Alcohol & Social Anxiety Disorder

Comorbid disorders are very common for individuals with a social anxiety disorder (SAD), occurring in up to 90% of patients. [1]

When it comes to alcohol use disorder (AUD) this has been found to occur in up to 50% of patients with SAD. [1]

Although of course not every person who drinks alcohol has AUD (also known as alcohol addiction), those with social anxiety are more susceptible to using drinks as a reliever of anxiety and therefore to develop AUD.

Furthermore, knowing the way in which alcohol affects anxiety and vice versa, as well as considering why such a large percentage of people with SAD have a dependence on alcohol, can help highlight the impact that both conditions have on people socially, psychologically and physically.

Recognising the link between these disorders can help both people struggling and mental health professionals to treat both conditions and improve recovery.

What Is Social Anxiety Disorder?

Social anxiety disorder is defined as an excessive fear of being in social situations. [2]

This can include interacting with a small or large group of people, and often people with SAD may be comfortable speaking to one or two close friends but fearful when interacting with others.

It is one of the common mental health disorders, with some studies estimating the prevalence of the disorder as affecting up to 1 in 3 people worldwide. [3]

Individuals with SAD often experience a lot of anxiety when meeting and speaking to people, and a fear of judgement, humiliation or rejection. [2]

SAD often causes people to avoid social interactions and can lead to isolation, employment issues and relationship problems.

If you think that you or a loved one might be struggling with social anxiety disorder, see if the following symptoms are applicable to you or your loved one. This can be a useful step as you can then consult your GP or medical professional and seek treatment.

Symptoms of Social Anxiety Disorder

• Worrying frequently about regular social situations such as meetings, social events, going to work, shopping or talking on the phone
• Avoiding social situations due to these worries
• Experiencing anxiety when having to talk to others e.g. strangers, friends or family
• Not being able to focus on doing something when others are watching for fear of judgement
• Experiencing physical symptoms such as sweating, blushing, trembling or rapid breathing when in social situations or in anticipation of them
• Having panic attacks with a sense of fear or dread
• Low self-esteem
• Avoiding eye contact
• Fear of rejection or criticism when interacting with others

It is normal to experience some degree of anxiety when in new situations, meeting new people or doing something intimidating such as speaking to a large crowd.

However, if the fear of interacting with or being in social situations impacts daily life, then seeking treatment can greatly help everyday life and can ensure that an alcohol use disorder does not develop.

What Is Alcohol Use Disorder?

Alcohol Use Disorder is a condition wherein an individual is unable to stop or control their alcohol use, even in cases where it is impacting daily life. [4]

If you find yourself drinking more often than you used to, and using drinking to cope with stress or socialisation, this can indicate an alcohol use disorder.

The use of alcohol in general is not a disorder, however many people who begin drinking socially and find that it might relax their social anxieties can become dependent on it.

Alcohol can often begin as a form of socialising or relaxation, easing the symptoms of anxiety, and therefore people suffering from anxiety disorders can begin drinking more heavily to relieve the symptoms of their disorder.

If you are concerned about your drinking, or have a loved one that you are worried about, take note of these common symptoms of AUD and speak to your GP or medical professional about treatment.

Symptoms of Alcohol Use Disorder

• Often drinking more than planned or drinking for a longer period of time
• Trying to cut down or stop drinking and not being able to
• Relying on alcohol in times of stress or in social situations
• Spending a lot of time drinking or drinking a significant amount often
• Drinking often interferes with other aspects of life such as relationships, family, jobs or self-care
• Continuing to drink in spite of negative after-effects such as anxiety, depression or physical health problems
• Increasing alcohol intake in order to get the effects desired (e.g. stress relief or to ‘forgot’ negative thoughts)
• Experiencing withdrawal symptoms when abstaining from drinking e.g. insomnia, shakiness, nausea, irritability

Even if you only experience one or two of these symptoms, or just wish to cut down on your drinking, seeking treatment can help you manage your alcohol intake before an alcohol use disorder develops.

What is the Relationship between Social Anxiety Disorder & Alcohol?

Alcohol use disorder and social anxiety disorder can reinforce one another, as alcohol can increase the anxiety and the anxiety can prompt the drinking.

This is known as mutual maintenance, and comorbid disorders which exhibit mutual maintenance can be complicated to treat as they are the perpetuating factors to one another.

Therefore, treating both disorders effectively is needed to ensure successful recovery from both.

