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Understanding the Hidden Impact of Social Anxiety and Substance Abuse

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 21.5 million adults in the U.S. alone have a co-occurring mental health disorder and substance use disorder (SUD). Moreover, mental health disorders and SUD share a bidirectional relationship. On one hand, SUD increases your risk of developing or exacerbating a mental health disorder. Meanwhile, on the other hand, unaddressed mental health challenges increase your risk of developing SUD. In particular, there is a high prevalence of co-occurrence between disorders like social anxiety and substance misuse.

At The Guest House, we specialize in treating both mental health disorders and SUD because surface-level disorder treatment does not get to the root of your challenges. Whether your surface-level disorder is SUD or social anxiety, only treating one of them leaves the door open for more distress. A narrow focus on only treating SUD or social anxiety allows deep-seated negative thinking and behavior patterns to be triggered.

Still, you may be asking yourself, “Why do social anxiety and substance use co-occur with each other?” or “What factors contribute to co-occurring disorders in general?” Increasing your mental health literacy (MHL) on co-occurring disorders, particularly social anxiety and substance use, can help you better recognize the consequences of leaving them untreated as well as understand the need for professional treatment to establish lasting recovery.

Different Types of Co-Occurring Disorders

Listed below are some of the most common mental health disorders and substances that co-occur with each other:

  • Mental health disorders
    • Anxiety disorders
    • Major depressive disorder (MDD)
    • Post-traumatic stress disorder (PTSD)
    • Bipolar disorder (BP)
    • Attention-deficit hyperactivity disorder (ADHD)
  • Substance misuse and SUD
    • Alcohol
    • Opioids
    • Prescription medication
    • Tobacco
    • Marijuana

Looking at the variety of co-occurring disorders and substances highlights the commonality of co-occurrence across substances. Although various disorders can co-occur with SUD, social anxiety and substance use share a higher rate of co-occurrence than many other disorders. As noted in Case Reports in Psychiatry, after depression and alcohol dependence, social anxiety disorder is the third most common mental health disorder. Further, social anxiety disorder commonly co-occurs with other anxiety disorders, depression, and SUD.

What Is Social Anxiety?

A lack of mental health literacy (MHL) often leads the public to believe social anxiety is the same as being shy. Although there are commonalities between shyness and social anxiety disorder, they are not the same. In general, social anxiety disorder can be defined as a persistent and irrational fear of situations where you are scrutinized, evaluated, or judged by others.

Moreover, unlike shyness, social anxiety disorder can impair your ability to function in every part of your life. As noted by the National Institute of Mental Health (NIMH), the symptoms of social anxiety disorder can impede your daily life, work, school, and relationships. Furthermore, the feelings of anxiety and fear you feel in different social situations stem from worry that you will be humiliated, judged, or rejected by others.

Listed below are some of the social situations that can trigger your social anxiety symptoms:

  • Meeting new people
  • Making small talk
  • Dating
  • Eating and or drinking in public
  • Attending social gatherings like parties
  • Speaking in public
  • Making phone calls
  • Using public restrooms
  • Going on job interviews
  • Being watched while doing things
  • Talking to a cashier or waiter in a store or restaurant
  • Asking a question in class or being asked to answer a question in class

Knowing some of the situational triggers of social anxiety showcases its profound impact on daily functioning. The impact of your social anxiety symptoms becomes so intense that engaging in these situations feels beyond your control. When you are overwhelmed by your symptoms, it becomes difficult to function and thus cope effectively with your distress. Listed below are some of the signs and symptoms of social anxiety disorder:

  • Physical signs and symptoms:
    • Rapid heart rate
    • Shortness of breath
    • Butterflies in your stomach
    • Nausea
    • Upset stomach
    • Dry mouth
    • Sweating
    • Trembling
    • Blushing
    • Dizziness
  • Behavioral signs and symptoms:
    • Staying quiet in social situations
    • Avoiding social situations
    • Trying to hide away from others during social situations
    • Feeling like you always need to have someone with you
    • Trying to soothe your anxiety with substances

Looking at the signs and symptoms of social anxiety further highlights the impact it can have on healthy coping strategies. Unaddressed social anxiety can erode adaptive coping skills and resilience to responding to distress with maladaptive coping mechanisms. Thus, increasing your awareness of coping mechanisms can help you better understand the connection between social anxiety and substance use.

Impact of Co-Occurrence: Self-Medicating Social Anxiety With Substance Use

The co-occurrence of social anxiety and substance use often stems from difficulty coping with your symptoms. In other words, when you lack the necessary tools to respond to your distress in healthy ways, you are at risk of developing maladaptive coping strategies. Self-medicating with substances like alcohol, in particular, is a common maladaptive coping strategy for social anxiety.

