Social Anxiety and Substance Use: A review of “Specificity of Social Anxiety Disorder as a Risk Factor for Alcohol and Cannabis Dependence”

Article summary provided by Kathryn Zumberg

In a recent study, Buckner et al. (2008) examined whether a diagnosis of social anxiety disorder among adolescents is a specific risk factor for the development of alcohol and/or cannabis use disorders in adulthood. As expected, the authors found that social anxiety disorder, but not anxiety or mood disorders, predicted the onset of alcohol and/or cannabis use disorders. The authors note that this finding underscores the need for early treatment of social anxiety disorder in order to reduce the likelihood of future substance use disorders.

What were the goals of this study?
The main goals of the study were the following:
1. To examine the rate of co-occurrence (or comorbidity) between specific anxiety disorders and alcohol and/or cannabis use disorders
2. To investigate whether specific anxiety disorders predicted the onset of alcohol and/or cannabis use disorders.
3. Lastly, the authors wanted to make sure that any associations between social anxiety disorder in adolescence and the later development of alcohol and/or cannabis use disorders was not due to other important variables known to be related to substance use behaviors (e.g., rule-breaking behaviors in adolescence, gender). In addition, they wanted to verify that these associations were not due to the influence of other anxiety and/or mood disorders, which often co-occur with social anxiety and substance use disorders.

How did the authors examine the study goals?
The authors examined the study goals by collecting data over time, in a prospectively-designed study. They randomly sampled high school students in Oregon and assessed them on a number of important variables and then followed-up with these individuals at
three additional time points. This design allowed the authors to examine how diagnoses of social anxiety disorder and other anxiety/mood disorders in adolescence were related to alcohol and/or cannabis use disorders at ages 24 and 30.

What were the main findings from this study?
There were three main findings:
1. Anxiety disorders were associated with alcohol and/or cannabis use disorders, that is, these two groups of disorders did tend to co-occur. More specifically, social anxiety disorder and panic disorder were associated with alcohol dependence, but not abuse. Similarly, social anxiety disorder was associated with cannabis dependence, but not abuse.
NOTE: The authors noted that they made this distinction between abuse and dependence because (1) dependence is often regarded as a more a severe diagnosis with more stable substance use and (2) other studies have found that social anxiety disorder is more related to dependence, than abuse.
2. Social anxiety disorder was found to predict the onset of alcohol and cannabis use disorders. This was not found for other anxiety disorders or mood disorders.
3. Importantly, the authors found that social anxiety disorder predicted the development of alcohol and cannabis use disorders even after controlling for other important variables, other forms of psychopathology, and other early substance use disorders.

What are the implications of this study?
The results of this study suggest that social anxiety disorder represents a unique risk factor for the later development of alcohol and cannabis use disorders. In particular, Buckner et al. (2008) noted that social anxiety disorder represented a unique risk factor for alcohol and cannabis dependence. In discussing why these associations exist, the authors noted that individuals with social anxiety disorder likely use alcohol and cannabis in an attempt to reduce their anxiety in social situations. This point is important for families to understand: individuals with social anxiety may use substances, such as alcohol and cannabis, to try to cope with anxiety. Indeed, experimental studies have found that both of these substances can have a calming effect that temporarily reduces anxiety (Bergamaschi et al., 2011; Sripada, Angstadt, McNamara, King, & Phan, 2011). Despite the ability of these substances to temporarily reduce anxiety, persistent use of these substances is associated with numerous long-term problems, such as substance use disorders (Buckner, Heimberg, et al., 2012), substance-related problems (Buckner, Zvolensky, & Schmidt, 2012), and greater psychiatric impairment (Buckner, Heimberg, et al., 2012).

What does this all mean for my child with social anxiety disorder?
The results of this study mean that individuals with social anxiety disorder are at an increased risk for developing an alcohol and cannabis use disorder. In other words, this does not mean that your child will develop a problem with these substances, only that they have an increased risk.

What can I do to help my child?
Understand that individuals with social anxiety need help learning how to cope with anxiety and that early treatment is best. These substances can temporarily reduce anxiety, which means that sufferers of social anxiety may find them particularly enjoyable and may want to use them as a coping tool. However, it is important to remember that the use of these substances is related to a number of problems and therefore they should not be used as a coping tool.

As the authors of this study noted, treating social anxiety disorder early may reduce the risk for later substance problems. Therefore, working with your child and their mental health care provider to reduce their social anxiety symptoms is key. In addition, you may find it useful to talk with your child’s mental health care provider and with your child (depending on their age) about the potential for problems with alcohol and cannabis use.

How can I learn more about this study?
If you would like to learn more about this study, please click the following link:


Bergamaschi, M. M., Queiroz, R. H. C., Chagas, M. H. N., de Oliveira, D. C. G., de Martinis, B. S., Kapczinski, F., . . . Crippa, J. A. S. (2011). Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naive Social Phobia Patients. Neuropsychopharmacology, 36(6), 8.
Buckner, J. D., Heimberg, R. G., Schneier, F. R., Liu, S.-M., Wang, S., & Blanco, C. (2012). The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence, 124(1-2), 128-134. doi: 10.1016/j.drugalcdep.2011.12.023
Buckner, J. D., Schmidt, N. B., Lang, A. R., Small, J. W., Schlauch, R. C., & Lewinsohn, P. M. (2008). Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research, 42(3), 230-239. doi: 10.1016/j.jpsychires.2007.01.002
Buckner, J. D., Zvolensky, M. J., & Schmidt, N. B. (2012). Cannabis-related impairment and social anxiety: The roles of gender and cannabis use motives. Addictive Behaviors, 37(11), 1294-1297. doi: 10.1016/j.addbeh.2012.06.013
Sripada, C. S., Angstadt, M., McNamara, P., King, A. C., & Phan, K. L. (2011). Effects of alcohol on brain responses to social signals of threat in humans. [Controlled Clinical Trial
Research Support, N I H , Extramural
Research Support, Non-U S Gov’t]. Neuroimage, 55(1), 371-380.

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