to participate in the Symposium and to speak about some of my views on the psychological predispositions for drug dependence in general, and in particular, on the psychological predisposition for cocaine dependence. At first, I did not grasp the seriousness and scope of the cocaine problem, but I accepted the invitation, believing I might make a contribution to the Symposium. I was not long in attendance at the Symposium before I realized that the Bahamian citizens, professionals, and health care leaders were facing a major crisis as a consequence of the cocaine epidemic.
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In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Ninety-eight outpatients meeting DSM-III-R criteria for social phobia were evaluated for past history of RDC alcoholism using the SADS-LA structured interview. The resulting 16 subjects with a history of alcoholism were then compared to the 82 nonalcoholic social phobics. The alcoholic social phobics had more severe social phobia and tended to be less likely to be married. Both groups were similar in other measures of demographics. The mean age of onset of social phobia was significantly earlier than the mean age of onset of alcoholism, and social phobia preceded alcoholism in 15 of the 16 dual diagnosis subjects. Most of the dual diagnosis subjects reported using alcohol to self-medicate social phobic symptoms. These findings are consistent with the hypothesis that social phobia can be an important factor in the development of alcoholism.
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Several large-scale studies examining outcome predictors across various substance use treatments indicate a need to focus on psychiatric comorbidity as a very important predictor of poorer SUD treatment involvement and outcome. We have previously argued that current cognitive-behavioral treatments (CBT) approaches to SUD treatment do not focus on the necessary content in treatment in order to effectively address specific forms of psychiatric comorbidity, and thus only provide clients with generic coping strategies for managing psychiatric illness (as would be achieved in other SUD treatment approaches; Conrod et al., 2000). Furthermore, following our review of the literature on dual-focused CBT treatment programs for concurrent disorders in this article, we argue that combining CBT-oriented SUD treatments with specific CBT treatments for psychiatric disorders is not as straightforward as one would think. Rather, it requires very careful consideration of the functional relationship between specific disorders, patient reactions to specific treatment components, and certain barriers to treatment in order to achieve an integrated dual-diagnosis focus in treatment that is meaningful and to which clients can adhere.
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This study examined the relationships between stress and both alcohol use and alcohol problems, in addition to testing the possibility that social support and coping styles significantly moderate these relationships. Two samples of men and women in their 20s and 30s were studied. Findings showed that stress was unrelated to alcohol consumption in 1 sample, and, although there were significant associations in the 2nd sample, the overall percentage of variance explained was small. Stress appeared to be more highly related to alcohol problems, with some stress measures showing a protective relationship vis á vis alcohol problems and others acting in ways that can put people at risk for alcohol problems. Coping styles and social support interacted significantly with some measures of life stress (e.g., daily hassles, negative life events), but only in some circumstances. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The utility of trait social anxiety and alcohol expectancies in predicting increased alcohol consumption under socially stressful conditions was investigated. Forty-two male and 42 female undergraduates participated in a 2-day study, serving as their own controls. In each session, participants consumed their preferred alcoholic beverage during a 30-min drinking period. The lst session established baseline consumption under nonstressful conditions, while in the 2nd session, participants drank while anticipating the required delivery of a speech. Measures of social anxiety and alcohol expectancies were completed. Participants consumed more absolute alcohol during the stressful session, but those with high trait social anxiety and men expecting alcohol to increase assertiveness were most likely to show this effect. These findings suggest specificity in the connection between individual characteristics and stress-induced drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A 4-factor measure of drinking motives based on a conceptual model by M. Cox and E. Klinger (see PA, Vol 75:32975; see also 1990) is presented. Using data from a representative household sample of 1,243 Black and White adolescents, confirmatory factor analyses showed that the hypothesized model provided an excellent fit to the data and that the factor pattern was invariant across gender, race, and age. Each drinking motive was related to a distinct pattern of contextual antecedents and drinking-related outcomes, and these relationships did not generally vary across demographic subgroups. Results support both the conceptual validity of Cox and Klinger's model and the utility of this measure for clinical and research purposes across a diverse range of adolescent populations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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288 adults and 265 university students responded to a questionnaire concerning beliefs about the effects of alcohol, which included a measure of evaluation of alcohol effects. Analyses were performed with measures of frequency of drinking episodes, usual quantity consumed/episode, frequency of intoxication and consumption of 8 or more drinks at one sitting, and estimated number of drinks per year. Evaluation of the undesirable consequences of drinking added significantly to the prediction of quantity-based drinking variables. It is suggested that perceived desirability of alcohol effects is an important factor in understanding the relationship of expectancies to drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study examined coping responses and alcohol outcome expectancies in alcohol abusing and nonabusing social phobics. The sample consisted of social phobics with current alcohol abuse or dependence (SPAs, n = 19), social phobics without lifetime alcohol use disorders (SPs, n = 19), and normal controls (NCs, n = 21). As predicted, SPs reported less problem-focused coping than did NCs in nonalcohol social situations and rated themselves as less skillful in interpersonal role-plays. However, observers did not rate SPs as less skillful than NCs in these role-plays. Consistent with the predicted situation-specific effects, SPAs reported less problem-focused coping than did SPs during alcohol-accessible social situations, but not during alcohol-inaccessible social situations. However, observer-rated and self-report results from role-plays of high-risk alcohol situations did not show the predicted lower drink refusal skills among SPAs compared to SPs. SPAs reported higher positive alcohol expectancies of tension reduction than did SPs but did not differ in negative alcohol expectancies of cognitive and behavioral impairment. These results are in several ways consistent with cognitive and social-learning theories of social phobia and alcohol abuse.
