Addiction and Social Anxiety

People who suffer from addiction often have a co-occurring mental health disorder that at least partially motivates their substance abuse. One condition frequently associated with substance use disorders is social anxiety, which creates high levels of stress, nervous tension, and personal disappointment in those who experience its symptoms. Men and women with co-occurring addiction and social anxiety can recover and go on to live satisfying lives, but only if they seek the assistance of trained addiction specialists and mental health counselors who understand the challenges they face.

What Is Addiction and Social Anxiety?


People who suffer from social anxiety experience feelings of significant stress and nervousness in a wide variety of social situations. They generally feel comfortable communicating with those they know well, but any other interpersonal interaction is likely to provoke at least some level of discomfort. Social anxiety is also known as social phobia, and if they experience serious life disruptions social phobia sufferers may be diagnosed with social anxiety disorder, which is the second most commonly diagnosed anxiety disorder.

Men and women with social anxiety lack confidence in their communication skills, which are generally underdeveloped because they are underused. More fundamentally, their self-esteem tends to be poor and their feelings of personal inadequacy leave them highly vulnerable to the judgments and opinions of others, which they expect to be negative unless they say and do exactly the right things every time.

Unfortunately, many people who experience the stress and nervousness of social anxiety turn to drugs and alcohol to help them relax, loosen up, or escape their constant discomfort. This is a temporary remedy at best, and if their substance use escalates they may eventually slide into addiction.

Facts and Statistics


Addiction and social anxiety statistics reveal problems that impact millions of lives. In 2016:

  • 20.1 million Americans age 12 and over suffered from a substance use disorder, including 15.4 million with an alcohol use disorder and 7.4 million with an illicit drug use disorder.
  • 44.7 million American adults age 18 and over suffered from some form of mental illness, including 15 million people with social anxiety disorder.
  • 8.2 million adults had co-occurring mental illness and substance use disorders.
  • Among the 12-17 age group, 5.5 percent reported symptoms consistent with social anxiety disorder, while 3.2 percent and 2.0 percent suffered from drug and alcohol use disorders, respectively.

Various studies have found that between 69 and 81 percent of social anxiety sufferers have co-occurring conditions, most frequently substance use disorders or major depression (or both).

Symptoms and Diagnosis of Addiction and Social Anxiety


The physical symptoms of severe social anxiety include:

  • Blushing
  • Sweating
  • Shaking, trembling
  • Rapid heartbeat
  • Dry mouth
  • Difficulty speaking clearly
  • Muscle pain
  • Dizziness, lightheadedness
  • Stomach cramps; feeling the need to vomit or go to the bathroom
  • Shallow breathing, possibly to the point of hyperventilation

People experiencing the physical symptoms of social anxiety will be unable to concentrate on anything but their anxiety symptoms, which intensifies their suffering and creates a strong urge to flee.

Other psychological and emotional symptoms of social anxiety include:

  • A strong fear of being judged, rejected, embarrassed, or laughed at
  • Intimidation in the presence of authority figures
  • Inability to offer opinions for fear of being thought stupid
  • Heightened emotional reactions of all types (i.e., stronger reactions of anger, frustration, embarrassment, or even excitement if the person is praised or treated kindly)
  • A phobia about being the center of attention
  • Defensiveness or secretiveness if asked to reveal personal information
  • Aggravation of low self-esteem, marked by negative mental self-talk (“I’m stupid,” I’m making a fool of myself,” “I’m pathetic,” etc.)
  • Unpleasant anticipatory anxiety before social encounters
  • Second guessing and self-criticism after a social interaction has ended (“Why didn’t I say this?”, “Why didn’t I say that?”)

The physical and emotional signs of social anxiety are exhausting, depressing, and discouraging, and it is not hard to understand why some people would choose to drink or take drugs if they thought it might momentarily relieve their misery.

The telltale signs of a co-occurring drug or alcohol addiction in a social anxiety sufferer include:

  • Growing tolerance that requires greater drug or alcohol consumption to achieve the same effects
  • Physical or psychological cravings or withdrawal symptoms that make it hard to quit using
  • Drinking or taking drugs every day, or in larger amounts than originally intended
  • Thinking about drugs and alcohol all the time and planning life around them
  • Defensiveness or secretiveness about substance abuse
  • Encounters with the law, or accidents, related to substance abuse
  • Alcohol and drugs interfere with management of daily routines related to work, school, parenting, and other areas of responsibility

To diagnose co-occurring addiction and social anxiety disorder, mental health and/or addiction specialists must uncover a range of symptoms associated with both conditions, and clearly establish life disruptions and declines in functioning associated with each.

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The Dangers of Overdose


Drug overdoses kill tens of thousands of Americans each and every year, and a few thousand more succumb to the effects of alcohol poisoning. The former is a consequence of growing tolerance for drugs, which pushes users to increase consumption to dangerous levels, while the latter is a hazard anyone can face if they drink copious quantities of alcohol within a condensed period.

