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Everyone feels uncomfortable once in a while in a social setting. A person might feel insecure when attending a party with new people, or they might occasionally feel judged by others. However, for some individuals, occasional social anxiety can become a persistent and pervasive illness called social anxiety disorder. Social anxiety disorder, if left untreated, has a higher risk of developing a substance abuse disorder.1
What is an Anxiety Disorder?
When danger presents itself, the human brain releases chemicals triggering the body’s stress response, also known as “fight-or-flight.” These chemicals prime the body to react to a threat by raising blood pressure, increasing heart rate, causing muscles to tense, and making breathing faster. This surge of energy enables humans to fight the threat or run from it. The same rush of energy allows a firefighter to save a life or helps someone driving avoid a car accident. When it works as it should, the stress response is a lifesaving reaction.
However, an anxiety disorder occurs when the body’s stress response fails to shut off, even when a threat is no longer around. Despite being in safe situations, the body remains primed for a fight and feels fear.
According to the American Psychiatric Association (APA), anxiety disorders are the most common mental disorders, affecting about 30% of adults at some point in their lifetime.2 Women are at a higher risk of developing anxiety disorders.
Different Types of Anxiety Disorders
For the most part, the following must be present for at least six months or more for a person to be diagnosed with an anxiety disorder: 2
- The anxiety must be out of proportion to the situation, or the fear must be inappropriate for the person’s age.
- The anxiety must interfere with the ability to function normally in their daily life.
The term anxiety disorder is an umbrella term used to describe several anxiety-related disorders. The following are some of the most common anxiety disorders.
Generalized Anxiety Disorder
In any given year, about 2% of the U.S. population has a generalized anxiety disorder, otherwise known as GAD. Generalized anxiety disorder involves persistent worry. This worry is excessive and overwhelming enough that it interferes with day-to-day activities.2
Due to the ongoing triggering of the stress response, physical symptoms can develop with GAD, such as restlessness, muscle tension, and irritability. The focus of the anxiety is typically on random everyday worries, like work, school, or finances.
Agoraphobia is the fear of being in situations where leaving might be difficult or that individual might be embarrassed. Without treatment, agoraphobia may become so severe that a person may not leave the house without feeling severe distress. About 2% of people experience agoraphobia.
An individual with agoraphobia feels anxiety in the following situations:2
- While utilizing public transport
- While in enclosed spaces
- While in open spaces
- While standing in a line
- While in a crowd
- While being outside the home
What is Social Anxiety Disorder (SAD)?
Approximately 7% of people in the U.S. struggle with social anxiety disorder, also known as social phobia. An individual with a social anxiety disorder feels extreme anxiety about being humiliated, judged, rejected, or ostracized in social situations. Left untreated, the disorder may become so severe that a person will go to great lengths to avoid social interactions. A few examples of situations a person who has social anxiety disorder might avoid are:
- Eating or drinking in public
- Public speaking
- Meeting new people
Social anxiety disorder causes, signs and symptoms, diagnosis, and treatment
Symptoms of Social Anxiety Disorder
When someone with social anxiety must face the situation they fear, they may show the following symptoms:
- Nausea or vomiting
- Excessive sweating
- Rapid heart rate
- Freezing or feel their mind “go blank”
- Minimal eye contact
- Speak softly
Social anxiety disorder makes it uncomfortable for someone to be in the presence of other people. Depending on an individual’s symptoms, the disorder might cause someone to avoid important social situations essential to their well-being. For example, a person might begin missing work because social anxiety makes work meetings intolerable. They may avoid meaningful events like their child’s graduation or wedding due to social anxiety.
The disorder can get in the way of a healthy social life by keeping a person from dating or making and maintaining friendships. It can be incredibly isolating, causing people to fear simple interactions with others, like simple one-on-one conversations or ordering food delivery over the phone.
This isolation makes recovering from this disorder even more complicated because sufferers may lack a robust support system. Ultimately, social anxiety symptoms can make it difficult for someone to obtain the life they want for themselves. The fear of embarrassment or rejection keeps them from succeeding at work or school and limits their opportunities overall.
The Role Trauma Plays in Social Anxiety Disorder
Current research into social anxiety disorder finds that trauma, especially trauma experienced in childhood, increases the likelihood of social anxiety.3 Interactions with caregivers during a child’s formative years impact their future view of the world and social relationships.
A childhood impacted by abuse or neglect can influence that future blueprint, making anxiety and apprehension a baseline blueprint for approaching others. Childhood trauma can cause negative thought patterns, creating cognitive distortions. In short, childhood trauma can make the world seem inherently unsafe, increasing the risk of developing social anxiety.3
A person with a history of trauma can develop social anxiety disorder because of triggers. Depending on the traumatic event, social interactions or situations may pose as triggers — increasing anxiety and bringing back distressing memories. Because social interaction is such a necessary part of life, a person with this disorder might try to push through uncomfortable social situations — sometimes using alcohol or drugs to alleviate their symptoms. The dependence on substances to get through social interactions can lead to a substance use disorder (SUD).
What is a Substance Use Disorder?
A substance use disorder, also known as an addiction, occurs when a person continues to use alcohol or drugs despite its detrimental effect on their life.4 Although they understand the harmful consequences, a person with a substance use disorder is unable to stop using the substance.
The desire or craving becomes so overwhelming that the individual will continue to seek out and use the substance, even after substance use causes disastrous problems. Drug and alcohol addiction typically occurs in these stages:5
- Substance use typically starts with experimental recreational use. The person using the substances is usually introduced to the substance through peers.
