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When alcohol consumption evolves from a 'social lubricant'
into a 'crutch'
Individuals with social anxiety disorder are pained at the
thought of being scrutinized, and have an extreme fear of looking foolish to others.
New research indicates that they may also deliberately drink
alcohol in order to cope with social interaction, and avoid social situations where
alcohol is unavailable.
Individuals with social anxiety disorder are not simply shy. They
are pained at the thought of being scrutinized, and have an extreme fear of looking
foolish to others. Findings published in the December issue of Alcoholism: Clinical &
Experimental Research indicate that they may also deliberately drink alcohol in order to
cope with social interaction, and avoid social situations where alcohol is unavailable.
"Social anxiety disorder can keep people from enjoying
social events and often interferes with their jobs, especially when they are required to
speak to a group as part of their work," explained Suzanne E. Thomas, assistant
professor of psychiatry at the Medical University of South Carolina and first author of
the study. "Besides avoiding situations where they might be evaluated, many
individuals with social anxiety disorder [also] use alcohol to cope."
Thomas noted that although reports vary, the average lifetime
prevalence of alcoholism among individuals with social anxiety disorder is 20 percent;
that is, one in five develops alcoholism at some point in their lifetime. This compares to
about a 10 percent lifetime prevalence of alcoholism in the general population, or, one in
10.
For this study, Thomas and her colleagues examined 46 study
participants (26 females, 20 males), evenly divided into two groups with similar
demographic variables and alcohol use: 23 had high social anxiety, and 23
"controls" were not socially anxious. All participants were asked about their
use of alcohol as a coping mechanism, the practice of avoiding social situations if
alcohol were not available, and the degree of relief attained by drinking alcohol.
Participants were also asked about using alcohol during 11 specific situations: four were
considered "social interactions," such as meeting people for the first time, and
seven were "performance" events, such as giving a speech to a group.
"We found that drinking to relieve social discomfort was a
common practice in both groups, but that individuals with high levels of social anxiety
use alcohol for this purpose more often, and they would drink both in anticipation of and
during social situations," said Thomas. "Also, more individuals with high social
anxiety avoid social situations if alcohol is not available. Lastly, they experience
greater relief from anxiety in social situations than do individuals who are not highly
anxious."
Thomas added that individuals with high levels of social anxiety
did not experience full relief from their symptoms by using alcohol, but perhaps just
enough to enable them to endure being in a social situation. "Individuals with high
social anxiety do not use alcohol indiscriminately," said Thomas, "they may
drink to cope with social-interaction situations, like meeting people for the first time,
but not in performance-type situations, like giving a talk in front of a group, which they
also fear."
Darlene H. Moak, a psychiatrist and assistant professor at the
Medical University of South Carolina, said that this ability to discriminate between
situations when alcohol use is acceptable or not warrants further research. "This
finding suggests that utilizing a single anxiety-provoking experience such as giving a
speech in front of a group may not be the best way to study the relationship between
social anxiety and alcohol use. Individuals with social anxiety seem to learn that
drinking before and during performance events is, in fact, counterproductive in that it
can lead to increased anxiety
due to poor performance."
"Our study shows that people with high social anxiety do
drink alcohol specifically to relieve anxiety more than controls," added Thomas.
"It does not, however, address whether they drink more alcohol in general than
controls, which should be the case if the self-medication hypothesis were completely
correct." The self-medication hypothesis proposes that some people use alcohol or
other drugs because they experience relief from existing psychiatric or emotional
problems. Consequently, the substance is used repeatedly, and for some people, leads to
chronic use in order to manage mood or
anxiety.
"Although alcohol is commonly used as a social
lubricant," said Thomas, "that doesn't mean that a person who uses alcohol to
feel comfortable in social situations is likely to become an alcoholic. We would argue
that people with high social anxiety who use alcohol repeatedly to relieve their stress
may come to rely on it as their primary coping strategy, and research suggests that such
people are at risk for alcoholism. However, not all socially anxious individuals use
alcohol to cope. What makes these individuals different from those who do is a fruitful
research area."
Alcoholism: Clinical & Experimental Research (ACER) is the
official journal of the Research Society on Alcoholism and the International Society for
Biomedical Research on Alcoholism. Co-authors of the ACER paper included Carrie L. Randall
and Maureen H. Carrigan of the Charleston Alcohol Research Center, and the Department of
Psychiatry and Behavioral Sciences, both of the Medical University of South Carolina. The
study was funded by the National Institute on Alcohol Abuse and Alcoholism. |
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