The Relationship Between Social Anxiety and Alcohol Abuse

Social Anxiety Disorder & Substance Abuse — The Recovery Village Drug and Alcohol Rehab

The Relationship Between Social Anxiety and Alcohol Abuse

Social anxiety and addiction frequently follow from one another. Social anxiety and alcohol addiction are especially common co-occurring conditions. Substance use can cause substance-induced social anxiety, but more commonly, people who have both conditions develop social anxiety disorder first.

Research shows that having an anxiety disorder increases the lihood a person will develop a substance use disorder. This finding is unfortunate because using substances interferes with recovery from social anxiety. Social anxiety symptoms can complicate the recovery process from substance use disorders.

Effects of Substance Abuse on Social Anxiety Disorder Symptoms

Some substances trigger an immediate increase in anxiety levels, while others provoke it as a residual effect. Marijuana, hallucinogens and stimulants can induce anxiety while the effects of the drugs are active. Withdrawal symptoms from alcohol, opiates and sedatives often include anxiety.

Anything that increases anxiety intensifies the symptoms of an anxiety disorder. People who use substances to gain relief from social anxiety often use them when they are alone or with a limited number of people. They might seek more social activity while substances are affecting them, but if the effects wear off while they are socializing, they can experience a sudden onset of anxiety.

If people suffer any humiliation while socializing under the influence, it can cause their social phobia to get worse.

Similarly, recurrent experiences of anxiety during the withdrawal phase can trigger anxious thinking and lead a person to develop even more socially phobic beliefs and thought patterns.

This cycle can cause people to become more withdrawn, making it harder to recover from either condition.

Social Anxiety Disorder and Alcohol

Social anxiety disorder and alcoholism are, unfortunately, strongly linked. Alcohol provides temporary relief from social anxiety symptoms, lowers anxiety levels and reduces social inhibition. Unfortunately, the temporary nature of this relief can cause a range of problems.

People under the influence of alcohol often do things they find embarrassing; remembering these events can become part of the social anxiety disorder cycle of anxious thinking.

Anxiety also typically increases as the effects of alcohol wear off, in what is sometimes called a boomerang effect.

The research revealed that while social anxiety disorders nearly always develop first, social anxiety associated with significantly higher rates of alcohol use disorders. Higher instances of co-occurring psychiatric conditions, greater severity of alcohol-related problems and lower rates of engagement in treatment link to comorbid disorders.

Social Anxiety Disorder and Marijuana

Marijuana and anxiety disorders also have a clinically significant relationship. Cannabis can have an immediate calming or dissociative effect that relieves anxiety temporarily or at least makes it less distressing.

However, high doses of marijuana frequently trigger anxiety and paranoia, immediately intensifying the symptoms of social anxiety disorder. alcohol, marijuana can also cause higher levels of anxiety in periods between use.

In one study, 26% of people in a treatment group for marijuana-related problems had co-occurring social anxiety disorders. These conditions led to increased cognitive and behavioral problems.

Other studies showed that people who have a pre-existing social anxiety disorder have more marijuana-related problems and are more ly to continue using marijuana even when they have negative expectations about the effect it will have on their symptoms.

Social Anxiety Disorder and Stimulants

Stimulants work by driving the sympathetic nervous system into action. This internal process is what triggers the fight-or-flight response and the release of adrenaline, which links to the subjective experience of anxiety. When environmental stimuli do not cause this response, it can result in prolonged anxiety.

Cases of stimulant-induced social phobia may be explained not only by this basic cause-and-effect relationship but also by the long-term dopamine depletion caused by stimulant abuse.

Drug Abuse as a Hindrance to Social Anxiety Disorder Treatment

Substance use can interfere with the treatment of social anxiety in many ways. Active use often makes people who have social anxiety disorders become even more avoidant and withdrawn. If they begin therapy for their anxiety before starting to use substances, they are ly to stop going as substance use progresses into addiction.

People may take actions they wouldn’t otherwise take because of progressive substance use. These actions and their unintended consequences can become significant sources of shame.

The understanding gained in recovery can make sense of these events and alleviate self-blame.

