Jessi didn’t drink every day. Sometimes she went for days or weeks without a drop of alcohol. But when she drank, she binged, cocktail after cocktail, shot after shot, waking up the next day with no memory of how she got home. Drinking gave her confidence and smoothed out the sharp edges of her anxiety, anxiety that pushed to the surface even when she was amongst friends. Especially when she was amongst friends.
But the anxiety didn’t dissipate along with her hangover. “Often, I was just as anxious in the wake of my binge as I had been the night of the bender itself, except my anxiety about being in a crowd had been replaced by the dread that I had done something irreparably wrong,” she says. She knew this anxiety well; it had been with her for years.
Sometimes I was too afraid to leave the house, and the simple act of driving seemed insurmountable. I feared being look at or judged, and couldn’t seem to get my legs to walk through the door. At the same time, I wanted to be liked, included, and the same as everyone else, a hard thing to recognize and an even harder thing to admit.
In fact, this fear of being judged had kept Jessi from drinking until her sophomore year of college, making her an anomaly in the college crowd. Her resistance to alcohol had been driven by a profound fear of public embarrassment and losing control. But when she finally did start drinking, she found that alcohol could be used to alleviate those very fears. “I enjoyed the outgoing person I became when I was drunk, even if I couldn’t remember her. Eventually it became difficult to separate binge drinking from who I was.”
For Jessi, social anxiety disorder and alcohol addiction intertwined tightly, as they so often do. It is estimated that 20% of people with social anxiety disorder struggle with co-occurring alcohol use disorder and women are particularly susceptible. By exploring the patterns common to people struggling with social anxiety disorder and alcohol addiction, you can gain a fuller understanding of the relationship between these two deeply connected conditions and why dual diagnosis treatment is necessary for healing.
The Patterns of Social Anxiety Disorder and Alcohol Addiction
For many, alcohol addiction is assumed to involve daily excessive drinking. But alcohol addiction can encompass a broad range of behavioral patterns and, for people with social anxiety disorder, those patterns often defy the stereotype. According to a study on university students in Germany, people who were diagnosed with social anxiety disorder did indeed drink more than people without the disorder. However, their drinking wasn’t constant; rather, it was modulated based on the social circumstances in which they found themselves. As clinical psychologist Joseph Nowinski writes:
[People with social anxiety disorder] tended to drink excessively mostly in situations in which drinking is more or less socially acceptable: parties, happy hours, and other similar gatherings. In contrast, they were inclined to suppress their drinking in situations in which it might make them stand out.
The amount people drank was also strongly affected by “the individual’s expectation for how drinking will affect them.” In other words, if a woman believes drinking will make her more fun and sociable at a party with her friends, she’s more likely to drink to excess and experience her drinking as anxiety-reducing. This excess drinking may occur entirely within the social situation or begin prior to the event; if she is worried that excess drinking will draw attention to her at the party, she may pre-drink at home in order to achieve the effect she wants while minimizing how many drinks she has in front of others. In contrast, she may abstain from drinking at a company cocktail hour where she fears her drinking will make her humiliate herself in front of her colleagues.
This ability to modulate drinking depending on social circumstance and perceived outcomes may lead some to believe that they don’t have an alcohol use disorder; after all, you can control it in some conditions. But abstaining in some situations doesn’t cancel out drinking in excess drinking in others and it is the distorted relationship with alcohol that lies at the heart of the problem. The fact is that the vast majority of people struggling with alcohol addiction will regulate their drinking: abstaining at work while drinking at night, keeping their drinking hidden from their spouse, not showing up drunk at family events. While some people, including some with social anxiety disorder, do progress to constant drinking, such behavior represents a severe, advanced stage of alcohol addiction rather than its first indicator.
The Dangers of Self-Medicating with Alcohol
Although many people with social anxiety disorder believe that alcohol is helping them cope with their distress and serves a positive function in their life (even if only temporarily), alcohol can have profound immediate and long-term consequences:
Alcohol is well-known to cause a host of physical health problems. However, it can also interfere with psychological functioning due to the way alcohol disrupts normal neurotransmitter behavior. Dr. Thomas Kash, assistant professor of pharmacology at the University of North Carolina School of Medicine, says, “Chronic exposure to alcohol can cause a deficit with regard to how our cognitive brain centers control our emotional brain centers.” More specifically, alcohol may impair the brain’s ability to overcome fear, increasing the severity of anxiety and decreasing your ability to cope. What’s more, even occasional exposure to alcohol can temporarily raise anxiety levels, which may augment the impetus to drink and create a cycle of anxiety and substance use. Mood may also be affected and you are more susceptible to developing depressive symptoms.
Stunted Emotional Growth
Using alcohol to self-medicate for anxiety also has dangers that are less frequently acknowledged. Specifically, relying on alcohol to deal with your distress keeps you from developing healthy coping mechanisms and learning behaviors that will help you feel comfortable in social situations. “If you’re relying on alcohol, you don’t build up your confidence much, or skills that you can use to negotiate social interactions, dating, parties,” says John Walker, a clinical psychologist at the University of Manitoba. Robin Kappy, a clinical social worker in New York, agrees. “While drinking may seem like a logical short-term emotional balancing agent, long-term use can stunt emotional growth and lead to dependency, irrational thinking, and impulsive behavior.”
Because people with social anxiety disorder are more prone to binge drinking, alcohol induced-amnesia (blackouts) is also a concern. Blackouts occur when alcohol interferes with your brain’s ability to form memories; short-term memories don’t transfer into your long-term memory. During blackouts, you may appear to be functioning normally, but you may not remember the events—or remember only partially—later. While this can be embarrassing, it can also lead to dangerous and traumatic events, including engaging in risky behaviors such as unprotected sex or drunk driving, physical injury, and being vulnerable to sexual assault.
Finding Dual Diagnosis Treatment
If you are experiencing social anxiety disorder and alcohol addiction, it is imperative that you seek comprehensive treatment to restore emotional balance and protect your health. While historically anxiety disorders and substance use disorders have been treated separately, we now know that simultaneous treatment of both disorders is necessary to break the cycle of use and distress and optimize recovery. Specialized dual diagnosis treatment programs are designed specifically for this purpose, ensuring that your full range of needs is addressed throughout the treatment process.
In a residential dual diagnosis treatment program, you can engage in a broad spectrum of therapies that allow you to deeply investigate both your social anxiety disorder and your alcohol addiction as well as the ties between them. Within a warm, supportive milieu, you will gain the tools you need to identify your triggers, the develop healthy coping mechanisms, and learn how to forge meaningful connections without the use of alcohol. Throughout this process, you will be guided by compassionate clinicians who understand the complexities of co-occurring disorders as well as peers who will act as your allies as you move through the recovery process. By participating in a program of holistic healing, you can enhance your confidence, expand your capacity for joy, and open up new possibilities for living a life of authenticity, resilience, and purpose.
“I’ve resent my life and habits around new activities that don’t center on alcohol,” says Jessi, who is now sober.
Journaling and therapy helped me regain my sense of self. I know the nuances of my mood. I’m more in tune with my body. And most importantly, I’m more balanced than I used to be. I no longer have panic attacks that last for days on end. That’s something I can’t imagine ever going back to.”
Alta Mira offers comprehensive treatment for people struggling with drug and alcohol addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our renowned Bay Area programs and how we can help you or your loved one start the journey toward lasting recovery.
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