- Regular use occurs and the user starts to forgo responsibilities such as school or work. Substance use increases and tolerance to the substance starts to develop. The user starts to miss more school or work and they begin to obsess about obtaining the substance.
- Substance use becomes very problematic and risky. They lose all interest in school or work and lack motivation. Their substance becomes more important than family and friends. They may incur legal problems due to substance use or desire to obtain the substance.
- Finally, the user faces a full-fledged addiction and cannot function in their daily life without substance use. They continue to deny that they have a problem, but lack control over substance use. They may become suicidal and their legal and financial problems increase. Their close relationships may be broken due to their behavior and addiction.
Co-Occurring Social Anxiety Disorder and Substance Abuse
Anxiety and addiction have common factors that contribute to both disorders. These common risk factors increase the probability that both disorders will occur simultaneously. Genetics may play a part in both SAD and addiction, with the probability of either disorder increasing if a family member is diagnosed with one or the other.
Brain areas and neurotransmitters most involved with anxiety — like the basal ganglia, extended amygdala, dopamine, and adrenaline—are also factors in addiction.6 Another factor is stress. Stress plays a role in both anxiety and addiction, where a substance might be used to manage the distress from social anxiety. Trauma and environmental factors also increase the likelihood of developing both disorders.
How Different Stimulants Affect Social Anxiety Disorder
Not all substances are the same, and different drugs affect social anxiety. Stimulants like Adderall, cocaine, methamphetamine, and Ritalin can, for a short period, relieve symptoms. In the long run, however, these drugs are addictive and exacerbate anxious feelings. Marijuana use may also increase feelings of anxiety.
For people with social anxiety, alcohol may seem like the magic bullet. Not only is alcohol available in most social situations, but consuming alcohol is also encouraged. According to the Anxiety and Depression Association of America, about 20% of people with social anxiety disorder struggle with alcohol abuse.7
Initially, alcohol can stem from the stress that results from a social environment. Because alcohol is a central nervous system depressant, it reduces the symptoms of anxiety by decreasing the heart rate, slowing breathing, and loosening muscle tension. However, excessive reliance on alcohol can lead to addiction and social functioning impairments. Worse yet, withdrawal from alcohol addiction can trigger a rebound in anxiety and induce panic attacks. This rebound increases a person’s risk for relapse and makes recovery more challenging.7
Treatment for Social Anxiety Disorder
Video: Treatment of Social Anxiety Disorder
Although medication for social anxiety disorder is effective, almost all social anxiety treatment plans incorporate psychological therapies like cognitive-behavioral therapy (CBT). A person struggling with SAD cannot learn to simply stop being anxious. Destructive thought patterns must be unlearned and healthy coping skills must be acquired. CBT utilizes “cognitive restructuring” a social anxiety treatment used to spot negative thoughts and replace them with healthier alternatives.
CBT helps manage both the physical and emotional symptoms that occur with the disorder. CBT centers on changing cognitive distortions, like harmful thought processes and behaviors. With CBT’s cognitive restructuring, an individual can learn the positive coping skills necessary to overcome social anxiety.
Through individualized CBT therapies, a person with social anxiety can find the skills necessary to engage with others on a comfortable level. Other therapies may include slowly exposing an individual to fear-inducing social situations, gradually training them to become comfortable in formerly uncomfortable social environments.8 This treatment may include making phone calls, taking the bus, or speaking in public.9
Eye Movement Desensitization and Reprocessing
Along with cognitive restructuring therapy like CBT and EMDR, people with SAD may benefit from medications like antidepressants and beta-blockers to manage symptoms. Support groups can also foster healing by reducing feelings of isolation.
Treating Co-Occurring Social Anxiety and Addiction
Treating anxiety and addiction typically begins with a detox. Detoxification is the process of letting toxins resulting from substance abuse out of the system.12
During this period, a patient may experience withdrawal symptoms as the body readjusts to being without the drug. The effects depend on a variety of factors, such as how long a person used the substance, what the substance(s) was, and the patient’s health status. A detox may last anywhere from 24 hours to a week or more. Some individuals undergo detox on their own at home, but for most individuals, admission into a clinic or treatment center is required for a safe detoxification process.
Done on its own, detox is vital — but it’s not the entire recovery process. Instead, detox is the all-important first step to overcoming addiction. Continuous comprehensive treatment is necessary to keep a person from relapsing.
Inpatient and Outpatient Care
With a professional support system and rehabilitation services on-site, inpatient care offers 24/7 drug treatment services. During inpatient care, an individual resides at the treatment center. Surrounded by highly trained rehabilitation workers, a person in an inpatient program has immediate access to people that can help them through the detox and recovery process.
With outpatient care, a patient lives at their home but attends scheduled therapy and drug treatment services at a specific site. Typically utilized as a transition after inpatient care, outpatient care continues the rehabilitation process but allows the individual the freedom to continue their daily lives.
Support groups like Alcoholics Anonymous enable people to share similar experiences and coping strategies. Support groups also provide an environment where members feel less lonely or judged. More importantly, a support group can become a protective factor in a person’s recovery, offering vital encouragement when they might feel like relapsing.
Social anxiety disorder places people at a higher risk for substance abuse, often because of the desire to banish the discomfort from the disorder. For this reason, people with social anxiety disorder must manage their anxiety rather than use substances like alcohol to control their emotions.
If addiction does develop, both social anxiety disorder and the addiction should receive concurrent treatment. Treating both at the same time, in a structured setting, offers the best chances for recovery.