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When Drinking Doesn’t Help: The Connection Between Alcohol and Social Anxiety

Alcohol and anxiety are closely related. Many people with social anxiety disorder (SAD) feel like drinking alleviates their symptoms. In the short term, that might even be true. But over time, any alcohol consumption can make matters worse. Heavy drinking not only increases anxiety; it can also turn into addiction.

If you have either of these conditions, treatment can help. You can attend inpatient rehab to treat a drinking problem, social anxiety, or both at the same time. During recovery, you’ll learn better ways to cope with your symptoms. And with those skills in hand, you won’t have to self-medicate with alcohol.

“Getting to the Root of My Anxiety”

If you’re using alcohol to cope with social anxiety,1 you might feel stuck in a cycle. But according to one anonymous Reddit user, there’s always a way out:

Alcohol “was like a miracle cure,” they write in a post. “Super confident, I’d walk up and talk to anyone. And embarrass myself obviously. I’d blackout drunk every single time because I never wanted the feeling to end. I didn’t want to go back to being scared.”

Over time, this person’s symptoms got worse, but “the increasing anxiety made me drink more.” They would experience withdrawal whenever they were sober. It turned into a vicious cycle. When drinking got in the way of their parenting, they knew something had to change.

“Getting to the root of my anxiety and feelings of self hatred was the important thing,” they explain on the Social Anxiety subreddit. “It’s been 4 years now and I haven’t had a drop.” It may feel like you need alcohol in order to function—but in reality, drinking just compounds the problem.

When Social Drinking Becomes a Problem

Many people feel like they need alcohol to be social. And it can be hard to spend time around drinkers without joining in. But anxiety disorders and alcohol addiction go hand in hand.2 If you have SAD, you may be at a higher risk of developing a drinking problem.

Defining Alcohol Abuse

The official criteria for alcohol abuse3 might surprise you. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as follows:

  • For men: Over 4 drinks in 1 day, or 14 drinks in 1 week
  • For women: Over 3 drinks in 1 day, or 7 drinks in 1 week

(These definitions are based on biological differences between cis male and female drinkers. They may not be accurate for people of all genders.)

These numbers might help you identify an addiction. But any quantity of drinking can cause anxiety.4 According to the Anxiety and Depression Association of America, “Even moderate amounts of alcohol can affect one’s mood and anxiety level.”

Alcohol use is so socially acceptable that it can take time to even realize you have a problem. But this addiction is all too common in people with anxiety. A study found that “about ⅕ of patients with social anxiety disorder also suffer from an alcohol use disorder.”2

How Alcohol Impacts Anxiety

Drinking has a complex effect on mental health. On one hand, alcohol is an anxiolytic5 —meaning that it reduces anxiety. However, data shows that alcohol abuse “can also lead to increased anxiety.”6 And when the same behavior makes your symptoms both better and worse, it can be hard to imagine recovery. But with expert support, you can absolutely break out of this cycle.

Treatment for Co-Occurring Social Anxiety and Alcohol Addiction

It may feel like drinking is the best way to manage your symptoms—but in rehab, you’ll find healthy alternatives. If you’ve been drinking to self-medicate your anxiety,7 you can recover from both. Experts say that treating these issues at the same time is “the current ‘gold standard’ model of care.” There are several ways you can approach treatment.

Detox

When you first quit drinking, medical detox is almost always necessary. This process can have serious side effects, and some people need 24-hour care. Your specific needs will depend on the amount you’ve been drinking and your physical health.

Anxiety is a common symptom of quitting alcohol.8 If you have SAD, your symptoms may get worse during detox. In an inpatient program, you might get a prescription to help with this side effect.

Medications for Social Anxiety Disorder

A wealth of data supports treating social anxiety disorder9 with medications. You might take SNRIs (ex. Cymbalta, Effexor) or SSRIs (ex. Prozac, Zoloft). A doctor or psychiatrist can determine whether any of these are the right fit for you.

Your physical and mental health should stabilize during your time in rehab. As that happens, your needs will change, too. Some people keep taking meds long after they start recovery, while others stop after a short time. No matter how long you spend taking meds, you should stay in close contact with your doctor the whole time. This is an important way to guard against relapse.

Cognitive Behavioral Therapy (CBT)

Research shows that CBT is a highly effective therapy for social anxiety disorder.10 It is also a well-regarded treatment for alcohol addiction.11 If you’re healing from both these conditions, it could be very helpful.

During CBT, you’ll meet with a therapist in 1:1 sessions. They’ll teach you practical skills that help you live with your anxiety. You’ll learn to reframe your thoughts and respond to triggers in a healthy way.

CBT is no substitute for traditional talk therapy. As a behavioral treatment, it’s designed to help you change your daily habits. However, you won’t spend much time talking about your past. And in order to move forward, it’s important to look back on where you’ve been. If you do CBT in rehab, it will likely be combined with other types of therapy.

Exposure Therapy

In exposure therapy, patients face stimuli that would normally trigger them. This involves creating a hierarchy of situations that cause anxiety and includes telling the story of a time you were triggered in real life. You’ll speak in the present tense, describing the event in great detail. Then, you and your therapist will talk through your emotional response. Preliminary research also shows that virtual reality exposure therapy can reduce social anxiety.12

Some data suggests that a version of this treatment called cue exposure therapy (CET) can treat alcohol addiction.13 However, much more research is needed on the subject.