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We examined the hypothesis that social anxiety and alcohol outcome expectancies interact in relating to the quantity and frequency of alcohol consumption. Two hundred twenty-nine undergraduates completed self-report questionnaires. The results showed situational specificity of alcohol expectancies. Expecting that alcohol would reduce anxiety in social situations moderated the relation between social anxiety and alcohol consumption; no such moderating effect was found for expectancy of general tension reduction. Among those who did not expect alcohol to reduce their anxiety in social situations, high-social-anxiety participants reported lower frequency and quantity of alcohol consumption than did low-social-anxiety individuals. High- and low-social-anxiety participants who expected alcohol to reduce their social anxiety did not differ in their alcohol consumption.
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In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual's responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
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Individuals with social phobia are at an increased risk for alcohol problems. Individuals with social phobia could increase their risk for pathological alcohol use if they drink as a means of coping with anxiety-provoking social situations. Providing a circumscribed test of this view, we evaluate the effect of alcohol on the intensity of social phobia anxiety responses. Sixty-one individuals with social phobia gave two speech challenges in front of a group (‘social anxiety challenge’), one occurring before and one after they consumed either: (a) an alcoholic drink they were told contained alcohol (‘alcohol group’), (b) a non-alcoholic drink they were told contained alcohol (‘placebo group’), or, (c) a non-alcoholic drink they were told contained no alcohol (‘control group’). Both the alcohol group and the placebo group showed greater reduction in performance anxiety from the first to the second speech challenge than did the control group. Further, there was a strong trend in the data for the alcohol group to show greater reduction in performance anxiety from the first to the second speech challenge than did the placebo group. We concluded from these findings that the pharmacologic effects of alcohol and the belief that one consumed alcohol decrease social performance anxiety in an additive fashion. These results provide direct support for the negatively reinforcing properties of alcohol and are consistent with the view that symptom reduction may motivate alcohol use among socially phobic individuals.
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Randomly assigned 32 female social drinkers (18–25 yr old undergraduates) to 4 conditions in a ^h 2 × 2 ^H factorial design that controlled for drink content and expectations. Ss were administered either an alcoholic or a nonalcoholic beverage and were led to believe that their drinks contained or did not contain alcohol. After finishing their drinks Ss participated in a study of social anxiety in which they were requested to interact with a male confederate of the experimenter. Multiple measures, including heart rate, skin conductance, and overt behavioral and self-report responses, were recorded. Ss who expected alcohol showed significant elevations in physiological arousal and were rated as more anxious on observational measures of social behavior. Self-report measures failed to yield any differences among groups. Implications for the tension reduction theory of alcohol use and the importance of multiple response measures are discussed. (1½ p ref)
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This preliminary study examined the relationship between social anxiety and specificity of positive alcohol outcome expectancies (AOE) in a community sample of 62 drinking adults. The sample was divided into subsets of socially anxious (n = 17) and nonsocially anxious (n = 45) men and women. The Drinking Expectancy Questionnaire (DEQ) and Alcohol Expectancies in Social Evaluative Situations Scale (AESES) were used to determine if groups differed in the general positive AOE they hold, or only in AOE specific to social situations. ANOVAs revealed that socially anxious individuals had greater positive AOE specific to social situations (DEQ-Assertion scale and AESES) than nonsocially anxious individuals, with no differences in other positive AOE. Partial correlations controlling for social anxiety revealed that AOE specific to social situations correlated with greater drinking and alcohol dependency levels. Findings indicate that identification of AOE specific to social Situations may be useful in classifying socially anxious individuals at risk for alcoholism and as a focus of expectancy challenge strategies for individuals with co-occurring social anxiety and drinking problems.
