Social Anxiety & Alcohol
Alcohol is among the most used substances socially anxious individuals consume in order to reduce their anxiety and arousal. While the rates for alcohol abuse and dependence are already high for the general population, they are significantly higher for people diagnosed with SAD (Kessler et al., 1997). Women with SAD have been found to display a greater risk for additionally suffering from an alcohol use disorder than men. In four out of five cases, social anxiety disorder develops prior to the substance use disorder (Buckner et al., 2008; Kushner et al., 2008, Marmorstein, 2012).
A significant proportion of SAD sufferers reports “self-medication” as their main drinking motive (Robinson, Sareen, Cox, & Bolton, 2009). Alcohol is often used in order to calm down before social events. Around half of SAD sufferers report engaging in drinking for this reason (Thomas, Randall, Book, & Randall, 2008). In the same study, eighty percent of people with SAD stated they had used alcohol to face and handle certain social situations.
Social Anxiety & Tobacco
Similar to drinking alcohol, smoking cigarettes has been socially accepted in Western countries. About every fifth person in the United States smokes (Lasser et al., 2000). For people suffering from SAD, the numbers double. It has been suggested that some SAD sufferers start smoking as an attempt to cope with their anxiety (Szafranski, Talkovsky, Farris, & Norton, 2014). For four out of five smokers with SAD, their social anxiety appeared before their smoking habit (Cougle et al., 2010).
Social Anxiety & Cannabis
Cannabis is among the most consumed substances in the world, ranking number three behind alcohol and tobacco in the United States (Tepe, Dalrymple, & Zimmerman, 2012; Conway et al., 2006). Among people with cannabis dependence, the probability of suffering from a psychiatric disorder at some point in their lives is considered to be around ninety percent (Agosti, Nunes, & Levin, 2002). Cannabis is also the most commonly consumed illegal drug among people suffering from social anxiety disorder (Conway et al., 2006). Almost every fifth person with SAD immerses in cannabis abuse. In fact, socially anxious people are much more likely to suffer from cannabis dependence than individuals suffering from other anxiety disorders (Agosti et al., 2002; Buckner, Schmidt, et al., 2008).
For more than half of SAD sufferers who also experience cannabis use disorder, their social anxiety had already appeared when they started smoking marijuana (Buckner, Schmidt, et al., 2008; Tepe et al., 2012). Just as with alcohol and tobacco use, it has been documented that SAD sufferers who consume cannabis tend to do so in order to calm down, reduce tension and anxiety, and improve their ability to deal with their social anxiety (Buckner, Heimberg, Matthews, & Silgado, 2012; Buckner, Bonn-Miller, Zvolensky, & Schmidt, 2007).
Since socially anxious people often rely on cannabis to reduce their tension and anxious states, a habit can be quickly developed. The correlation between SAD and cannabis dependence might exist because individuals start believing they need the substance in order to cope (Buckner, Schmidt, Lang, Small, Schlauch, & Lewinsohn, 2009). Thus, the likelihood of learning and engaging in more adaptive coping strategies decreases over time. The belief of being unable to cope without the substance leads to a significant risk of developing a dependence. The development of better and sustainable coping strategies should be addressed in the therapeutic process, in order to reduce the perceived need to keep consuming the drug.