Social Anxiety and Alcohol Abuse

Social Anxiety Help

Larry Cohen, LICSW

Social Anxiety and Alcohol Abuse


Anxiety Disorders Association of America
June 2009

“At around the age of 10, I became aware that I was different. I felt intense social anxiety. I had no skills to use to interact socially with my peers. I was quiet and blended into the walls. I didn¹t trust my perceptions and it took many years before I could admit, much less say aloud, how I felt.”

These are the words of Cynthia Kipp, who has social anxiety disorder.

“My family didn¹t seem to pay too much attention to my phobia. I did what was expected as a good girl.”

Cynthia¹s tumultuous childhood ­ her father was abusive and suffered from schizophrenia ­ coupled with social anxiety led to difficult teenage years. She didn¹t feel part of any group of friends, and she started drinking to alleviate her anxiety around her peers. But her drinking soon became as big of a problem as her anxiety, if not bigger.

About 15 million U.S. adults, or 7 percent of the population, have social anxiety disorder in any given year. And it isn¹t unusual for people with social anxiety disorder ­ or other anxiety disorders ­ to drink excessively to cope with symptoms or try to escape them.

Murray Stein, MD, MPH, and John Walker, PhD, write in Triumph Over Shyness: Conquering Social Anxiety Disorder that social anxiety disorder frequently travels in the company of other emotional difficulties such as alcohol or drug abuse, depression, and other anxiety disorders….

“My drinking was self-destructive, and that compounded my low self-esteem.”

About 20 percent of people with social anxiety disorder also suffer from alcohol abuse or dependence, and a recent study found that the two disorders have a stronger connection among women.

Although alcohol can temporarily reduce symptoms of social anxiety ­ which is the reason many turn to it ­ Stein and Walker note that alcohol can also increase anxiety, irritability, or depression a few hours later or the next day. Even moderate amounts of alcohol can affect one¹s mood and anxiety level.

If you do at least one of the following, you may suffer from alcoholism:

  • Drink alcohol four or more times a week
  • Have five or more drinks containing alcohol in one day
  • Not be able to stop drinking once you¹ve started
  • Need a drink in the morning to get yourself going
  • Feel guilty or remorseful after drinking
  • Heard a relative, friend, co-worker, or doctor express concern about your drinking or suggest you cut down

Excessive drinking can lead to addiction and delay the desire to seek treatment and interfere with the effectiveness of therapy or medication once on a treatment plan.

“On the verge of losing everything, and not really knowing myself, I started attending AA meetings. For the first year I couldn¹t speak. Finally, I shared my story. Speaking at meetings slowly gave me confidence to speak in front of others.”

Cynthia credits Alcoholics Anonymous meetings for not only helping her with her alcohol problem, but for putting her on the path to overcoming her social anxiety. The meetings allowed her to gradually become comfortable speaking before other people, and once she became sober, Cynthia could focus on further reducing her social anxiety disorder symptoms through therapy.

Some people with social anxiety, however, find AA meetings and other support groups to be too anxiety-provoking. Working one-on-one with a doctor or therapist with experience in treating anxiety disorders may be best and can help one prepare to successfully participate in an alcohol treatment program at a later time.

A recent clinical study also found that a combination of cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET) may be successful in treating co-occurring social anxiety disorder and alcohol abuse. Motivational enhancement therapy is used in drug abuse counseling and encourages patients to turn their desire to change into concrete goals to do so.

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If you have any questions or comments, please email Larry Cohen, LICSW, with offices in Washington, DC.

Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):