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This study examined the relationships between stress and both alcohol use and alcohol problems, in addition to testing the possibility that social support and coping styles significantly moderate these relationships. Two samples of men and women in their 20s and 30s were studied. Findings showed that stress was unrelated to alcohol consumption in 1 sample, and, although there were significant associations in the 2nd sample, the overall percentage of variance explained was small. Stress appeared to be more highly related to alcohol problems, with some stress measures showing a protective relationship vis a vis alcohol problems and others acting in ways that can put people at risk for alcohol problems. Coping styles and social support interacted significantly with some measures of life stress (e.g., dally hassles, negative life events), but only in some circumstances.
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No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients. Project MATCH is a multisite clinical trial designed to test a series of a priori hypotheses on how patient-treatment interactions relate to outcome. Two independent but parallel matching studies are being conducted, one with clients recruited from outpatient settings, the other with patients receiving aftercare treatment following inpatient care. Patients are randomly assigned to Twelve-Step Facilitation, Cognitive Behavioral Coping Skills, or Motivational Enhancement Therapy. Subjects are followed at 3-month intervals for 1 year following completion of the 12-week treatment period and evaluated for changes in drinking patterns, functional status/quality of life, and treatment services utilization. Interaction effects with selected patient characteristics will be studied. Project MATCH will provide a rigorous test of the utility of patient-treatment matching in general and, depending on the specific a priori hypotheses validated, will have important implications for clinical practice.
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Objectives Our goals were (1) to ascertain the range of functional impairment attributable to social phobia in a community sample, and (2) to verify the existence of social phobia subtypes in the community, and report on their relative prevalence, severity, and levels of impairment.Methods Community surveys were conducted contemporaneously in Winnipeg, Manitoba, and in Alberta, with a total of 1956 respondents. Instruments included the Comprehensive International Diagnostic Interview–Version 2.1 module for DSM-IV social phobia, enhanced with 6 additional (for a total of 12) social phobic situational probes to provide a more comprehensive assessment of possible subtypes, and additional questions about specific functional impairment due to social phobia.Results Of those persons in the community surveyed, most had no (60.4%) or few (ie, 1-3) (27.8%) social fears; few persons (3.4%) had many (ie, ≥7). Among those with DSM-IV social phobia (7.2%), classification based on number (normally distributed with median of 3, mode of 5) or content (eg, speaking-only vs other fears; performance-only vs interactional fears) of social fears failed to yield a defensible subtyping solution. Impairment increased linearly as the number of social fears was increased, with no clear threshold evident.Conclusions Social phobia is associated with substantial impairment in multiple functional domains. Support for subtyping based on the extent or pattern of social fears was not provided. Rather, social phobia in the community seems to exist on a continuum of severity, with a greater number of feared situations associated with greater disability.
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• A survey evaluated the lifetime and current prevalence of mental disorders in 501 patients seeking assistance with alcohol and other drug problems at an addiction research and treatment facility. Information was gathered using the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and computer diagnoses were generated according to DSM-III criteria. Four fifths (78%) of the sample had a DIS lifetime psychiatric disorder in addition to substance use, and two thirds (65%) had a current DIS mental disorder. Excluding the unreliably diagnosed generalized anxiety disorder, the most common lifetime disorders were antisocial personality disorder, phobias, psychosexual dysfunctions, major depression, and dysthymia. Patients who abused both alcohol and other drugs were the most psychiatrically impaired. Patients with DIS psychiatric disorders had more severe alcohol and other drug problems. Barbiturate/sedative/hypnotic, amphetamine, and alcohol abusers were the most likely to have a DIS mental disorder.
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No single treatment approach is effective for all persons with alcohol problems. A more promising strategy involves assigning patients to alternative treatments based on specific needs and characteristics of patients. Project MATCH is a multisite clinical trial designed to test a series of a priori hypotheses on how patient-treatment interactions relate to outcome. Two independent but parallel matching studies are being conducted, one with clients recruited from outpatient settings, the other with patients receiving aftercare treatment following inpatient care. Patients are randomly assigned to Twelve-Step Facilitation, Cognitive-Behavioral Coping Skills, or Motivational Enhancement Therapy. Subjects are followed at 3-month intervals for 1 year following completion of the 12-week treatment period and evaluated for changes in drinking patterns, functional status/quality of life, and treatment services utilization. Interaction effects with selected patient characteristics will be studied. Project MATCH will provide a rigorous test of the utility of patient-treatment matching in general and, depending on the specific a priori hypotheses validated, will have important implications for clinical practice.
