Social anxiety disorder-an excessive fear of social situations, such as eating or speaking in public-affects 2 to 13 percent of the U.S. population. About one-fifth of patients with social anxiety disorder also suffer from an alcohol use disorder (AUD) (i.e., alcohol abuse or dependence). One theory to explain the comorbidity between social anxiety disorder and A UDs is the tension reduction theory, which posits that people with social anxiety use alcohol to alleviate their fears. This expectation that alcohol reduces anxiety may motivate alcohol consumption even if pharmacological studies do not support that assumption. Social anxiety disorder is treatable with both pharmacotherapy and psychotherapy, and some of those treatments also would be expected to be effective for patients with comorbid AUDs. Evaluation of patients seeking alcoholism treatment for coexisting social anxiety disorder is important for improving treatment outcome. KEY WORDS: comorbidity; anxiety; social phobia; AODU (alcohol and other drug use); alcoholic beverage; tension reduction theory of AODU; diagnostic criteria; prevalence; positive AOD (alcohol and other drug) expectancies; drug therapy; psychotherapy; monoamine oxidase: benzodiazeines; serotonin uptake inhibitors; literature review
Many people experience social anxiety-that is, they feel uncomfortable or even anxious in social situations, such as talking with strangers (or even friends) or speaking in front of a group of people. In the general population, levels of social anxiety exist on a continuum from mild to severe. A clinical diagnosis of social anxiety disorder, also referred to as social phobia,1 is assigned only when the social anxiety results in significant fear when faced with the situation, impairment of performance, or avoidance of anxietyprovoking situations. People with high levels of social anxiety typically report that alcohol helps them feel more comfortable in social situations. Thus, it is not surprising that individuals with clinically diagnosed social anxiety disorder have a higher incidence of alcohol-- related problems than does the general population. This article explores the diagnosis and prevalence of social anxiety disorder and reviews studies evaluating the relationship between alcohol consumption and social anxiety. In addition, the article summarizes treatment approaches for social anxiety disorder alone as well as in combination with alcohol-related problems.
SOCIAL ANXIETY DISORDER
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IM (1994), social anxiety disorder is defined as excessive fear in social situations in which the person believes he or she will do something embarrassing or have anxiety symptoms (e.g., blushing or sweating) that will be humiliating. The feared situations can vary from interpersonal social interactions in small groups to talking to strangers. Performance fears, such as speaking in public, also are common. People with social anxiety disorder either avoid feared situations or experience them with extreme anxiety. Most individuals with the disorder have the more severe, "generalized" type, in which the person has other social fears in addition to the common fear of public speaking. The complete criteria set for an official diagnosis of social anxiety disorder is detailed in the textbox.
Typically, social anxiety disorder begins in the teenage years and does not improve without treatment. The mechanisms or causes underlying the disease are unknown but may involve multiple predisposing factors. These potential factors include genetic background, traumatic early emotional learning experiences, observation and modeling of parental behaviors, and biological irregularities in brain chemical systems. People with the disorder often report having been shy or behaviorally inhibited as small children and, in severe cases, a child with social anxiety may not want to go to school (Beidel 1998). …