Truth or Perception: A Deeper Understanding of Social Anxiety and Alcohol Abuse
One of my favorite memories as a child is watching Dick Van Dyke dance across London’s rooftops in Mary Poppins, covered in soot and grinning from ear to ear. His exuberance and energy were infectious, and joy seemed to radiate through him. It can be hard to reconcile the image of that seemingly gregarious man with the one Van Dyke spoke of recently in an interview with Oprah Winfrey, where he opened up about his battle with alcoholism. His drinking, he says, began as a way of coping with overwhelming social anxiety. “I was very shy—with strangers—I couldn’t talk to people,” he told Winfrey. “And I found if I had a drink, it would loosen me up. The barriers went down and I became very social. That’s what got me started.”[1. https://www.thefix.com/dick-van-dyke-says-social-anxiety-led-battle-alcoholism]
Van Dyke’s story may be surprising, but it is not unique; alcohol has been the treatment of choice for countless people struggling with social anxiety disorder across cultures and eras. As Donald Horton famously wrote in 1943, “The primary function of alcoholic beverages in all societies is the reduction of anxiety.”[2. https://books.google.ca/books?id=2AUH0vchHRIC&dq=the+primary+function+fo+alcohol+beverages+in+all+societies+is+the+anxiety&source=gbs_navlinks_s] Alcohol’s reputation as a social lubricant makes it seem like a logical choice for many to cope with feelings of social fear:
I have a tendency to binge drink. I feel that I do this because I am a shy, inhibited person, and I just love that it helps me interact freely with others without feeling self conscious or thinking too much. [2. http://ask.metafilter.com/69148/I-use-drinking-to-manage-social-anxiety]
I pretty much owe my social life to alcohol.[3. http://www.socialanxietysupport.com/forum/f26/does-alcohol-help-125122/]
I can’t seem to be comfortable talking to anybody unless I drink…not even my friends. Whenever my friends come around the first thing I do is grab a beer so I don’t feel awkward.[4. http://www.mentalhealthforum.net/forum/thread48108.html]
As a result of this powerful connection between alcohol and social anxiety, at least 28% of people with social anxiety disorder also experience alcohol use disorder at some point in their lives.[5. https://www.psychologytoday.com/blog/the-new-grief/201310/social-anxiety-and-problem-drinking-the-connection] But what if the relationship between social anxiety and alcohol abuse is more complex than we assume?
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Self-Medication as a Predictor of Social Anxiety Disorder
A study published in the Archives of General Psychiatry in 2011 examined the relationship between anxiety and self-medication with alcohol. Researchers at the University of Manitoba found that “people with diagnosed anxiety disorders who self-medicated at the start of the study were two to five times more likely than those who did not self-medicate to develop a drug or alcohol problem within three years.”[6. http://www.cnn.com/2011/HEALTH/08/01/alcohol.anxiety.risky.health/] More surprisingly, people who used alcohol to treat subclinical anxiety levels were significantly more likely to develop full-blown social anxiety disorder by the end of the study. This predictive relationship between self-medication and the emergence of a clinically validated diagnosis was unique to social anxiety disorder. Self-medication did not predict any other types of anxiety disorders except for panic disorder, and then only in a very limit subset of research subjects. The study’s findings are particularly significant because social anxiety disorder typically emerges in early childhood; alcohol’s ability to trigger the disorder in adults profoundly changes the way we understand the evolution of the illness. The authors of the study propose several possibilities to account for this phenomenon:
One explanation may be that these individuals had preexisting subthreshold social phobia that was exacerbated by other drug use. Substance use may, therefore, cause existing social anxiety symptoms to reach clinically significant levels in self-medicating individuals. Another possibility is that the social unacceptability of substance use may create a desire to avoid social contact in those who actively use other drugs.
In other words, using alcohol to ease normal feelings of anxiety may cause social anxiety. As such, developing the ability to cope with subclinical fears without self-medication and early intervention in new social anxiety disorder diagnoses may reduce the risk or severity of both alcohol addiction and social phobias.
The Power of Expectation
While the University of Manitoba study reveals that alcohol can have a damaging effect on social anxiety in the long-term, it is still widely assumed that it is genuinely effective in the short-term. However, studies began calling this common wisdom into question as early as 1977, when two researchers from Rutgers University examined the effect of alcohol on physiological social anxiety symptoms.[7. http://link.springer.com/article/10.1007%2FBF01186793] Participants were told that they would be receiving either vodka and tonic or tonic alone. In fact, half were given only vodka and half were given only tonic. After consuming the drinks, “subjects’ heart rates were monitored during a brief social interaction with a female confederate.” Upon analysis of the heart rate data along with the social anxiety questionnaires participants filled out before and after the interaction, the researchers found that:
Subjects who believed that they had consumed alcohol showed significantly less increase in heart rate than those who believed that they consumed tonic alone, regardless of the actual contents of their drinks. There was no effect of alcohol per se.
A number of subsequent studies also support the idea that expectations of anxiety reduction may produce placebo effects. Drs. Sarah Book and Carrie Randall of the Center for Drug and Alcohol Programs and Alcohol Research Center at the Medical University of South Carolina offer a hypothesis for the power expectation has to shape experience:
Positive expectancies that alcohol can relieve social fears may explain why some people experiment with alcohol as a coping strategy in the first place. If a person’s expectancy that alcohol reduces stress is left unchallenged, it may be a powerful enough belief system to explain why a person continues to use alcohol to relieve stress. Alternatively, one can argue that for a subgroup of socially anxious people alcohol may have a genuine pharmacological effect that results in decreased social anxiety. These individuals may have started drinking as a coping mechanism because of their positive expectancies, but they may continue to use alcohol because they associate alcohol consumption with symptom relief.
The fact that anxiety reduction is caused by perception rather than chemistry is of course largely irrelevant to the person seeking relief from acute social distress; they benefit regardless of the specific trigger for that benefit. However, the knowledge that the relief is caused by your own mind and not the alcohol itself is significant in terms of treatment potential and enhancing your sense of agency; if you can cope with your social anxiety disorder by altering your perception of unhealthy behaviors, you can also cope with it by engaging in positive, productive behaviors.
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Treating Social Anxiety Disorder and Co-Occurring Alcohol Abuse
If you are struggling with social anxiety and co-occurring alcohol abuse, it is likely that you require more intensive and specialized care than outpatient treatment can offer. Residential mental health treatment can be an intimidating prospect to many people suffering from social anxiety disorder; being surrounded by strangers and expected to participate in therapy groups may be the last thing you think you need. In reality, however, residential care is often exactly the place that you will find true healing and relief from psychological distress. At Bridges to Recovery, we offer a warm, inviting environment where you are treated with compassion, love, and kindness. Because we take a maximum of only six clients at a time, we are able to create a uniquely intimate and inclusive community. Our serene Los Angeles-based facilities offer plenty of spaces for private reflection and private accommodations are available for your comfort.
Most importantly, however, we offer personalized treatment of the highest quality to help you recover from both social anxiety and alcohol abuse. Our highly trained clinicians have the experience to guide you towards complete wellness using a unique mix of the most modern individual, group, and holistic therapies. We will support you towards ever-deeper levels of self-understanding and instill the coping skills you need to successfully face your fears, create meaningful emotional and behavioral change, and discover confidence to create the life you want. You are also welcome to attend off-site 12-step meetings several times a week to augment your recovery process.
Bridges to Recovery offers comprehensive residential treatment for people struggling with social anxiety and co-occurring alcohol abuse. Contact us for more information about how we can help you or your loved one start the journey toward healing.