Article
It is well documented that many individuals endorse the belief that alcohol reduces social anxiety. Individuals with social phobia, therefore, might be expected to use alcohol as a coping strategy in an attempt at self-medication. The purpose of the present paper was to review the published literature on the relationship between alcohol use and social phobia to test the self-medication hypothesis (SMH). Support for one aspect of the SMH was found; individuals with social phobia use alcohol to reduce anxiety. Support for the second premise, that alcohol actually reduces social anxiety, was less conclusive.
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This paper reviews evidence from clinical, epidemiologic, and family studies regarding the association between social phobia and other syndromes. Social phobia is strongly associated with other anxiety disorders, substance abuse, and affective disorders in both clinical and community samples. An average of 80% of social phobics identified in community samples meet diagnostic criteria for another lifetime condition. Social phobia is most strongly associated with other subtypes of anxiety disorders, with an average of 50% of social phobics in the community reporting a concomitant anxiety disorder including another phobic disorder, generalized anxiety, or panic disorder. Approximately 20% of subjects in the community meet lifetime criteria for a major depressive disorder. The onset of social phobia generally precedes that of all other disorders, with the exception of simple phobia. Both clinical severity and treated prevalence are consistently greater among social phobics with comorbid disorders. The results of family and twin studies reveal that shared etiologic factors explain a substantial proportion of the comorbidity between social phobia and depression, whereas the association between social phobia and alcoholism derives from a nonfamilial causal relationship between the two conditions. Clinical and phenomenologic implications of these findings are discussed.
Article
The development and validation of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) two companion measures for assessing social phobia fears is described. The SPS assesses fears of being scrutinised during routine activities (eating, drinking, writing, etc.), while the SIAS assesses fears of more general social interaction, the scales corresponding to the DSM-III-R descriptions of Social Phobia—Circumscribed and Generalised types, respectively. Both scales were shown to possess high levels of internal consistency and test–retest reliability. They discriminated between social phobia, agoraphobia and simple phobia samples, and between social phobia and normal samples. The scales correlated well with established measures of social anxiety, but were found to have low or non-significant (partial) correlations with established measures of depression, state and trait anxiety, locus of control, and social desirability. The scales were found to change with treatment and to remain stable in the face of no-treatment. It appears that these scales are valid, useful, and easily scored measures for clinical and research applications, and that they represent an improvement over existing measures of social phobia.
Article
history of the diagnosis [of social phobia] / development of Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for social phobia / thresholds for the diagnosis [the issue of 'caseness," shyness, social phobia secondary to other psychiatric or medical illness] / differential diagnosis and comorbidity [panic disorder with agoraphobia, generalized anxiety disorder, depression, avoidant personality disorder, schizophrenic spectrum disorders] / social phobia subtypes (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Experimental literature is reviewed to show that reinforcement theory can explain the rewards of drinking behavior, even in the case of the man who is apparently punished by such behavior. Differential effects can be understood by reference to inhibition of response by fear through alcohol, or by depression of other drives which might be inhibited, or by different effects on two incompatible response tendencies, or by the overriding effects of learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Investigated the linear relationships between 248 male and 195 female undergraduates' alcohol (AL) intake and attributes, including age, AL-related attitudes, and assertiveness level. AL intake and grade point average (GPA) were inversely related, and responsible attitudes toward AL consumption were important elements of AL intake. Men were more likely than women to report higher AL intake. Heavier drinkers were more likely to be male seniors with lower than average GPAs who had relatively low general well-being, low self-esteem, and more negative attitudes toward responsible AL consumption. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Describes the clinical presentation of social phobia, discusses theoretical perspectives on etiology, and surveys empirically supported treatments used to treat the disorder. Although social phobia occurs in children and adults, its manifestation and treatment differ in various age groups. The authors describe the similarities and differences in the syndrome across all ages. Drawing from the clinical, social, and developmental literatures, as well as from their own extensive clinical experience, the authors illustrate the impact of developmental stage on phenomenology, diagnoses, and assessment and treatment of social phobia. Within the different age groups, issues of etiology, prevalence, and clinical management are presented. The volume includes many case illustrations and practical information. This book will be useful for practitioners, researchers, and students. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Objective: The goal of this consensus statement is to provide primary care clinicians with a better understanding of management issues in social anxiety disorder (social phobia) and guide clinical practice with recommendations for appropriate pharmacotherapy. Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Julio Bobes, Deborah C. Beidel, Yukata Ono, and Herman G. M. Westenberg. Evidence: The consensus statement is based on the 7 review papers published in this supplement and on the scientific literature relevant to the issues reviewed in these papers. Consensus process: The group met over a 2-day period. On day 1, the group discussed each review paper, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. Conclusions: The consensus statement underlines the importance of recognizing social anxiety disorder and provides recommendations on how it may be distinguished from other anxiety disorders. It proposes definitions for response and remission and considers appropriate management strategies. Selective serotonin reuptake inhibitors are recommended as first-line therapy, and effective treatment should be continued for at least 12 months. Long-term treatment is indicated if symptoms are unresolved, the patient has a comorbid condition or a history of relapse, or there was an early onset of the disorder.