As the National Institute on Alcohol Abuse and Alcoholism (NIAAA) states, the nature of self-medicating in social anxiety and substance use is the desire for positive effects in social situations. Self-medicating with alcohol, in particular, is a common yet unhealthy coping tool for social anxiety. Through the misuse of alcohol and other substances, you attempt to alleviate your distress in your daily life, activities, situations, and relationships.

Listed below are some of the social anxiety symptoms you attempt to alleviate with alcohol and other substance use:

  • Increase feelings of sociability with others
  • Decrease your distress and rumination over others’ perception of you
  • Increase feelings of comfort in social situations

Thus, your symptoms highlight the level of impairment that comes from social anxiety. Further, understanding the extent of impairment speaks to the prevalence of self-medicating in the relationship between social anxiety and substance use. Although self-medicating with substances can alleviate social anxiety symptoms, the relief is temporary. At first, self-medicating increases perceived positive effects as your mood improves and socializing becomes easier.

However, the short-term perception of the positive effects of substance use enables the co-occurrence of social anxiety and substance abuse. In reality, the self-medicating nature of social anxiety and substance misuse has long-term consequences. The long-term consequences of co-occurring social anxiety and substance use include:

  • Increasing the risk of SUD and addiction
  • Increased difficulties with other mental health disorders
    • Anxiety
    • Depression
  • Difficulties with emotional regulation
    • Irritability

Looking at the consequences of co-occurring social anxiety and substance use can give you insight into maladaptive coping strategies. With greater awareness of maladaptive coping strategies, you can understand how social anxiety and substance use occur.

Understanding Safety Behaviors in Social Anxiety

The maladaptive coping strategies like substance misuse seen in social anxiety are born from safety behaviors. Your behavioral response to social anxiety is an effort to keep yourself safe in mind, body, and spirit. According to “The Relationship Between Three Subtypes of Safety Behaviors and Social Anxiety” by Dahye Kim et al., safety behaviors are a collection of mental processes and behavioral strategies. Further, you utilize safety behaviors in social anxiety to reduce distress and suppress your anxiety symptoms.

The safety behaviors that come from social anxiety include impression management, avoidance, and anxiety-symptom control:

Impression management: You attempt to make a good impression on others by tightly monitoring and controlling your behavior:

  • Censoring what you say to others to avoid looking or sounding stupid
  • Rehearsing sentences and conversations

Avoidance: You engage in low self-disclosure and physically hide yourself during social situations to hide, conceal, and limit social engagement:

  • A lack of sharing of personal details about your life and yourself like your thoughts, feelings, and memories
  • Avoiding eye contact with others
  • Staying on the edge of social groups
  • Speaking less or at all in social situations

Anxiety-symptom control: You attempt to hide your physical symptoms and suppress your cognitive symptoms

  • Using makeup to hide blushing or gripping objects like a cup to hide shaking and trembling
  • Switching off mentally during social interactions and situations
  • Avoiding pauses in your speech

The three subtypes of safety behaviors are a direct reflection of the impairment and harm to well-being that social anxiety can cause. Therefore, with more insight, you can understand how safety behaviors influence the co-occurrence of social anxiety and substance misuse.

Challenges of Dismantling Social Anxiety and Substance Use

On the surface, safety behaviors seem like great tools for managing the distressing symptoms of social anxiety. However, safety behaviors contribute to maintaining and worsening the unhelpful cognitions found in social anxiety. As Dahye Kim et al. note, it can be difficult to dismantle social anxiety and substance misuse due to perceptions. You get caught up in using safety behaviors because they temporarily increase your sense of security.

Yet, the long-term consequences of safety behaviors increase your anxiety rather than truly alleviating it. The increased state of anxiety found in safety behaviors is a reflection of low self-awareness and self-understanding. Thus, safety behaviors contribute to the co-occurrence of social anxiety and substance misuse because you are unable to recognize irrationality in your symptoms. Listed below are several of the major ways safety behaviors exacerbate challenges with social anxiety and substance use:

  • Feeling like you cannot confirm that the catastrophes you fear will not come true without safety behaviors
    • You believe negative social consequences will not occur if you use safety behaviors like impression management
      • This way of thinking prevents you from recognizing that your maladaptive beliefs about social interactions and situations are untrue
  • The use and or overuse of safety behaviors can lead to bad impressions and thus a negative evaluation from others:
    • Avoiding eye contact may lead others to believe you are not interested in them or what they have to say
    • Low self-disclosure can make it difficult for others to get to know you
      • Prevents trust building and deeper intimacy for emotional bonding
      • Disrupts relationship building
      • Reduces opportunities for social support
      • Impair your sense of belonging
  • Safety behaviors eventually lead to full avoidance by escaping social situations:
    • Finding excuses for not attending social occasions
    • Hiding in the restroom during social occasions
    • Dropping a class or skipping class to avoid giving a presentation
    • Ignoring job opportunities to avoid interviewing
    • Calling in sick for work to avoid social interactions
      • Consistently using safety behaviors allows social anxiety to persist and thus prevent a decrease in anxiety over time
  • The habitable use of safety behaviors in social situations can induce post-event processing (PEP)
    • PEP is a method of information processing in which you monitor the negative self-perceptions and reactions of others after a social interaction
    • With PEP you can access past events you perceive as failures in social situations
      • Frequent retrieval of perceived failures through PEP encourages you to view those memories more negatively
        • The negative bias PEP you develop of yourself aggravates your social anxiety symptoms