However, before recovery begins, these experiences tend to reinforce the cognitive distortions linked with social anxiety disorder.

Taking actions that trigger self-accusation and shame can reverse the progress made in cognitive behavioral therapy (CBT).

Therapists might try to help clients who have social anxiety and a co-occurring substance use disorder try to understand that addiction is a disease, not a moral failing, but this is difficult when active substance use is impacting a person’s cognitive and emotional functions.

Under these circumstances, therapy can become a prolonged cycle of crisis management and damage control, instead of a journey of progressive recovery.

Drug Abuse as a Cause of Social Anxiety Disorder

It is rare for a social anxiety disorder to develop later in life, but it is possible.

Environmental or physical causes chronic stress, medical conditions, hormone imbalances and substance use can trigger anxiety symptoms in people who did not have them before.

If these symptoms arise in contexts that cause people to attribute them to social situations, they can develop into a social anxiety disorder.

The feelings of shame complicate this predicament that many people develop from addiction. Due to the social stigma, people often see their substance use as a moral failure rather than as an abnormal survival strategy or a disease rooted in neurochemistry.

A major component of social anxiety disorder is the fear of or actual experiences of negative judgment for using substances, which can cause people to become more withdrawn and anxious. In some cases, this can develop into clinical levels of social phobia.

Statistics on Social Anxiety Disorder and Drug Abuse

  • There have been several studies conducted to learn more about social anxiety disorder and drug addiction, some of the statistics that were uncovered include: Nearly 20 percent of people who have a social anxiety disorder also have a co-occurring alcohol use disorder.
  • Almost 80 percent of people with both had social anxiety disorder before they developed an alcohol use disorder.
  • People who have social anxiety disorder are 5 times more ly to develop cannabis dependence and 4.5 times more ly to develop alcohol dependence.
  • At least 10 percent of people with cannabis use disorders have a lifetime prevalence of social anxiety disorder.

Treatment for Social Anxiety Disorder with Co-Occurring Substance Use Disorders

An integrated approach best serves simultaneous treatment of both social anxiety and substance use disorders. Ideally, all treatment services are provided by the same organization, through an integrated approach is possible if treatment providers coordinate their interventions.

A clinical review advises that, in addition to integrated treatment, it is important to treat co-occurring anxiety and substance use disorders with interventions that minimize the use of medication.

This approach can help break the “self-medication cycle” and facilitate the adoption of new coping strategies, helping clients learn how to regulate their emotions and manage their anxiety on their own.

Cognitive behavioral therapy (CBT) is recommended as the most effective therapeutic intervention for both social anxiety and substance use disorders. These co-occurring conditions can be targeted together in CBT groups or separately in a group and individual therapy.

If you or someone you know is struggling with a substance use or co-occurring disorder social anxiety, help is available. At The Recovery Village, a team of professionals provides a continuum of care for substance use and co-occurring disorders. Call and speak with a representative to learn more about which treatment program could work for you.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes.

We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment.

It should not be used in place of the advice of your physician or other qualified healthcare provider.

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Visions Journal

The Relationship Between Social Anxiety and Alcohol Abuse

When you feel shy while at a party full of strangers, do you sometimes reach for a glass of wine or a cold beer to help you ‘loosen up’? If so, you are not alone.

Many people who are socially anxious use alcohol to decrease their anxiety and to cope better with social situations.

While it may be common to occasionally use alcohol for a temporary boost of “liquid courage,” research suggests that the link between alcohol and anxiety is not always so straightforward.

A brief look at anxiety

Everyone knows what it is to feel anxious—butterflies in the stomach, rapid heart rate, dry throat, and racing thoughts. Anxiety is the most common mental health concern, with one in 10 people suffering from levels of anxiety that are problematic and significantly disruptive to their daily lives.

While occasional feelings of anxiety are common, anxiety that is debilitating, intense and long-lasting is characteristic of an anxiety disorder. Some of the more common examples of anxiety disorders are social anxiety disorder; panic disorder (with or without agoraphobia—i.e.

, the fear of public places and/or of going outside, which often results in the sufferer becoming housebound); generalized anxiety disorder; and specific phobias. Untreated anxiety can lead to continued avoidance of anxiety-provoking situations and missed opportunities, creating a significantly decreased quality of life.