Although alcohol can relieve anxiety whilst a person is drinking, anxiety can actually increase after a person has stopped drinking due to their effect on brain chemistry.

Therefore, although the night before you might feel anxiety free, the next day you are likely to feel anxious and depressed. Alcohol withdrawal can therefore then lead you to drink again to relieve this anxiety, trapping you in a vicious cycle.

Many people turn to alcohol as it can temporarily reduce the symptoms of social anxiety, and therefore begin drinking to either cope with stress or to feel more comfortable during social interactions. [6]

These reasons for drinking are also common among other people with other comorbid mental health issues such as depression or generalised anxiety disorder (GAD) as well as people without social anxiety who want to drink to enhance social situations.

However, both reasons for drinking, although often viewed within society as normal (drinking when out with friends, or having a drink when it’s been a hard day at work for example) can lead to heavy drinking and AUD. [5]

Symptoms of Comorbid Social Anxiety & Alcohol Use Disorder

The difficulty of comorbid disorders is that often they interact negatively with one another, exasperating the effects of the other disorder.

However, if you find that you are:

• Drinking in order to function in social situations such as meeting friends, working, going to the shop, speaking on the phone or other interactions
• Frequently drinking to relieve stress and anxiety
• When sober, after drinking, experiencing increased levels of anxiety or depressive symptoms yet continue to drink to relieve these
• Missing work, school or social functions due to drinking
• Secretly drinking to cope with anxiety-inducing situations

Then you may have or be on the road to having comorbid social anxiety and alcohol use disorder.

Treatment for Social Anxiety & Alcohol Use Disorder

Treating SAD and AUD needs to be done with the other disorder in mind, as treating one without the other can lead to a worsening of the other disorder and is likely to lead to relapse.

1. Social Anxiety

One treatment option that is frequently used for people with SAD is medication such as SSRIs and benzodiazepines. [2]

However, for those who have social anxiety and drink alcohol, some medications can be dangerous. Therefore it is very important to disclose to your GP or medical professional that you have either a diagnosed alcohol disorder or that you drink alcohol.

A meta-analysis of 21 studies into alcohol use disorder and anxiety, found that SSRI’s such as sertraline were effective in SAD and AUD treatment, especially when combined with psychotherapy. [3]

Cognitive Behavioural Therapy is also regularly used in the treatment of anxiety and has been shown to be effective in SAD and AUD.

There are different types of CBT, including exposure-based CBT where you can work with a therapist to increase your comfort in social situations.

This involves working your way up to tackling your anxiety in small increments, for example, if you get anxious when going shopping, you might start by going to a small shop for 5 minutes, and then reflect on your thoughts and feelings.

Over time you might tackle larger shops with more people, different locations or staying in a place for a longer period of time.

2. Alcohol Use Disorder

Treatment for Alcohol Use Disorder often depends on the severity of the disorder, and there are therefore several inpatient and outpatient treatment options available.

The first thing to be aware of is that detoxing from alcohol can be dangerous and scary to do alone, therefore most people are advised to attend a residential alcohol detox centre.

When you stay at these centres, the staff can help you manage withdrawal symptoms and safely detox to make sure all of the harmful chemicals from alcohol are out of your system.

There are several detox centres that Rehab4Alcoholism work with, and you can call their confidential hotline on 0800 111 4108 if you are concerned for yourself or a loved one.

Cognitive Behavioural Therapy (CBT) is commonly used to treat several disorders including alcohol addiction, as it can help deconstruct thought patterns and be a tool for changing our behaviours.

There are several types of CBT which can be used to treat alcohol addiction as well as a social anxiety disorder. It is a flexible and popular treatment, often used in detox centres and outpatient treatment.

CBT is conducted by a mental health professional, however, there are resources such as workbooks which help patients to change their thoughts and behaviours themselves.

Alcohol addiction counselling is also a commonly used treatment for alcohol dependenceand is conducted in one-to-one sessions with a mental health professional. These sessions explore the reasons for drinking and how you can develop new coping mechanisms.

Alcohol intervention counselling is an 8-12 week course of treatment and is conducted following an intervention by professionals and loved ones. If you are worried about a loved one or concerned about your own alcohol use, then reaching out for an intervention may help.

What Are the Negative Effects of Alcohol?

There are several negative psychological and physical effects that alcohol has on the body, for those with and without a social anxiety disorder.

