Social Anxiety Disorder (Social Phobia) and Addiction

People who struggle with social phobia sometimes resort to substance use in an attempt to cope with their symptoms. Fortunately, treatment for social anxiety is available.

Social anxiety disorder (SAD) is challenging to manage, particularly when it is severe. Often, people who struggle with this condition become isolated as a result of their difficulties. Also known as social phobia, SAD can impact a person’s ability to work, attend school or go into public places, such as the grocery store. SAD goes beyond the fleeting fears of disapproval or nervousness that most people experience. Rather, it can get in the way of living a satisfying life and even cause someone to use drugs or alcohol in an attempt to self-medicate. 

An estimated 15 million people in the U.S. struggle with social anxiety disorder. In a study of 43,000 individuals, 17.7% of those with a substance use disorder also met the criteria for an anxiety disorder. Among people who had an existing anxiety disorder, 15% also had a co-occurring substance use issue. 

Because social phobia and substance use disorders often overlap and exacerbate one another, it is important to explore ways to treat both conditions simultaneously.

Effects of Substance Use on Social Anxiety Symptoms

Certain substances can worsen symptoms of social phobia. In some rare cases, substances can even cause social anxiety to emerge. Consider:

• Inhalant abuse is commonly associated with anxiety disorders and can increase or cause symptoms.
• Alcohol use can increase anxiety and symptoms like irritability and depression. These symptoms can emerge within a few hours or begin the next day in some cases.
• Marijuana can exacerbate anxiety symptoms, particularly when used excessively. High doses of marijuana can bring on anxiety reactions, even in long-term users.
• Stimulant misuse depletes dopamine stores in the brain, which can lead to increased social phobia symptoms or cause them to develop.

Social Anxiety Disorder and Alcohol

Research consistently demonstrates a close relationship between social anxiety disorder and alcohol misuse. Many individuals with social anxiety turn to alcohol as a quick, short-lived solution to ease their discomfort in social settings. This temporary relief lowers inhibitions and reduces anxiety but comes at a price. Under the influence, people may act in ways they later regret, fueling a cycle of self-conscious thoughts once they recall these incidents. Furthermore, as alcohol’s effects fade, anxiety often rebounds, a phenomenon sometimes referred to as the “boomerang effect.”

Studies suggest that social anxiety disorder generally appears before any alcohol use disorder develops. When both conditions co-occur, they are linked to higher rates of psychiatric conditions overall, more severe alcohol-related challenges and decreased engagement in treatment.

Social Anxiety Disorder and Marijuana

There is also a notable clinical link between marijuana use and anxiety disorders. Cannabis can briefly diminish or dissociate the discomfort of social anxiety, temporarily making these symptoms less distressing. However, larger doses can provoke intense anxiety and paranoia, abruptly heightening social anxiety symptoms. Like alcohol, cannabis may also lead to increased anxiety during the intervals between uses.

One study found that 26% of participants in treatment for cannabis problems had co-occurring social anxiety disorders, which led to greater cognitive and behavioral impairments. Other research indicates that people with pre-existing social anxiety disorder frequently experience more severe marijuana-related issues and continue using marijuana despite negative expectations regarding its impact on their anxiety.

Social Anxiety Disorder and Stimulants

Stimulants trigger the sympathetic nervous system, instigating the release of adrenaline and activating the fight-or-flight response, an effect closely associated with anxiety. When no external threat justifies this heightened state, the persistent surge of adrenaline can lead to prolonged anxious feelings.

In certain cases, social phobias triggered by stimulant use may stem from both the immediate cause-and-effect response of adrenaline and the gradual depletion of dopamine in the brain linked to long-term stimulant misuse.

The Connection Between SAD and Drug Addiction

SAD can stem from genetic influences and may also be caused by underdeveloped social skills or excessive stressors in a person’s environment. People with social anxiety often have thoughts that others may be judging them or staring at them, and these thoughts can create feelings of anxiety and increase social avoidance. In an effort to reduce uncomfortable anxiety symptoms and tend to necessary tasks, people with social phobia sometimes resort to substance use. 

Using drugs or alcohol as a coping strategy for SAD often results in worsened SAD symptoms. As dependence on drugs and alcohol increases, anxiety levels increase as well, resulting in a cycle that continuously reinforces itself. Withdrawal symptoms can mimic anxiety symptoms, which can also worsen substance use.

How Drug Abuse Hinders Social Anxiety Disorder Treatment

Substance use often complicates the treatment of social anxiety disorder. Ongoing misuse tends to increase avoidance and social withdrawal, especially in individuals already grappling with anxious symptoms. If therapy has begun before substance use escalates, it is common for people to disengage from treatment as addiction deepens.

As substance use progresses, individuals may behave in ways that breed guilt and shame, which only amplifies negative self-perceptions. Although insight and recovery can ultimately reframe these experiences as part of a disease process rather than moral failings, these events frequently reinforce distorted thought patterns in the meantime.

