Author: Carolyn Weisman, Director of Adolescent Program 

Anxiety is a familiar term and experience for many people. According to the National Alliance on Mental Health, 19% of individuals experience an anxiety disorder. Yet, anxiety is an overarching term for many distinct experiences and symptoms. Specifically, social anxiety can be a debilitating experience for some, affecting individuals in various ways and levels of severity. In this blog, we'll explore the relationship between social anxiety and substance use, detailing how individuals may turn to substance use as a coping mechanism for managing the complexities of social anxiety. 


Understanding Social Anxiety 

Social anxiety specifically is an experience that often gets mislabeled and minimized as shyness or being introverted. Social anxiety disorder is the intense fear of being scrutinized, fear of being embarrassed, or fear of judgment, that can cause debilitating symptoms, and even avoidance to the point where it impacts our relationships, work and well-being. 

Social anxiety disorder often begins in the early to mid-teenage years. However, it can also start in childhood or early adulthood. Situations and triggers for social anxiety will be different for everyone who experiences it. In general, these can include social situations, asserting your needs, like ordering in a restaurant or asking a question, participating in a group discussion for school project; or if you are the focus of attention, like playing in a sports game or needing to give a speech. Triggers can also include unpredictable social engagements, being caught off guard and not being given time to plan what you are going to say.  

The symptoms of social anxiety disorder can lead to significant impairments in daily functioning. Individuals might struggle with forming new relationships, participating in class or work meetings, and may even avoid education or career opportunities that require social interactions. 

Symptoms can range in intensity, depending on the individual and the situation. While some might feel anxious in all social situations, others may only experience significant anxiety in specific scenarios. Symptoms of social anxiety can include:   

Cognitive Symptoms: negative thoughts, intrusive thoughts, excessive self-consciousness, and fear of negative evaluation. These are cognitive distortions, causing us to experience an increase in anxiety and a focus on worst case scenarios. When social anxiety is the mental filter through which our thoughts pass, we are not able to fully nor accurately see what is really happening in front of us.  

Physical Symptoms: blushing, shakiness, feeling lightheaded, sweating, an increase in heart rate, nausea, and muscle tension. Physical symptoms can be a manifestation of anxiety and be labeled as discomfort. However, the brain cannot differentiate whether these symptoms are caused by excitement or nervousness, leading to all social events feeling overwhelming.  

Behavioral Symptoms: avoidance, refusal to participate, isolation, reliance on safety behaviors, or seeking reassurance. While cognitive and physical symptoms are not in our control, behavior is. When desperate, humans will go at great lengths to alleviate or avoid discomfort. Quick fixes like avoidance, rehearsing scenarios in your mind, and substance use can assist short term and are counter-therapeutic and unhelpful in the long term.   


Impact on Mental Health 

People with social anxiety disorder often experience other mental health conditions, such as depression, other anxiety disorders, and substance use disorders. The simultaneous presence of two disorders, identified as co-occurring, can cause difficulties in diagnosing and treating social anxiety disorder.  

It is not uncommon for a person struggling with social anxiety, as well as other anxiety and mood disorders, to use substances like alcohol, nicotine, THC, etc., as a coping mechanism. In these situations, this can also be called a safety behavior, to alleviate social discomfort and anxiety, despite the possibility of it leading to a range of negative outcomes, including the development of substance use disorder. This is of significant concern as the co-occurrence of social anxiety and substance use is a complex issue in terms of presentation, treatment, and impact. According to the National Alliance of Mental Health, 8% of individuals experience a co-occurring substance use and mental health disorder.   

The co-occurrence of social anxiety disorder and substance dependence disorder highlights the need for comprehensive assessment and treatment strategies that address the complex nature of these conditions. By understanding the interconnections between social anxiety and substance use, healthcare providers can better support individuals in overcoming these challenges and achieving improved mental health outcomes. 


Social Anxiety and Substance Use 

Research shows that individuals with social anxiety disorder are at a higher risk of developing substance dependence disorder compared with the general population due to the nature of social anxiety disorder’s symptoms (Rosenström &Torvik, 2023). Using substances can create a false sense of connection in several ways, often by altering perceptions, emotions, and behaviors temporarily, which can lead to superficial interactions that lack the depth and authenticity of genuine connections.  

Substances like alcohol and certain drugs lower inhibitions, making individuals feel more open, extroverted, or willing to engage in social interactions. While this might lead to an increased quantity of social interactions, the quality and authenticity of these interactions can be questionable. People might feel a sense of connection, which is the result of impaired judgment rather than a true bond. In these altered states, individuals may perceive connections with others as more profound or meaningful than they actually are, mistaking shared intoxication for shared experience or emotional intimacy. 

Some individuals with social anxiety disorder may use alcohol to self-medicate in social situations to reduce anxiety and inhibitions. Self-medication is a widely recognized explanation for the increased parallel between social anxiety disorder and substance dependence disorder. While the individual uses substances to cope with social anxiety symptoms, the adverse effects on their health and the potential for addiction are disregarded. This use may become a crutch, leading to chronic use which can exacerbate anxiety, starting a vicious cycle of increased use and heightened anxiety. 

