Does Social Anxiety Cause Substance Abuse?

Although not everyone with a social anxiety disorder misuses substances, the two can be connected.
Social Anxiety Disorder

Table of Contents

What Is Social Anxiety?

Social anxiety disorder is an anxiety disorder that presents as an unreasonable and excessive fear of social scenarios. Individuals with a social anxiety disorder are often nervous or self-conscious in public and fear being watched, judged, and criticized by others.

Typically, those with social anxiety will experience excessive stress when they:

  • Meet new people.
  • Are criticized or teased.
  • Speak in public.
  • Address people in positions of authority.
  • Are the center of attention.
  • Are being observed while performing a task.

Social anxiety disorders fall into one of two categories: general social anxiety and specific social anxieties.

Those who have general social anxiety are uncomfortable and anxious in nearly all social situations, no matter where they are. However, specific social anxiety means that an individual only experiences stress in a particular circumstance. For example, public speaking is a common specific social anxiety.

Generalized social anxiety is the most common form of social anxiety.

Substance Abuse and Social Anxiety Statistics

Anxiety is the most common mental health disorder, and there are more than 15 million American adults today with social anxiety disorder. However, there is most likely more as it takes 36% of individuals ten years or more to seek treatment.1

Although social anxiety disorder and substance misuse are two separate mental health issues, they’re connected: 22% of individuals with social anxiety misuse alcohol at some point in their lives.2

Signs And Symptoms of Social Anxiety Disorder

Physical Symptoms

Social anxiety can manifest physically with symptoms that include:

  • Blushing.
  • Trembling.
  • Rapid heart rate.
  • Dizziness or lightheadedness.
  • Difficulty breathing or catching your breath.
  • Sweating.
  • Muscle tension.
  • Nausea or upset stomach.

Psychological Symptoms

In addition to physical symptoms of social anxiety disorder, there are many psychological symptoms of anxiety as well:

  • Intense fear and anxiety during social situations.
  • Anxiety in anticipation of a social situation.
  • Expecting the worst possible consequences from a negative social experience.
  • Worry about embarrassing or humiliating yourself.
  • Fear of the physical symptoms of anxiety that might cause you embarrassment, such as blushing or trembling.
  • Analysis of your performance or identifying flaws after interactions with others.

Most of us feel anxious in front of others at certain points in our lives. Doing a job interview or speaking in public are common fears. However, a social anxiety disorder results in behaviors that may interfere with their lives:

  • Avoiding situations where they might be the center of attention.
  • Avoid doing activities or speaking with others out of fear of embarrassment.

Commonly Avoided Situations

Some common experiences that people may actively avoid include:

  • Meeting new people.
  • Dating.
  • Going to work or school.
  • Making eye contact.
  • Entering a room where people are already seated.
  • Returning items to a store.
  • Eating in front of people.
  • Making a phone call in earshot of other people.
  • Using a public restroom.

In addition, children may exhibit social anxiety by clinging to parents, crying, or having temper tantrums in social situations.

Severe Social Anxiety Symptoms

When social anxiety disorder is left untreated, it can take over an individual’s life. Extreme social anxiety disorder can result in other mental health disorders, including depression and substance abuse issues. In addition, severe or acute social anxiety, called social phobia, can result in panic attacks, paralyzing fears, and extreme measures to avoid exposure.

Substance Abuse and Social Anxiety Causes and Diagnosis

There is no one set cause of social anxiety. However, social anxiety causes include:

  • Inherited traits. Typically, anxiety disorders are found in families. However, researchers have not found an exact genetic connection. It’s not clear to experts whether it’s mostly due to genes or learned behaviors.
  • Environment. Social anxiety disorder may be a learned behavior. Many people develop significant anxiety after an embarrassing or unpleasant social situation. Also, there is an association between children who develop a social anxiety disorder and parents that are more controlling, overprotective, or exhibit anxiety themselves.
  • Brain Structure. Researchers found that the part of the brain associated with fear and threat, called the amygdala, is overactive in those with a heightened fear response and related to social anxiety disorder.3

Diagnosing Social Anxiety

While there is no social anxiety disorder test, speaking with a healthcare provider can help determine a diagnosis. Typically, a diagnosis consists of:

  • A physical exam to rule out any medical conditions or medication contributing to anxiety.
  • Discussing symptoms, including how often anxiety occurs and what situations.
  • Filling out a self-report questionnaire about social anxiety symptoms.