How Alcohol Affects the Body

• Alcohol can greatly increase the risk of liver diseases
• Throat and mouth cancers have been linked to alcohol use
• Heavy drinking can lead to high blood pressure which increases the risk of heart attacks, heart failure or other cardiac diseases
• Alcohol use can lead to pancreatitis
• Long-term alcohol use can also weaken your immune system
• Excessive alcohol use can lead to an alcohol overdose, whereby there is so much alcohol entering the bloodstream that the body is struggling to keep itself alive.

How Alcohol Affects the Mind

• As well as social anxiety, alcohol can have a negative effect on other anxiety disorders too.
• Depression is often associated with alcohol use due to its chemical impact on the brain and the effects of alcohol addiction on daily life
• When drinking, alcohol interferes with brain pathways, leading to common things associated with drinking such as slurred speech, poor judgement and poor balance.
• Drinking at a young age can impact brain development
• Alcohol can increase the risk of psychosis and exacerbate other mental health and behaviour issues

There are several mental and physical health issues which have been linked to alcohol use, demonstrating the need to change drinking behaviours ideally before they develop into AUD.

If AUD does develop, then seeking help as soon as possible can ensure that your body and mind are not at risk from the potentially fatal effects of alcohol.

How to Overcome Social Anxiety Without Alcohol

Managing one mental health disorder is a challenge, but when you are faced with two comorbid disorders – or your mental health issue potentially leading to another disorder – this can be even more challenging.

However, one key aspect of treatment when getting help for social anxiety disorder when alcohol is used as a coping mechanism is to ensure that anxiety can be relieved in another way.

Medication, as previously mentioned, is often used to relieve the symptoms of an anxiety disorder, therefore, taking away a large part of the reason that many with comorbid SAD and AUD drink or began drinking.

Other treatments such as CBT can reframe thought processes and challenge negative thoughts, again relieving the symptoms of SAD.

For example, by noting down the thoughts you have in a social situation such as ‘they are judging me’, CBT can help you challenge this thought and consider why this might not be a true reading of the situation.

Practising mindfulness and Techniques such as breathing exercises, and keeping a journal to document your thoughts and challenge why those thoughts arise, can also help in managing your anxiety without alcohol. [7]

Recognising when and why you drink can also begin to eliminate instances, where you begin drinking almost without consciously being aware of what you, are doing it.

Whether it becomes a habit or instinct to get a drink before meeting a group of friends or having a few glasses of wine when stressed, being aware of it means that you erase the automatic response that your brain is used to.

Social anxiety disorder is unfortunately very commonly associated with alcohol use, as alcohol can temporarily relieve the symptoms that often make life so difficult for those struggling with SAD.

However, in the long term, alcohol can have a very detrimental effect on mental and physical health, and the possibility of developing alcohol use disorder is higher for those with SAD than without.

However, by recognising the symptoms of social anxiety disorder and getting treatment, one can avoid developing alcohol dependency issues before it develops into AUD.

If you fear that AUD has already developed either for you or a loved one, however, then treatment options are available to treat both comorbid disorders.

Managing SAD and recovering from alcohol addiction can help you to live free from constant worries and alcohol dependency, freeing you from the cycle of these disorders.

Get Help Today

Please contact our dedicated team on 0800 111 4108 for more information and advice. 

References

[1] Ahmet Koyuncu et al. (2019) Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges, Drugs in Context, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448478/

[2] Gregory M. Rose and Prasanna tadi (2022) Social Anxiety Disorder, National Library of Medicine, https://www.ncbi.nlm.nih.gov/books/NBK555890/ ; National Institute of Mental Health (2022) Social Anxiety Disorder: More than Just Shyness, https://www.nimh.nih.gov/sites/default/files/documents/health/publications/social-anxiety-disorder-more-than-just-shyness/social-anxiety-disorder-more-than-just-shyness.pdf

[3] Philip Jefferies and Michael Ungar (2020) ‘Social anxiety in young people: A prevalence study in seven countries’, Plos One

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239133

[4] .National Institute on Alcohol Abuse and Alcoholism (2021) Understanding Alcohol Use Disorder, https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder

[5] Fallon R. Goodman (2022) ‘Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study’, Behavior Therapy, https://www.sciencedirect.com/science/article/abs/pii/S0005789422000090

[6] Antonia Abbey et al, (1993) ‘The Relationship Between Reasons For Drinking Alcohol And Alcohol Consumption: An Interactional Approach’, Addictive Behaviours, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493891/

[7] Phillipe R. Goldin et al (2010, ‘Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder.’, Emotion, https://psycnet.apa.org/record/2010-01983-016