Substance use, like alcohol, is also normalized and available at almost all social interactions. Using substances as a means to facilitate social interaction can make people feel that substances are necessary, leading individuals to avoid sober situations where real emotional engagement and vulnerability are required. This avoidance can impede the development of authentic relationships and emotional growth. Relationships built around substance use may lack depth beyond the shared activity of using and might not offer support or engagement in sober environments. 

Both social anxiety disorder and substance use disorder have genetic components, and individuals with a family history of either condition are at an increased risk. Environmental factors, such as exposure to trauma, can also play a significant role in the development of these disorders.  

Link Between Social Anxiety & Substance Use

The Importance of Seeking Help 

It is important to note that the understanding of social anxiety disorder continues to evolve. Increasing awareness can improve success with effective treatment, including therapy and sometimes medication. By understanding the interconnections between these disorders, healthcare providers can better support individuals in overcoming these challenges and achieving improved mental health outcomes.  

Studies from the National Alliance on Mental Illness show that the average delay in seeking support for a mental health disorder from the onset of symptoms is 11 years. Early interventions can be crucial to prevent the development of a mental health disorder. Educating individuals with social anxiety about the risks of substance use as a coping mechanism can help mitigate the risk of developing dependence. Effective treatment for individuals with both social anxiety disorder and substance use dependence often requires an integrated approach that addresses both conditions simultaneously.  

Talk Therapy: Talk therapy is a form of psychotherapy where a therapist works one-on-one with a client to explore their feelings, beliefs, behaviors, and response to life events and challenges. This personalized approach allows for deep exploration and understanding of personal issues and the development of strategies to promote growth and problem-solving.  

CBT: Cognitive Behavioral Therapy focuses on identifying and challenging negative thought patterns and beliefs to change unwanted behavior and emotions. This approach helps individuals become aware of inaccurate, intrusive, or negative thinking, i.e. cognitive distortions, so they can see difficult situations more clearly and respond to them in a more effective way. CBT is evidence-based and widely used to treat a variety of mental health disorders, including social anxiety and substance dependence, by teaching practical self-help strategies. 

ACT: Acceptance and Commitment Therapy encourages individuals to accept their emotions and thoughts rather than pushing them away or feeling bad about having them. It utilizes mindfulness strategies to help people become aware of and accept their internal experiences and commit to making necessary changes in their behavior, regardless of what is going on in their lives and how they feel about it. The core of ACT is to live a values-driven life, rather than one dictated by the avoidance of discomfort, thereby increasing psychological flexibility and the capacity to engage in meaningful activities. 

Group Therapy: At Compass Health Center, group therapy is a primary intervention. It is a form of psychotherapy that involves one or more therapists working with several people at the same time. Groups are formed to support a specific focus, like social anxiety, substance use, or both. Group provides a supportive environment for vicarious learning, where participants can discuss their issues openly, with guidance from trained therapists. Members benefit from the collective experiences and insights of the group, which can provide multiple perspectives on common issues, enhancing understanding and coping strategies. 
It also offers a unique opportunity for individuals to learn and practice interpersonal skills, such as communication, empathy, and assertiveness, in a safe and controlled setting. Hearing from others with similar issues helps individuals realize they are not alone in their struggles, which can be incredibly validating and reduce feelings of isolation. Group therapy allows for real-time feedback from peers and therapists, offering new insights into behaviors, thoughts, and emotions. The group setting fosters a sense of community and support amongst members. 

Medication: Medication can be helpful in treatment by correcting imbalances in brain chemistry associated with various mental health disorders, while in turn reducing symptoms and improving quality of life. It often works in combination with talk therapy to enable individuals to engage more effectively in psychotherapy by stabilizing mood, reducing anxiety, or improving concentration. 

It is important to note the challenges of treatment with these diagnoses due to the potential reluctancy to seek treatment from fear of social stigma or judgment. If substance use is continued while engaging in treatment, it can interfere with the effectiveness of the interventions for social anxiety.  


Breaking the Stigma 

Taking the step to talk about and seek treatment for social anxiety and substance use is a brave and significant decision towards a healthier, more fulfilling life. It's important to remember that you're not alone in this journey. Many people have navigated similar challenges and have found not just relief but also profound personal growth on the other side of treatment. 

The courage used to face these issues head-on is the first step towards growth. By seeking help, you're opening a world of possibilities that include genuine connections and self-discovery. Treatment can provide you with the tools and strategies to manage anxiety in healthy ways, build stronger relationships, and live a life not defined by anxiety or substance use. 

Progress may sometimes feel slow, however each step forward is a step towards a more authentic you. Your experiences, struggles, and victories can also serve as hope and a source of strength for others facing similar challenges. Your journey might inspire others to seek the help they need, spreading hope and healing further than you might imagine. 


Navigating Social Anxiety and Substance Use: Seeking Help 

Interested in learning more about managing social anxiety and substance use? Explore Compass Health Center's programs designed to provide personalized support and guidance. Take the next step towards improving your mental health and overall well-being. 

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Additional Resources and Support 



Further Reading: 

Carolyn Weisman

Director of Adolescent Program