In addition, a professional will use DSM-5 criteria to determine whether your symptoms qualify as social anxiety. The criteria include:

  • Persistent and intense fear of social situations where you fear being judged, humiliated, or embarrassed.
  • Avoidance of social situations or enduring them with extreme fear.
  • Anxiety that is out of proportion to the event or situation.
  • Distress that interferes with daily life.
  • Anxiety isn’t better explained by medication or a medical condition.

Causes and Diagnosis of Substance Abuse

Like social anxiety, there are several causes of substance abuse. For some, social anxiety is a significant factor. Common symptoms of a substance use disorder include:

  • Needing to use a substance regularly, even daily.
  • Intense urges for the substance that block out other thoughts.
  • Requiring more substance for the same effect.
  • Always maintaining a supply of the substance.
  • Spending money on the substance even when it’s not financially wise.
  • Continuing to use the substance even when it is causing harm.
  • Failing in attempts to stop using the substance.
  • Experiencing withdrawal symptoms when stopping.
  • Taking larger amounts of the substance over a longer period than intended.
social anxiety treatment

Does Social Anxiety Cause Substance Abuse?

Most mental health disorders develop during young adulthood. However, social anxiety is unique in that it happens in childhood, with an average onset around age 13. For most individuals, then, social anxiety comes first. However, abusing certain types of substances can also lead to anxiety. Anxiety is a side effect of many substances, such as marijuana, cocaine, meth, or others.

How Does Anxiety Lead to Substance Abuse?

Living with social anxiety can be crippling and interfere with essential activities. Some individuals with social anxiety disorder turn to alcohol and drugs to self-medicate. While some may turn to alcohol or certain drugs to combat feelings of anxiety, it’s not uncommon for a substance misuse disorder to develop.

Read on to learn more about the dual diagnosis process for social anxiety and addiction, alongside the types of substances most commonly abused by those suffering with social anxiety.

Dual Diagnosis of Social Anxiety and Substance Abuse

Getting a dual diagnosis is critical for proper treatment. For many, treating a substance abuse disorder without also addressing the social anxiety disorder that fueled it will cause higher instances of relapse. Social anxiety treatment is a critical factor in maintaining sobriety.

Social Anxiety and Alcohol

Unfortunately, there is a strong link between social anxiety and alcoholism. Temporarily relieves social inhibition, leading to lower anxiety levels. However, this short-term solution often fuels social anxiety disorder. Anxiety most often increases as the alcohol wears off, referred to as a boomerang effect.

Social Anxiety and Marijuana

Like alcohol, marijuana and social anxiety disorder share a clear link. In one study, 26% of people attending a treatment group for marijuana-related issues also had a dual diagnosis of social anxiety. However, they also fuel the problem as they can cause more anxiety in between use.4

Social Anxiety and Stimulants

Stimulants activate the nervous system’s fight-or-flight response and cause the body to release excess adrenaline — both actions fuel prolonged feelings of anxiety. Cases of stimulant-induced social phobia are not uncommon.5

Substance Abuse and Social Anxiety Disorder Treatment

There is help for both social anxiety disorder and substance abuse. With the right social anxiety treatment plan, many individuals can take the journey to recovery while overcoming their anxiety. The typical steps of substance abuse and social anxiety treatment include:


It’s critical to first detox under the care of a professional. As the body adjusts to functioning without substances, withdrawals and uncomfortable symptoms may occur, such as increased anxiety.


There are several types of substance abuse and social anxiety therapy. Cognitive-behavioral therapy (or CBT) is considered the most effective social anxiety treatment. It helps individuals retrain their thinking patterns and focus on shifting their actions to overcome their fear.

In addition, social anxiety group treatment can help individuals receive therapy as a group or family and uncover underlying interpersonal relationships.


Many individuals in recovery avoid the medications used to treat acute anxiety because they have high abuse potential. Typically, therapy for social anxiety is effective for those with anxiety disorders.

Medication can be used to help improve the symptoms of detox. Naltrexone and disulfiram are often used to help improve recovery, but they do need to be taken under the supervision of professionals.

Get Help at The PAC Program

While there is no one social anxiety disorder cure, social anxiety and substance abuse disorders are treatable. With the help of professionals, you or your loved one can be on the road to recovery. Contact one of our experts today to see how we can get you on the path to a better life.


If you or a loved one needs help, please call us at
623-523-4748 and our team at Blueprints For Recovery in Arizona will help.

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