Fortunately, with the right kind of professional help, anxiety disorders are treatable for the vast majority of people.

The anxiety–alcohol connection

Researchers have found that the risk for having either an anxiety disorder or alcohol use disorder is about three times greater if the other disorder is present.

This is particularly true for people with social anxiety disorder (SAD), with one in five people also meeting the criteria for an alcohol use disorder (i.e., alcohol abuse or dependence).

Socially anxious individuals report finding temporary relief from debilitating shyness and self-consciousness when consuming alcohol, and thus are more ly to use alcohol as an anxiolytic (i.e., it reduces feelings of anxiety).

In this way, alcohol quickly becomes a means of coping or of self-medicating. Once alcohol has become a primary coping mechanism for people with SAD, alcohol dependency may be close behind.

Over time, these socially anxious individuals may require increasingly higher doses of alcohol.

SAD usually begins early in the adolescent years (and therefore precedes alcohol dependency), so clinicians have a valuable window of opportunity to treat SAD before alcohol dependency begins.

A vicious cycle

Although it makes sense that anxiety symptoms can lead to alcohol dependence, in fact, the opposite can be true as well. Both long-term alcohol misuse and alcohol withdrawal can significantly increase anxiety levels.

One study of American war veterans in an alcohol treatment program found that 98% reported at least one symptom of anxiety during drinking or withdrawal, with 80% experiencing heart palpitations and/or shortness of breath, and 4% experiencing at least one panic attack.

When feelings of anxiety are a consequence of heavy drinking, alcohol is said to be acting as an anxiogenic (i.e., it creates feelings of anxiety).

Unfortunately, it is during this uncomfortable time of heightened anxiety that an individual is most tempted to use alcohol to self-medicate.

As Matt Kushner, a leading researcher in the area of anxiety and alcohol describes: “[D]rinking leads to greater anxiety, which in turn, leads to more drinking. Once this vicious cycle is firmly in place, which disorder is operating as the cause and which is the effect becomes murky.

Alcoholics may begin to experience panic attacks for the first time when withdrawing from alcohol. Declining blood-alcohol levels cause feelings of having ‘shakes and sweats,’ which can be very similar to the physiological symptoms of anxiety.

During the withdrawal period, anxiety is most ly caused by neurochemical changes as well as environmental/life stressors.

Not surprisingly, individuals diagnosed with panic disorder often avoid alcohol because of their extreme sensitivity to changes in their bodily sensations.

To summarize, the relationship between alcohol and anxiety can be described as a >reciprocal causal relationship, which means that anxiety disorders lead to alcohol dependence, and alcohol dependence lead to anxiety disorders.

Issues in treatment

For individuals suffering from co-occurring alcohol use disorder and anxiety, pharmacological and/or psychological interventions (e.g., cognitive-behavioural therapy, which looks at the role of thinking in how a person feels and behaves) are the two means of treatment.

However, what disorder should be treated first is not always immediately clear. Some evidence suggests that the alcohol use disorder should be the first line of treatment, since drinking is often used to avoid feelings of anxiety.

8 When deciding on a treatment plan, it is essential for clinicians to establish whether or not both clinical problems are present and, whenever possible, to ascertain which disorder developed first.

Fortunately, research in this area continues to grow, helping researchers and clinicians better understand the factors that contribute to the development and perpetuation of these frequently co-occurring issues.

Stephenie has a master’s degree in counseling psychology. She has worked on several research projects involving evidence-based programs for child and adolescent anxiety, and is currently developing resources for the Anxiety Disorders Association of British Columbia (ADABC)


Associations of Social Phobia and General Anxiety with Alcohol and Drug Use in A Community Sample of Adolescents