Mindfulness

Mindfulness strategies can treat many mental health issues, including anxiety and addiction. One study looked at mindfulness-based interventions (MBIs) as a treatment for social anxiety.14 Researchers found a “a dose-response relationship between MBIs duration and effect size.” In other words, the longer you spend practicing mindfulness, the more effective it can be in reducing anxiety.

For people recovering from an alcohol addiction, mindfulness can help prevent relapse.15 Learning mindfulness techniques early in recovery may set you up for future success.

Support Groups

For people with social anxiety, the very idea of going to a meeting can be a trigger. But for people with alcohol addiction, support groups can improve treatment outcomes.16 Talk to your primary therapist about whether attending a support group is a good idea for you.

If you decide to try it out, there are many options available. Most peer-led support groups host free meetings all over the world. You can even connect with your peers online, from anywhere. In these groups, you can connect with people who share some part of your experience. If you feel anxious to be around them, that’s okay. They might feel that way, too. Talking about it can help you build meaningful relationships. And that’s an essential part of healing.

Specialized Care, in a Protected Space

And it can be hard to treat just one of these issues at a time. Instead, experts recommend integrated treatment for addiction and social anxiety.17 In layman’s terms, that means starting recovery for both diagnoses at once.

Many rehabs offer this kind of specialized care. A team of providers can design a treatment plan to meet your needs. And in the privacy of an inpatient program, you can focus on what’s most important: your own recovery process.

In the right program, you’ll get the coordinated care you need. Connect with a rehab that specializes in treating co-occurring anxiety and alcohol addiction here.

Reviewed by Rajnandini Rathod

 

  1. Efilnikufecin. (2021, October 18). I became an alcoholic due to Social Anxiety [Reddit Post]. R/Socialanxiety. www.reddit.com/r/socialanxiety/comments/qau9cf/i_became_an_alcoholic_due_to_social_anxiety/ []
  2. Book, S. W., & Randall, C. L. (2002). Social anxiety disorder and alcohol use. Alcohol Research & Health, 26(2), 130–135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683821/ [] []
  3. Drinking levels defined | national institute on alcohol abuse and alcoholism(Niaaa). (n.d.). Retrieved July 5, 2022, from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking []
  4. Social anxiety disorder and alcohol abuse | anxiety and depression association of america, adaa. (n.d.). Retrieved July 5, 2022, from https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse []
  5. Gilman, J. M., Ramchandani, V. A., Davis, M. B., Bjork, J. M., & Hommer, D. W. (2008). Why we like to drink: A functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol. Journal of Neuroscience, 28(18), 4583–4591. https://doi.org/10.1523/JNEUROSCI.0086-08.2008 []
  6. Lingford-Hughes, A., Potokar, J., & Nutt, D. (2002). Treating anxiety complicated by substance misuse. Advances in Psychiatric Treatment, 8(2), 107–116. https://doi.org/10.1192/apt.8.2.107 []
  7. Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 35(9), 851–860. https://doi.org/10.1002/da.22771 []
  8. Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health and Research World, 22(1), 5–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761824/ []
  9. Rose, G. M., & Tadi, P. (2022). Social anxiety disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK555890/ []
  10. Evren C. An overlooked combination in treatment: addiction and social anxiety disorder comorbidity. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2020;33:331-333. https://dusunenadamdergisi.org/storage/upload/pdfs/1614849083-en.pdf []
  11. Kiluk, B. D., Ray, L. A., Walthers, J., Bernstein, M., Tonigan, J. S., & Magill, M. (2019). Technology‐delivered cognitive‐behavioral interventions for alcohol use: A meta‐analysis. Alcoholism: Clinical and Experimental Research, 43(11), 2285–2295. https://doi.org/10.1111/acer.14189 []
  12. Chesham, R. K., Malouff, J. M., & Schutte, N. S. (2018). Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety. Behaviour Change, 35(3), 152–166. https://doi.org/10.1017/bec.2018.15 []
  13. Mellentin, A. I., Nielsen, B., Nielsen, A. S., Yu, F., & Stenager, E. (2016). A randomized controlled study of exposure therapy as aftercare for alcohol use disorder: Study protocol. BMC Psychiatry, 16(1), 112. https://doi.org/10.1186/s12888-016-0795-8 []
  14. Liu, X., Yi, P., Ma, L., Liu, W., Deng, W., Yang, X., Liang, M., Luo, J., Li, N., & Li, X. (2021). Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis. Psychiatry Research, 300, 113935. https://doi.org/10.1016/j.psychres.2021.113935 []
  15. Zgierska, A., Rabago, D., Zuelsdorff, M., Coe, C., Miller, M., & Fleming, M. (2008). Mindfulness meditation for alcohol relapse prevention: A feasibility pilot study. Journal of Addiction Medicine, 2(3), 165–173. https://doi.org/10.1097/ADM.0b013e31816f8546 []
  16. Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance Abuse and Rehabilitation, 7, 143–154. https://doi.org/10.2147/SAR.S81535 []
  17. Nguyen, A., Mirbaba, M., Khaleghi, F., & Tsuang, J. (n.d.). Current treatment options for co-morbid anxiety and alcohol use disorders: A review. Journal of Addictive Behaviors and Therapy, 1(1), 0–0. Retrieved from https://www.primescholars.com/abstract/current-treatment-options-for-comorbid-anxiety-and-alcohol-use-disorders-a-review-106758.html []

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