A Biopsychosocial Model of Social Anxiety and Substance Use

Abstract

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction-based theories) to understand SAD-SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance-related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD-SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance-related behaviors.

Mechanisms of Hypnosis:Toward the Development of a Biopsychosocial Model

“…Biopsychosocial models have proven to be useful in understanding other complex issues, such as chronic pain (Novy, Nelson, Francis, & Turk, 1995), depression (Schotte, Van Den Bossche, De Doncker, Claes, & Cosyns, 2006), and substance abuse (Buckner, Heimberg, Ecker, & Vinci, 2013). Importantly, biopsychosocial models allow for the possibility that many factors can play a role and contribute to hypnotic responding.…”

Social anxiety and alcohol-related impairment: The mediational impact of solitary drinking

“…Consistent with tension-reduction based models (Conger, 1956), it has been theorized that socially anxious persons are vulnerable to alcohol-related impairment due to reliance on alcohol as a strategy to help manage chronically negative affective states (cf, Battista, Stewart, & Ham, 2010; Buckner, Heimberg, Ecker, & Vinci, 2013; Carrigan & Randall, 2003). Despite accumulating data of a relation between social anxiety and alcohol problems (for review, see Buckner et al, 2013), data are mixed regarding whether social anxiety is related to greater quantity or frequency of drinking, with some studies finding a positive relation between social anxiety and drinking quantity and frequency (e.g., Neighbors et al, 2007; Stewart, Morris, Mellings, & Komar, 2006; Terlecki, Buckner, Larimer, & Copeland, 2011) and others finding social anxiety to be inversely (e.g., Eggleston, Woolaway-Bickel, & Schmidt, 2004; Ham & Hope, 2005) or unrelated to alcohol use quantity and frequency (e.g., Bruch, Heimberg, Harvey, & McCann, 1992; Bruch, Rivet, Heimberg, & Levin, 1997; Buckner, Ecker, & Proctor, 2011; Buckner, Mallott, Schmidt, & Taylor, 2006; Ham & Hope, 2006; O'Grady, Cullum, Armeli, & Tennan, 2011; Terlecki, Ecker, & Buckner, 2014).…”

“…Despite accumulating data of a relation between social anxiety and alcohol problems (for review, see Buckner et al, 2013), data are mixed regarding whether social anxiety is related to greater quantity or frequency of drinking, with some studies finding a positive relation between social anxiety and drinking quantity and frequency (e.g., Neighbors et al, 2007; Stewart, Morris, Mellings, & Komar, 2006; Terlecki, Buckner, Larimer, & Copeland, 2011) and others finding social anxiety to be inversely (e.g., Eggleston, Woolaway-Bickel, & Schmidt, 2004; Ham & Hope, 2005) or unrelated to alcohol use quantity and frequency (e.g., Bruch, Heimberg, Harvey, & McCann, 1992; Bruch, Rivet, Heimberg, & Levin, 1997; Buckner, Ecker, & Proctor, 2011; Buckner, Mallott, Schmidt, & Taylor, 2006; Ham & Hope, 2006; O'Grady, Cullum, Armeli, & Tennan, 2011; Terlecki, Ecker, & Buckner, 2014). Further delineation of whether and under what circumstances social anxiety is related to heavy drinking will be critical to inform alcohol intervention efforts given that socially anxious students appear vulnerable to heavy drinking after undergoing alcohol treatment (Terlecki et al, 2011).…”

Alcohol-induced risky sexual behavior among socially anxious drinkers

“…Specifically, HSA undergraduates who drink to cope with negative affect experience more frequent alcohol-induced risky sexual behaviors and consequences, including regretted sexual experiences, unprotected sex, unwanted sex, sex with unwanted partners, pressured sex, and pressured another for sex. This finding offers some insight into the social anxiety and alcohol problem relation (for review see, Buckner, Heimberg, Ecker, & Vinci, 2013). Specifically, greater coping motivated drinking in sexual/intimate situations (Terlecki et al, 2014) may render HSA undergraduates vulnerable to alcohol impairment, including more frequent risky sexual behavior and reduce related negative consequences.…”