The Relationship Between Social Anxiety and Alcohol Abuse

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Aims: This study explores whether associations between anxiety and alcohol and other substance use are already evident in middle adolescence, and whether general anxiety or symptoms of social phobia affect continuity of frequent alcohol use, frequent drunkenness and cannabis use. Methods: Data from the Adolescent Mental Health Cohort Study, a school-based Finnish survey among adolescents aged 15–16 years at baseline, was utilized to assess prevalence, incidence and continuity of symptoms of social phobia, general anxiety, frequent alcohol use, frequent drunkenness and cannabis use (which in this context was smoked ‘hashish’ of unknown constituency), and the associations between the substance use variables and the anxiety variables in 2-year follow-up. Results: Anxiety preceded substance use while no reciprocal associations were observed. Depression mediated the associations between anxiety and substance use. Symptoms of social phobia did not elevate the incidence of substance use, but general anxiety did. Frequent drunkenness was less significantly associated with anxiety than the other two substance use variables. Co-morbid general anxiety increased the persistence of frequent alcohol use while co-morbid social phobia decreased its persistence. Continuity of frequent drunkenness and cannabis use were unaffected by co-morbid anxiety. Conclusions: General anxiety in middle adolescence places adolescents at risk for concurrent and subsequent substance use. The risk may, however, be associated with co-morbid depression. Social phobia in middle adolescence may protect from substance use. Adolescents with internalizing symptoms may need guidance in coping with the symptoms even if the symptoms do not fulfil the criteria of mood or anxiety disorder.

Three stages of adolescence, early, middle and late, are experienced by most individuals, but the age at which each stage is reached may vary. These different rates of maturation are connected to physical and cognitive development, and hormone balance.

Middle adolescence (age 15–17 years) is the time when the proportion of alcohol users increases (Duncan et al., 2006; Lintonen et al., 2000).

While for a majority of persons initiating heavy alcohol consumption in middle adolescence the behaviour may subside towards young adulthood (Maggs, 2005), early age of onset of frequent alcohol use may signal later development of alcohol dependence (Grant et al., 2006).

Also, regular cannabis use in adolescence may link with a higher tendency for continuation into adulthood (Patton, 2002; Perkonigg et al., 2008). Co-morbid behaviour-internalizing disorders may be related to trajectories characterized by steep increases in illicit substance use during adolescence and high rates of illicit substance use over time (Lansford et al., 2008).

Anxiety symptoms tend to increase from middle adolescence to late adolescence (Van Oort, 2010).Anxiety disorders have repeatedly been found to be associated with alcohol misuse and substance use disorders. Longitudinal studies suggest that anxiety disorders usually precede substance use problems (Buckner et al., 2008; Costello et al.

, 2003; Deas, 2006; Zimmermann, 2003). The self-medication theory suggests that alcohol and other substances may be used to alleviate symptoms of anxiety (Gilman, 2008; Sher, 2005; Viveros et al., 2005).

An alternative order of progression may be explained by substance use altering brain functions, making them more vulnerable to stress, thus creating a state of anxiety (Wand, 2008). The order of progression is, thus, not yet fully understood.

Since both substance use and anxiety may peak in adolescence, longitudinal studies using pure adolescent samples may be needed to ascertain the order of progression. Further, the natural course of these symptoms can only be studied in community samples.

According to the Diagnostic and Statistical Manual on Mental Disorders, 4th edition (DSM-IV), seven types of anxiety disorders can be distinguished in children and adolescents (Bernstein, 1997). Of these, among the most important clinically are social phobia and generalized anxiety disorder.

The core symptom of social phobia is a marked and persistent fear of one or more types of social situations, leading to excessive anxiety or avoidance of such situations. Generalized anxiety disorder is characterized by disproportional, uncontrollable and often irrational worry about everyday matters.

Because of the differences in symptomatology, specific types of anxiety disorders may have different kinds of associations with substance use. General anxiety may, for example, lead to self-medication with alcohol, while social phobia may lead to avoidance of noisy, drinking peer groups, thus decreasing the urge to drink alcohol.

Cross-sectional studies have suggested that social anxiety may be associated with lower levels of substance use (Myers, 2003; Stewart, 2006). With regard to prospective studies, most have follow-up periods spanning from middle or late adolescence to adulthood, typically assessing substance use outcomes in adulthood.

In general, these studies suggest that some anxiety disorders are associated with subsequent alcohol misuse or substance use, while others are not (Buckner et al., 2008; Zimmermann, 2003), and that the associations may not be reciprocal (Patton, 2002).