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Although the Fear of Negative Evaluation (FNE) Scale has widespread applicability to many areas of research in personality and social psychology, its utility is sometimes limited by its length. This article presents a brief, 12-item version of the FNE that correlates very highly (f96) with the original scale and that demonstrates psychometric properties that are nearly identical to those of the full-length scale.
Article
The present study compares male and female alcoholics with concurrent social phobia (N = 110) enrolled in an alcohol treatment study. Groups were compared using demographics, social phobia symptoms and severity, and psychiatric variables. Results showed that females reported higher fear ratings than males on some social phobia measures, although for the most part, the genders were more similar than different on social phobia symptoms and severity. There was a high occurrence of psychiatric comorbidity, especially for females. Females also reported more distress than males in family and social functioning. The results are discussed in terms of their implications for treatment for individuals with concurrent alcoholism and social phobia.
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Background: Social anxiety disorder (also called social phobia) is an anxiety disorder in which affected individuals fear the scrutiny of others. Clinical reports suggest that individuals with social anxiety disorder often use alcohol to alleviate anxiety symptoms, a practice that leads to alcohol abuse and/or dependence in approximately 20% of affected individuals. The present study investigated whether simultaneous treatment of social phobia and alcoholism, compared with treatment of alcoholism alone, improved alcohol use and social anxiety for clients with dual diagnoses of social anxiety disorder and alcohol dependence. Methods: The design was a two-group, randomized clinical trial that used 12 weeks of individual cognitive behavioral therapy for alcoholism only (n = 44) or concurrent treatment for both alcohol and social anxiety problems (n = 49). Outcome data were collected at the end of 12 weeks of treatment and at 3 months after the end of treatment. Results: Results with intent-to-treat analyses showed that both groups improved on alcohol-related outcomes and social anxiety after treatment. With baseline scores covaried, there was a significant effect of treatment group on several drinking measures. Counter to the hypothesis, the group treated for both alcohol and social anxiety problems had worse outcomes on three of the four alcohol use indices. No treatment group effects were observed on social anxiety indices. Conclusions: Implications for the staging of treatments for coexisting social phobia and alcoholism are discussed, as well as ways that modality of treatments might impact outcomes.
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The self-medication hypothesis of addictive disorders postulates that individuals with psychiatric symptoms use drugs to alleviate their symptoms. Although commonly cited to explain the etiology of substance abuse, self-medication has not been experimentally validated. This study evaluated one version of the self-medication hypothesis by formulating it into a testable hypothesis: are highly anxious volunteers more likely to self-administer anxiolytic drugs than non-anxious controls. Anxious (ANX,n=22) and control (CTL,n=23) subjects participated in two double-blind placebo-controlled experiments, one testing ethanol (0.8 g/kg) and the other testing diazepam (20 mg). Subjects sampled and then chose between ethanol and placebo in one experiment, and diazepam and placebo in the other. The main dependent measures were choice of drug over placebo and subjective responses to the drugs. Ethanol decreased self-reported anxiety in ANX subjects, but ANX subjects did not choose ethanol more often than CTL subjects. Diazepam did not measurably reduce anxiety, but ANX subjects nevertheless chose diazepam more often than did CTL subjects. Thus, there were some differences in drug responses between the ANX and CTL subjects, and the study provided limited support for the self-medication hypothesis. However, drug choice was not directly related to anxiolytic drug effects with either ethanol or diazepam. The procedure may be used to test other formulations of the self-medication hypothesis (e.g., examining other psychiatric risk factors).