An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder

Abstract

Social Anxiety Disorder (SAD) commonly co-occurs with, and often precedes, Alcohol Use Disorder (AUD). In this paper, we address the relationship between SAD and AUD by considering how natural selection left socially anxious individuals vulnerable to alcohol use, and by addressing the underlying mechanisms. We review research suggesting that social anxiety has evolved for the regulation of behaviors involved in reducing the likelihood or consequences of threats to social status. The management of potential threats to social standing is important considering that these threats can result in reduced cooperation or ostracism – and therefore to reduced access to coalitional partners, resources or mates. Alcohol exerts effects upon evolutionarily conserved emotion circuits, and can down-regulate or block anxiety (or may be expected to do so). As such, the ingestion of alcohol can artificially signal the absence or successful management of social threats. In turn, alcohol use may be reinforced in socially anxious people because of this reduction in subjective malaise, and because it facilitates social behaviors – particularly in individuals for whom the persistent avoidance of social situations poses its own threat (i.e., difficulty finding mates). Although the frequent co-occurrence of SAD and AUD is associated with poorer treatment outcomes than either condition alone, a richer understanding of the biological and psychosocial drives underlying susceptibility to alcohol use among socially anxious individuals may improve the efficacy of therapeutic interventions aimed at preventing or treating this comorbidity.

Non-pharmacological factors that determine drug use and addiction

“…complete abstainers (Peele and Brodsky, 2000;Skogen et al, 2009). Evidence supports the view that alcohol is consumed to provide relief from negative affect (Peele and Brodsky, 2000;Bulley et al, 2016). There is a considerable co-morbidity of the diagnoses 'major depression' and 'alcohol addiction' in clinical populations (Brown et al, 1995;Preuss et al, 2002).…”

Explaining the association between anxiety disorders and alcohol use disorder: A twin study

“…One study has supported this hypothesis (Kushner et al, 2012). On the other hand, alcohol is likely to be particularly "useful" to individuals with SAD (Bulley, Miloyan, Brilot, Gullo, & Suddendorf, 2016), and in studies that analyzed all anxiety disorders together, only SAD predicted AUD in adjusted analyses (Buckner & Schmidt, 2009;Buckner & Turner, 2009;Buckner et al, 2008). Thus, we have four possible explanations of the association: (a) direct effects from SAD to AUD, (b) direct effects from AUD to SAD, (c) shared genetic and/or environmental risk factors, and (d) a general relationship between anxiety disorders and AUD.…”

“…It could, therefore, be that the association between SAD and AUD reflects a broader association between AUD and anxiety disorders, rather than SAD specifically. On the other hand, alcohol is likely to be particularly "useful" to individuals with SAD (Bulley, Miloyan, Brilot, Gullo, & Suddendorf, 2016), and in studies that analyzed all anxiety disorders together, only SAD predicted AUD in adjusted analyses (Buckner & Schmidt, 2009;Buckner & Turner, 2009;Buckner et al, 2008). On the other hand, alcohol is likely to be particularly "useful" to individuals with SAD (Bulley, Miloyan, Brilot, Gullo, & Suddendorf, 2016), and in studies that analyzed all anxiety disorders together, only SAD predicted AUD in adjusted analyses (Buckner & Schmidt, 2009;Buckner & Turner, 2009;Buckner et al, 2008).…”

Psychosocial factors of the neurotic disorders treatment and prevention in metropolis

“…Очевидно, что в таком случае возникает существенное нарушение социального функционирования, мешающие строить личные отношения, общаться, учиться, заниматься профессиональной деятельностью, добиваться карьерного роста [20,29,30]…”