Therefore, engaging in safety behaviors works against building healthy coping skills to dismantle social anxiety and substance use. However, with more awareness, you can learn how to break away from safety behaviors to reduce challenges with social anxiety. When you recognize the maladaptive nature of your coping strategies, social anxiety and substance misuse can be treated. With recognition comes resilience and the ability to build adaptive coping mechanisms against social anxiety.

Yet, you may question how you can dismantle safety behaviors and foster adaptive coping skills. An important step in building healthier coping skills is in recognizing social anxiety and substance misuse as co-occurring. Without recognition of the impact of co-occurring disorders, healing social anxiety and substance misuse is not possible.

As noted by the North Carolina Department of Health and Human Services (NCDHHS), using substances to alleviate anxiety can impede your ability to develop healthier coping skills. Thus, through an integrated treatment program, you can uncover the tools you need to heal as a whole person. Listed below are some of the adaptive coping skills you can utilize in your daily life to address social anxiety:

  • Practicing skills: Building social skills can help you cope with the self-defeating thoughts and emotions of social anxiety
    • Verbal communication skills: Supports starting and maintaining positive conversations
      • Engage in active listening
      • Ask open-ended questions
      • Share personal details about yourself and your life
    • Nonverbal communication skills: Supports feeling more confident in your social interactions
      • Practice relaxing your posture to appear more approachable
    • Assertive skills: Supports building more assertiveness in your social interactions
      • Practice asserting your needs calmly while respecting the needs of others
      • Utilize ‘I’ statements to express yourself
  • Strengthening social support: This includes feeling valued, cared for, respected, and loved by the loved ones in your life
    • Support can be tangible assistance from others or perceived social support for confidence
      • Bringing you soup when you are sick
      • Offering to wash your dishes or laundry, prepare a meal, and go grocery shopping for you
      • Giving you a ride
      • Talking about your social anxiety with trusted people in your life
      • Feeling that your emotions are valid
      • Receiving encouragement
      • Providing guidance
  • Dismantling negative thoughts: Social anxiety encourages the misinterpretation of comments and facial experiences of others as negative
    • Write down your negative thoughts from before, during, and after a social situation to challenge the accuracy of those thoughts
  • Engaging in bodily practices: Practicing different breathing techniques can support reductions in somatic symptoms of social anxiety
    • Deep breathing helps relax the body and support refocusing on the present moment rather than your negative thoughts
  • Active coping: Focuses on providing a direct and rational response to distress and or challenges
    • Supports fostering better emotional regulation of chronic life stressors
      • Positive re-interpretation: Seeking reappraisal of the positives rather than the negatives in social situations

With more insight into adaptive coping skills for social anxiety, you can start building tools for long-term recovery. Now you can better understand the roots of your challenges with co-occurring social anxiety and substance use.

Finding Healing in Integrated Treatment at The Guest House

At The Guest House, we recognize the need for treatment that integrates mental health and SUD recovery into the program. Without an integrated approach to recovery, you run the risk of ignoring treatment needs for one or more co-occurring disorders. Moreover, viewing recovery as a one-size-fits-all process opens the door to relapse.

Therefore, we are committed to providing a holistic individualized approach to healing as a whole person. Through a variety of therapeutic modalities, you can work with clinicians to build the right treatment program for you. With holistic healing, there is a path to recovery available to address your specific needs to lead an independent and fulfilling life in long-term recovery.

Social anxiety disorder is the persistent fear of being scrutinized, evaluated, or judged by others in social situations. When left unaddressed, you may seek self-medicating with substances to alleviate your anxiety symptoms. Thus, social anxiety and substance misuse often co-occur as you rely on substances to make you feel more comfortable. Although substances may temporarily decrease anxiety, the long-term consequences can lead to substance use disorder (SUD) and increased anxiety. However, an integrated treatment program can support building adaptive coping skills to heal. At The Guest House, we are dedicated to providing holistic care to address your co-occurring disorders and other needs for recovery. Call us at (855) 483-7800 to learn more about the impact of co-occurring disorders.