The Relationship Between Alcohol and Social Anxiety Disorder

Alcohol and Social Anxiety Disorder May Cause Or Worsen Panic AttacksAbout 15 million US adults, or 7% of the population, experience social anxiety disorder in a given year. According to the American Psychiatric Association, social anxiety disorder is defined as an excessive fear in social situations in which a person believes he or she will do something embarrassing or exhibit anxiety symptoms that will be embarrassing. Tragically, addiction to alcohol and social anxiety disorder are a very common pair. Research has shown that alcohol use disorders frequently co-occur with anxiety disorders, as alcohol is often used as a coping mechanism to alleviate social fears. About 20% of social anxiety disorder patients also suffer from alcohol abuse or dependence, and recent studies have revealed that these numbers are only increasing.

What Is Social Anxiety Disorder?

Social anxiety disorder is one of the most common psychiatric disorders in America and is second only to depression in its frequency. More than just shyness or feelings of awkwardness, social anxiety disorder involves a deep irrational fear of humiliation or judgment by others during social interactions. Most individuals suffering from the disorder typically have the more severe, “generalized” type, in which he or she has other social fears besides just the common fear of public speaking. The feared situations can include almost any social circumstance, ranging from interpersonal social interactions in small groups to talking to strangers. People with social anxiety disorder either avoid feared social situations altogether or experience them with extreme anxiety.

Social anxiety disorder typically begins in teen years and does not improve without treatment. People with the disorder are often shy and introverted as small children, which then intensifies with age. Young adults suffering from social anxiety disorder often base every day and life decisions off of their fears, such as avoiding classes that require oral presentations or accepting jobs beneath their ability because it allows them to work alone. Although those suffering from the disorder may realize that their social fears are excessive or unreasonable, they are unable to suppress or overcome them.

Many individuals with high levels of social anxiety report that alcohol enables them to feel more comfortable and act more freely in social situations. Thus, it is not surprising that many with social anxiety disorder turn to alcohol as a means of relief.

Symptoms of Social Anxiety Disorder

  • Difficulty talking or interacting with others
  • Fear of judgment
  • Avoidance of social interactions
  • Nausea, trembling, and lightheadedness around others
  • Excessive worrying about social events
  • Erratic sleep patterns
  • High levels of self-consciousness in the presence of others
  • Enduring social situations with intense fear or anxiety
  • Trouble with concentration
  • Constant self-analysis of performance in social situations

Alcohol as a Coping Mechanism

Alcohol and Social Anxiety Disorder Are One Of The Most Common Dual Diagnosis PairingsAppropriately called “liquid courage,” alcohol reduces inhibition and is associated with increased confidence, prompting those with social anxiety disorder to often see alcohol as symptom relief in a bottle. Whether alcohol actually reduces social anxiety is still up for debate; however, positive expectations that alcohol can relieve social fears may explain why so many people turn to alcohol as a coping strategy in the first place.

Aside from completely avoiding anxiety-inducing social situations, people with social anxiety disorder report that alcohol use is one of their primary methods of coping. Many researchers attribute this to the Tension Reduction Theory, the belief that alcohol acts as a negative reinforcer to reduce stress and anxiety. Once a person experiences stress relief after consuming alcohol, he or she is likely to continue to use alcohol before and/or during stressful situations. Some people with social anxiety then drink excessive amounts because they strongly associate alcohol with reduced feelings of anxiousness in social situations. This can then create an unhealthy cycle of substance abuse.

From research within the community and clinical samples, we have learned that not only do individuals with social anxiety drink during social situations to feel more relaxed, they are also more likely to drink before engaging in a planned social activity that they believe will make them anxious. They believe that they ‘need’ alcohol, in order to participate in social situations.

Sarah Book
Management of Patients with Alcohol and Co-Occurring Disorders: Problems and Solutions

Alcohol is a depressant and therefore has a sedative effect, which is why many people often use the substance to “unwind” or relax. However, although alcohol may seem to temporarily reduce symptoms of social anxiety, alcohol can actually exacerbate symptoms of the disorder within just a few hours of consumption such as anxiety, irritability, and depression.

Social Anxiety Disorder, Alcoholism, and Other Psychiatric Disorders

About 50% of people suffering from social anxiety disorder are thought to experience other psychiatric problems at the same time. Individuals with social anxiety disorder may also develop other anxiety disorders, such as Panic Disorder and Obsessive-Compulsive Disorder. Panic disorder is particularly likely, as people with social anxiety can become so anxious that they then begin to experience panic attacks when faced with dreaded social situations. As situational panic attacks become more frequent, people may start to take extreme measures to avoid situations in which they fear another panic attack may occur. This avoidance can eventually develop into more severe and specific phobias, such as agoraphobia – the inability to go beyond known and safe surroundings because of intense fear and anxiety. Co-occurring mental health issues and substance abuse are often a symptoms of anxiety disorders, as alcohol often becomes a means of self-medication.

Treatment for Addiction to Alcohol and Social Anxiety Disorder

Both alcohol addiction and social anxiety disorder are treatable, and multiple studies have revealed that treatment should simultaneously address both issues using a multi-disciplinary, holistic approach. Cognitive behavioral therapy and motivational enhancement therapy are considered to be the most promising approaches for treatment of the co-occurring disorders.

If you have social anxiety disorder and are abusing alcohol, contact a treatment specialist today. There are many effective treatments for both disorders, including individual and group therapy. Although you may have begun to use alcohol as a self-medicating measure, alcohol causes more problems for people with anxiety than it seemingly solves.

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