Social Anxiety Disorder and Substance Abuse

Social anxiety and alcohol addiction are especially common co-occurring conditions. Substance abuse can induce social anxiety, but more commonly, people who have both conditions develop social anxiety disorder first.

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 likelihood 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 This cycle can cause people to become more withdrawn, making it harder to recover from either condition.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. Like 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 likely 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 likely 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 like 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 likely to develop cannabis dependence and 4.5 times more likely 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 like 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.

Editor – Jennifer Kopf

Jennifer Kopf is a Florida-based writer who likes to balance creative writing with helpful and informative pieces. Her passion for helping people has translated into writing about the importance of treatment for substance use and mental health disorders. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more