Also, associations between a specific type of anxiety and different substance use variables may vary. A recent report suggests an association between alcohol abuse and anxiety disorders but not between cannabis abuse and anxiety among adolescents (Low et al., 2008).

The associations between anxiety disorders and substance use may be modified by such factors as developmental stage or legal regulations governing access to alcohol. In Finland, alcohol purchase and possession is prohibited for adolescents under the age of 18 years.

Despite this, a significant percentage of adolescents report using alcohol (Lintonen et al., 2004), meaning they have to make special arrangements with older adolescents or adults to obtain access to alcohol.

Cannabis is an illegal drug in Finland, yet repetitive use of cannabis is reported by 14–22% of middle adolescents (Korhonen, 2008; Poikolainen, 2001). Social phobia may, however, be hypothesized to hinder purchasing illegal drugs.

This study explores whether associations between anxiety and alcohol and other substance use are already evident in middle adolescence, and whether general anxiety or social phobia affect continuity of frequent alcohol use, frequent drunkenness and cannabis use. Using a community sample of adolescents aged 15–16 at baseline, and followed up for 2 years, the study posed four questions:

  • (a) Are symptoms of social phobia and general anxiety associated with current and subsequent alcohol and cannabis use?
  • (b) Are the associations of anxiety with substance use different by the type of anxiety (general anxiety vs. symptoms of social phobia)?
  • (c) Do the associations differ by type of substance use?
  • (d) Do co-morbid conditions show stronger continuity than non-co-morbid conditions?


The present study is part of an ongoing prospective follow-up study entitled the ‘Adolescent Mental Health Cohort Study’.

Ninth grade students (aged 15–16 years) from all Finnish-speaking secondary schools in two Finnish cities, Tampere (200,000 inhabitants) and Vantaa (180,000 inhabitants), filled in a person-identifiable questionnaire during a school lesson supervised by a teacher.

The questionnaires were returned in sealed envelopes and collected by a member of the research team. Thus, the teacher did not have access to the responses. Questionnaires with two reminders were mailed to students absent from school on the day of the survey.

The final T1 sample consisted of 1609 girls and 1669 boys, with a mean age of 15.5 (SD 0.39). The response rate was 94%. The procedures for the baseline (T1) data collection are described in detail elsewhere (Fröjd et al., 2006).

Subjects responding to the first survey were contacted through their current educational institutes, by post and finally through the Internet to seek their participation in the 2-year follow-up survey (T2). A total of 2082 responses were received. Two participants responded twice, once at the educational institute and once on the Internet, and so their Internet responses were excluded.

Ten respondents were excluded as they were judged by the researchers to have been completed facetiously. The final T2 sample (2070 respondents) represented 63% of the adolescents who responded to the first survey, with a mean age of 17.6 (SD 0.41). Of the surveys received, 54% were completed while at educational institutes, 44% were sent by post and 2% were completed via the Internet.

Sample and dropout

The sample consisted of 903 boys and 1167 girls. Of the adolescents, 27% lived in a non-intact family and 34% in families where neither of the parents had completed college or high school.

Of the adolescents, 10% consumed alcohol at least once a week, 3% reported frequent drunkenness, 3% reported cannabis use, 4% exceeded the cut point for general anxiety and 9% exceeded the cut point for social phobia at baseline.

Dropout from follow-up

Altogether 28% of the girls and 46% of the boys responding to the baseline survey dropped out in the follow-up. Attrition was significantly associated with the adolescents’ socio-demographic background and also with the outcome variables. Those with an intact family (65 vs. 58%; P 


Does Social Anxiety Disorder Cause Substance Abuse?

The Relationship Between Social Anxiety and Alcohol Abuse

Social anxiety disorder is also known as social phobia. It’s a form of anxiety disorder that induces feelings of extreme fear in social settings. People who have social anxiety disorder struggle to:

  • Talk to people
  • Make new friends
  • Attend social events and gatherings

They have a deep-rooted fear of being judged, mocked, or otherwise scrutinized. If you have social anxiety, you might understand that your concerns are unreasonable and still be helpless to overcome them.

