Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys

According to the self-medication and biopsychosocial models, individuals with social anxiety disorder (SAD) are at increased risk of developing an alcohol use disorder (AUD) as alcohol represents a maladaptive coping mechanism for some sufferers of SAD. The SAD-to-AUD causation was earlier supported in Norwegian longitudinal twin data and later questioned using longitudinal data from the USA.
Researchers re-analysed partly the same USA-based data (National Comorbidity Surveys, with 5001 participants), conducting theoretical and simulation analyses on different formulations of temporality to investigate whether baseline SAD was associated with AUD at the follow-up.
The researcher found that SAD preceded AUD. Specifically, SAD was the only one of the seven anxiety disorders that predicted 10-year later AUD after adjusting for all other anxiety disorders and AUD at the baseline (odds ratio was 1.70% and 95% CI= 1.12–2.57). SAD was also associated with incident AUD (OR = 1.64, 95% CI = 1.14–2.37). The researchers demonstrated temporality and specificity in SAD-to-AUD association, which are considered signs of causation.
The findings add support for models positing causal effects of SAD on AUD, such as the self-medication and biopsychosocial models. The available evidence suggests that treating SAD should incur better chances of preventing AUD compared to treating other anxiety disorders, which lack comparable evidence on causation.
Source: Tom H. Rosenström, Fartein Ask Torvik. Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys, Drug and Alcohol Dependence, Volume 249, 2023, 109945 ISSN 0376-8716.