Certain therapeutic methods, such as cognitive behavioral therapy (CBT), can be especially vulnerable to setbacks when active substance use is in play. Therapists may emphasize that addiction is a medical condition instead of a moral shortcoming, but it becomes challenging to maintain therapeutic momentum when substance use disrupts thinking and emotional stability. Consequently, therapy may devolve into crisis management, derailing the path toward meaningful recovery.

Can Drug Abuse Cause Social Anxiety Disorder?

It is rare for social anxiety disorder to develop in adulthood, but it can happen. Environmental factors, physical health issues, hormonal imbalances and chronic substance use can spark anxiety symptoms in individuals with no prior history of anxiety. If these symptoms surface in situations where the individual attributes them to social interaction, a social anxiety disorder may form.

A sense of shame often complicates this issue, especially when addiction is involved. Many people view substance use through the lens of moral judgment rather than recognizing it as a disease or survival mechanism. This perception can be particularly challenging for someone with social anxiety disorder, where fear of negative judgment is already prevalent. As individuals become more withdrawn and self-conscious, this avoidance can escalate to clinical levels of social phobia.

Treatment of Co-Occurring SAD and Substance Use

When someone struggles with social anxiety and addiction, both of their conditions should be treated simultaneously. If only one of the disorders is treated, it can worsen the other and make recovery more challenging.

Effective treatment options for co-occurring conditions are offered in professional rehab facilities like The Recovery Village Cherry Hill at Cooper in New Jersey. If you’re looking elsewhere, consider programs that offer comprehensive services that include psychotherapy, pharmacotherapy, family work and group therapy.

Psychotherapy

There are many effective therapeutic approaches for social anxiety disorder, including cognitive-behavioral therapy (CBT). CBT is an evidence-based treatment that includes several subcategories, such as:

• Acceptance and commitment therapy
• Motivational interviewing
• Exposure therapy

All of these CBT treatment options help people identify triggers, address underlying thoughts and feelings and find ways to challenge unhelpful beliefs that may be exacerbating their condition. Behavioral changes help reinforce cognitive and emotional work while helping people practice how to live in a different way and experience success. CBT methods are effective for social anxiety and substance use disorders, particularly when treated together as co-occurring conditions.

Pharmacotherapy

Co-occurring treatment that includes medication management offers an additional layer of protection for people in recovery. Medications can treat the physical aspects of substance dependence and social anxiety so people in treatment can focus on recovery. In addition to managing medications, medical experts at comprehensive treatment facilities also monitor and treat symptoms that may arise.

Family and Group Work

People with social anxiety and substance use disorders may also benefit from additional types of treatment, including family or group therapy. As part of the assessment and planning process, each client can work with their team and determine a treatment approach that best addresses their needs.

What Is Social Anxiety Disorder (Social Phobia)?

Social anxiety disorder is a condition in which a person has difficulty being around others or in social settings. When people with social phobia are faced with these situations, they may have an extreme anxiety response that includes emotional and physical reactions. 

Social anxiety disorder can be generalized or non-generalized. Some people struggle only in certain settings, such as public places with a lot of people or while interacting with strangers. Others may have difficulty interacting one-on-one with people, even family members or friends. Social phobia is believed to be caused by genetic factors as well as environmental and personal experiences. 

Social Anxiety Symptoms

The symptoms of social anxiety can vary from person to person, but they are often overwhelming. Common symptoms include:

• Trembling
• Sweating
• Racing heartbeat
• Feeling nauseous
• Feeling self-conscious
• Thoughts that others are judging or staring at you
• Shortness of breath
• Fear of or avoiding social interactions
• Experiencing the loss of thoughts or feeling “blank”

When these symptoms arise, it can feel difficult to communicate with others and express one’s thoughts and feelings. The urge to escape can be overwhelming for people with SAD, especially when symptoms are activated.

Statistics on Social Anxiety Disorder and Drug Abuse

A number of studies shed light on the relationship between social anxiety disorder and substance use:

• Nearly 20% of those with social anxiety disorder also have a co-occurring alcohol use disorder.
• In approximately 80% of those cases, social anxiety disorder appears before alcohol misuse begins.
• Individuals diagnosed with social anxiety disorder are 5 times more likely to develop a dependence on cannabis and 4.5 times more likely to develop alcohol dependence.
• At least 10% of people with cannabis use disorders have a lifetime prevalence of social anxiety disorder.

Helping Someone With SAD and Drug Addiction

Social anxiety disorder and substance use disorder are common co-occurring conditions. When both conditions are present, it is often the result of self-medicating for anxiety and becoming addicted.

If you or someone you love is struggling with social anxiety disorder and co-occurring addiction, help is available at The Recovery Village Cherry Hill at Cooper. Our accredited rehab facility offers comprehensive co-occurring disorders treatment in a supportive, enriching environment that helps you take the critical first steps of recovery. Contact us today to learn more about treatment programs that can work well for your needs.