Social anxiety disorder is very common: 15 million American adults have this condition. And it’s not the same as shyness, which tends to be short-term and non-disruptive and can be overcome with encouragement and effort. Social anxiety disorder is chronic, debilitating, and persistent. Until it’s treated, you will ly have trouble working, going to school, or developing new relationships.

Symptoms and Characteristics of Social Anxiety

The symptoms of social anxiety disorder show how this can be a very serious condition:

  • Nausea
  • Difficulty speaking
  • Dizziness
  • Excessive sweating
  • Trembling
  • Rapid heart rate

You may obsess over social interactions, worrying intensely before a social event. At worst, you may go your way to avoid social situations, and if you attend, you’ll do your best to go unnoticed and obsess about your performance afterwards.

The fear behind social anxiety is rooted in a fear of embarrassment—on a much deeper level than simple stage fright. Social anxiety disorder often feeds on itself.

You worry that others might notice you’re anxious or stressed, which can cause even more anxiety.

Some people turn to alcohol or drugs to work up the courage to interact with others because some substances depress the nervous system and lower inhibitions. This can help them feel they’re overcoming the anxiety.

A certain level of anxiety in social situations is normal and might even be healthy. But social phobia pushes the anxiety to extreme levels. It leaves you with a pathological fear of being judged and humiliated. When social anxiety reaches these levels, you might even skip important situations and events, :

  • Job interviews
  • Grocery shopping
  • Using public restrooms
  • Going on dates
  • And more

What makes social anxiety disorder even more difficult to live with (and diagnose) is that its symptoms may not appear in all situations. You might be fine when talking to strangers but experience crippling symptoms when going on a date. You can’t choose when and how your symptoms appear, and you don’t necessarily know which activities will be harder than others.

What Causes Social Anxiety Disorder?

Social anxiety stems from both your biology and your environment, many other mental health disorders.

Factors might include:

  • A family history of social phobia – Anxiety disorders tend to be genetic, the presence of social anxiety in your relative doesn’t mean the condition will develop in you.
  • Brain structure – The amygdala, the region of the brain responsible for emotional processing and decision-making, may play a role in controlling anxiety. People with well-functioning amygdalae will ly react reasonably to stressful situations. But if your amygdala misfires or is overactive, you will probably experience more fear in general. This fear extends even to non-threatening events and situations, social settings.
  • Environment and setting – It’s possible social anxiety disorder is a learned behavior. This means some people develop the condition after a distressing social situation. Children may develop social anxiety after watching their parents display socially anxious behavior. Parents who are overprotective or controlling may instill social anxiety in their children.

What Is the Relationship Between Social Anxiety and Substance Abuse?

There’s often a connection between social anxiety and substance abuse. Social phobia and alcohol addiction, for instance, are very common co-occurring conditions. Research suggests having an anxiety disorder can increase your chances of developing a substance use disorder.

Children who’ve been severely bullied or otherwise abused may be prone to developing social anxiety disorder in adulthood. Other kinds of trauma, family conflict or sexual or physical abuse, can make children very scared of other people. Trauma can also lead to substance abuse.

Some drugs cause an anxiety response, such as methamphetamine and hallucinogenics. But the type of anxiety they create is usually more paranoid than anxiety about social situations. Even so, it’s important for drug-induced anxiety to be ruled out before determining whether social anxiety is co-occurring with substance abuse.

Some drugs, alcohol and opioids, can also cause generalized anxiety during withdrawal. Under the right circumstances, this could develop into a full-blown anxiety disorder.

It’s also possible for someone to present with the symptoms of social anxiety disorder for the first time after getting sober, simply because they’ve been using substances to cope with their social anxiety symptoms and no longer have those substances to fall back on.

Social Anxiety and Substance Abuse: A Dual Diagnosis

Having a mental health and substance abuse condition at the same time is called a dual diagnosis. Both diagnoses should be treated at the same time, rather than one after the other.

This is because when the two conditions combine, they form a new set of problems that needs its own unique interventions.

Treating them separately will ly cause a relapse on whichever condition was treated first.

