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Social Anxiety in Teenagers Raises Substance-Abuse Risk

Social anxiety in youth, but not other anxiety or mood disorders, seems to set the stage for marijuana or alcohol dependence. So treating adolescents with social anxiety might reduce such dependence.

Individuals who are socially anxious often use alcohol or marijuana to calm their nerves. But can social anxiety actually predispose people to marijuana or alcohol dependence? The answer seems to be yes, a large prospective study by N.B. Schmidt, Ph.D., a professor of psychology at Florida State University, and colleagues suggests. Their report is in press with the Journal of Psychiatric Research.

Some 1,700 high school students with an average age of 17 were assessed for a lifetime history of DSM-IV Axis I disorders and for a lifetime history of alcohol- or marijuana-use disorders. Of those 1,700, 816 were followed until age 30 to determine whether they developed alcohol or marijuana dependence. Then the researchers looked to see whether those subjects with a history of social anxiety disorder at age 17 were more likely to later experience alcohol and marijuana dependence than were subjects without such a history.

When possibly confounding variables such as having a lifetime history of another affective disorder besides social anxiety disorder or having already experienced an alcohol- or marijuana-use disorder by age 17 were taken into account, having a lifetime history of social anxiety disorder at age 17 was significantly linked with the development of alcohol or marijuana dependence by age 30.

Moreover, having a history of social anxiety disorder at age 17 was linked with a fivefold risk of developing alcohol dependence and with a sevenfold greater risk of developing marijuana dependence, compared with peers who did not have such a history at that age.

Finally, the investigators evaluated whether having a lifetime history of anxiety disorder other than social anxiety disorder at age 17 likewise predicted the later development of alcohol or marijuana dependence, but they found no such link. They also failed to find a link between a lifetime history of a mood disorder at age 17 and later alcohol or marijuana dependence.

Thus, "among the internalizing disorders, social anxiety disorder appears to serve as a unique risk factor for the subsequent onset of cannabis and alcohol dependence," Schmidt and his group concluded.

The results have implications for clinical psychiatrists, Schmidt told Psychiatric News. "I think it is relevant to consider assessing for cannabis use among patients with social anxiety disorder, which might tend to be overlooked.... Also, we need to do a good job of educating social anxiety disorder patients regarding utilization of alcohol and cannabis to help them cope with their anxiety because of their high risk for problematic use of these substances."

Schmidt and his team will continue to follow their study cohort to see if future assessments can shed more light on the link between social anxiety and alcohol and marijuana dependence. For instance, it might possibly answer the question of whether subjects' social anxiety declines as they mature, and if so, whether their alcohol and marijuana dependence eases as well. Also, one of Schmidt's graduate students has received a grant from the National Institute on Drug Abuse to examine some of the mechanisms involved in the relationship between social anxiety and marijuana use.

"It may be that treatment of adolescent anxiety disorder could reduce the incidence of adult substance use disorders," Schmidt and his team speculated.

The study was funded by the National Institutes of Health and the John Simon Guggenheim Foundation.

An abstract of "Specificity of Social Anxiety Disorder as a Risk Factor for Alcohol and Cannabis Dependence" can be accessed at <www.sciencedirect.com> by clicking on "J" under "Browse by title," then "Journal of Psychiatric Research."

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