Anytime an alcohol or drug overdose is suspected, emergency medical assistance should be requested immediately.

Causes and Risk Factors for Addiction and Social Phobia


Certain factors can predispose a person to developing a substance use disorder, even above and beyond the effects of their social anxiety. Likewise, social anxiety can be at least partially explained in some instances by various risk factors, and to some extent the risk factors for addiction and social anxiety will overlap.

The risk factors for addiction include:

  • Family history and genetics (parental substance abuse is the strongest predictor)
  • Exposure to unstable or abusive environments in childhood
  • Being exposed to alcohol consumption by peers in high school and college
  • Early age of first usage
  • Previous history of mental illness

Social anxiety risk factors also include a family history of the disorder and childhood trauma, both of which increase the chances for all types of emotional and behavioral health disorders. Other risk factors for social anxiety disorder and social phobia include:

  • Shyness or introversion as a personality trait
  • Stressful or disruptive life changes (divorce, loss of a parent, moving to a new city or taking on a new job, etc.)
  • Scars or other physical features that may lead to being teased or bullied

More severe social anxiety increases the chances of addiction, although people who were not exposed to substance use in their families or in peer groups are far more likely to avoid that trap.

Withdrawal and Detox


Serious drug and alcohol dependency can create powerful physical and psychological withdrawal symptoms that endanger newfound sobriety. In some instances, people undergoing withdrawal may be at risk for serious health complications if they don’t receive timely assistance, and that’s one reason why medical detox in a residential treatment facility is highly recommended.

During medical detox, patients diagnosed with a drug or alcohol use disorder will be monitored and cared for around the clock, in a fully stocked and staffed hospital-like facility. In addition to early visits with counselors, they may also be given medications that can help relieve the worst symptoms of alcohol and/or drug withdrawal.

Detox may last for up to a week or possibly a bit more if medical complications arise, but after the symptoms of withdrawal have stabilized, the patient can move on to inpatient or intensive outpatient treatment.

Co-Occurring Disorders


Substance use disorders and anxiety disorders are frequently comorbid, and in some instances people may suffer from another anxiety disorder as well. Many social anxiety disorder sufferers have panic attacks, for example, and may be diagnosed with panic disorder, another serious anxiety-related condition that can raise the likelihood of addiction if sufferers use drugs or alcohol to help calm their nerves.

Among people with social anxiety, by far the most common co-occurring disorder is major depression. More than 50 percent of social anxiety sufferers will experience depression at some point in their lives, and people with depression often seek out prescription medications or drugs like cocaine or methamphetamine to improve their mood.

Mood disorders, anxiety disorders, and personality disorders may all be diagnosed in those who suffer from co-occurring addiction and social anxiety, and if such conditions are present they must be addressed during treatment if recovery is to occur.

Treatment and Prognosis for Addiction and Social Anxiety


Addiction and social anxiety both respond well to treatment, and those who are diligent about following their recovery regimens have a good chance of finding long-term relief from both. Dual diagnosis treatment programs that help patients learn to cope with their social anxiety, even as they recover from a substance use disorder, offer the best chance of recovery, and residential addiction facilities are well prepared to provide comprehensive, integrated treatment services to those who suffer from both conditions.

Unfortunately, people with social anxiety disorder are often reluctant or unable to ask for help when they need it, because they feel they will be judged as weak and as failures if they admit they have a problem (with social anxiety or substance abuse). Once this barrier is surpassed, however, social anxiety sufferers tend to make excellent progress during recovery, since their desire to change is strong and their motivation to do so high.

During recovery from addiction and social anxiety, patients in residential rehab will participate in dual diagnosis treatment regimens that include:

  • Individual, group, and family therapy. Cognitive behavioral therapy (CBT) is considered the gold standard for social anxiety treatment, and it can be highly effective in drug and alcohol treatment as well. Peer group meetings can be beneficial to addiction and social anxiety sufferers, since each condition thrives on isolation.
  • Medication management. Medications that help control drug and alcohol withdrawal symptoms may be prescribed, along with antidepressants or anti-anxiety medications that work well for social anxiety symptom control.
  • Holistic healing techniques. Yoga, meditation, massage therapy, arts therapy, Tai Chi, biofeedback, and acupuncture are just some of the wellness and stress management practices that can help anxiety disorder sufferers with substance use issues find peace of mind.
  • Life and coping skills classes. Recovering addicts and alcoholics need to learn better coping skills, and people with social anxiety need practical instruction that can help them overcome the debilitating effects of their unwanted anxious responses.

Dual diagnosis treatment programs—and the aftercare programs that reinforce learning and help protect against relapse—must be complex and multi-layered if they are to help those with co-occurring conditions reach a better place in their lives. Fortunately, those who embrace their healing programs with enthusiasm and an openness to learning and growing can meet just about any challenge they might face, including those created by chemical dependency and social anxiety disorder.