Many drug and alcohol treatment programs offer specialized treatment plans for dual diagnosis. In one of these programs, you will learn how you developed an addiction to substances. You will also learn the exact ways your substance use has served you. Once you identify your unhealthy coping skills, you can replace them with healthier ones that you learn in treatment.

Anxiety, especially when it has been covered up by substance abuse, can cause a person to spiral after becoming sober. The dual diagnosis treatment approach is beneficial because it’s a supportive recovery community that can help keep you grounded. Otherwise, you might be tempted to give up. When getting sober, you need to have strong coping skills and a supportive environment at the ready.


People with social anxiety disorder have a 20% chance of also having alcohol problems. Many drink to lower their inhibitions so they can feel more comfortable in social situations.

Unfortunately, some people behave in embarrassing ways under the influence of alcohol. This can be especially hard if you have social anxiety.

The memory of acting un yourself while under the influence can push social phobia to extreme levels and may even lead to more substance abuse.

In a boomerang effect, anxiety can also increase as the effects of alcohol wear off. This is the result of fluctuations in brain chemistry.


Research has found significant connections between marijuana and anxiety disorders. alcohol, cannabis can temporarily calm anxiety. Many users report feeling dissociated, or disconnected, from their usual anxiety.

At higher doses, cannabis can induce anxiety and paranoia, which can make social anxiety worse. As with alcohol, cannabis can also induce higher levels of anxiety between periods of use.

A study in the Depression and Anxiety journal showed that 107 marijuana users, 26% had social anxiety disorders.

Patients experienced worsening cognitive and behavioral problems because of how the conditions interacted. Other studies show that people who have social anxiety disorder use more cannabis.

They’re more ly to continue using it even when they know it will make their symptoms worse.


Stimulants are effective because they jumpstart your sympathetic nervous system. This is what activates the release of adrenaline and your flight-or-fight response. These responses are connected to how you experience anxiety. Things in your environment can naturally cause your fight-or-flight response, but stimulants can make the anxiety response last much longer.

Healthier Ways to Manage Anxiety

Anxiety is a normal—even healthy—response to stress. Without anxiety and adrenaline, your body and mind cannot overcome adversity. Human beings evolved as a social species, so it’s natural to be concerned about what others think of you.

But nature and nurture can inflate these perfectly healthy feelings to overwhelming degrees. Social anxiety disorder distorts the reality of your environment, setting, or situation. The phobia exaggerates any sense of danger or consequences. But you can learn to manage your social anxiety by identifying your exaggerated thoughts and changing them.

Relabeling & Breathing

One way to cope is by relabeling. In many ways, anxiety and excitement are two sides of the same coin, and they have many symptoms in common. The surge of adrenaline is usually associated with anxiety. Through practice and training, you can change the thought from, “I’m anxious” to, “I’m excited.” A quick relabeling this can empower you.

Breathing exercises are a great way to cope with social anxiety. Most people feel that when their anxiety starts to kick in, it will uncontrollably spiral. But practicing diaphragmatic breathing is clinically proven to ease anxiety. It involves slow, deep breaths from the stomach.

With practice, breathing to control anxiety can become natural and even easy. Part of the process is being aware of your breathing when you feel an anxiety attack coming on. Then you learn to implement the breathing techniques to get the anxiety under control.


Grounding is a way of shifting mental focus to think less about your anxiety symptoms. Instead, you focus on anything else: the task at hand or things around you.

This is a mechanism of acceptance and commitment therapy, which posits that certain experiences are worth the anxiety.

Patients are encouraged to endure distressing feelings in order to continue making the most of their lives.


Identifying your anxious thoughts and changing them isn’t easy to do! And some people have severe social anxiety disorder that cannot simply be “thought” around. This is where therapy can be vital. A psychologist teaches you to control your anxious thoughts. You can learn to see through them to the reality of the situation, not what anxiety wants you to see.

If you’re struggling with social anxiety and substance abuse, it’s crucial to treat both disorders at the same time. Many of the therapies that help with addiction also help with social anxiety. To learn more about treating these co-occuring disorders, contact Footprints to Recovery today.



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