“I was very shy – with strangers – I couldn’t talk to people. And I found if I had a drink, it would loosen me up. The barriers went down and I became very social. That’s what got me started.”
These words from iconic American entertainer Richard “Dick” Wayne Van Dyke would shock many people, given his immense popularity as an actor in films such as “Mary Poppins” and “Chitty Chitty Bang Bang,” and his role in the hit television sitcom “The Dick Van Dyke Show.” In a candid interview with Oprah Winfrey on her show “Oprah: Where Are They Now?”, the legendary actor admitted that the onset of his alcoholism was due to shyness emanating from social anxiety. Although Van Dyke’s admission may have raised eyebrows, it is not a unique case – alcohol is considered a popular self-medicating option, second only to food, for individuals battling social anxiety.
Eating is a tried-and-tested way of feeling better, explains Tian Dayton, clinical psychologist and author. “Sitting down to a yummy sweet along with a cup of tea or coffee is an age-old way of self-soothing. And a perfectly harmless one if done in moderation,” she says. However, when eating becomes the sole option to calm frayed nerves, it assumes serious overtones. “Food starts to be a ‘substance’ that we use, or misuse, to feel better fast,” the author adds. Depending on something external, rather than internal self-regulation, weakens the body’s natural ability to calm down. In such situations, food becomes “a sort of self-administered medication.” The same is true for alcohol and other substances.
Placebo effect of positive expectancies of anxiety reduction
According to the Anxiety and Depression Association of America (ADAA), nearly 15 million American adults, representing 7 percent of the adult population, suffer from social anxiety disorder (SAD) in any given year. It also reports that around 20 percent of Americans with an anxiety or mood disorder such as depression suffer from an alcohol or other substance use disorder (SUD) – the same holds true the other way around. The substances can aggravate anxiety symptoms.
Past research by the University of Manitoba in Winnipeg, Canada, examined the association between SAD and using alcohol to self-medicate anxiety symptoms. Individuals with anxiety disorders who self-medicated at the beginning of the study had a two- to five-time higher likelihood of developing SUD within three years, compared to those who did not self-medicate. Moreover, self-medicating with alcohol to treat ordinary feelings of anxiety led to a significantly higher likelihood of developing full-blown SAD by the time the study ended. The findings showed that although alcohol produced beneficial short-term results, its impact worsened social anxiety in the long term.
Various researchers offer hypotheses regarding the placebo effects produced by positive expectancies of anxiety reduction. Researchers from the Center for Drug and Alcohol Programs and Alcohol Research Center at the Medical University of South Carolina (MUSC) explain that “Positive expectancies that alcohol can relieve social fears may explain why some people experiment with alcohol as a coping strategy in the first place.” If such positive expectancies are not disputed, individuals develop a strong belief system to justify continued alcohol use for suppressing anxiety.
The use of substances such as benzodiazepines (frequently prescribed for anxiety) and alcohol, which act as central nervous system depressants, temporarily soothe nerves and help in suppressing some of the acute psychological symptoms of anxiety. This may explain the high popularity of alcohol use as a self-medication option and one of the “primary means of coping” with SAD.
Treatment of co-occurring SAD and alcohol use disorder
Eagerly anticipating the first drink at a social event may indicate some degree of social anxiety or even alcoholism. However, looking forward to a drink because an individual is fond of it (and not because it alters mood) is something else. The treatment of co-occurring SAD and alcohol abuse requires comprehensive and specialized care. Attending support groups may be intimidating and trigger further anxiety in people already suffering from SAD. The same may hold true for seeking admission in a residential mental health treatment program where the patient will be expected to live among strangers and participate in group therapy sessions.
In such cases, one-on-one counseling sessions with therapists specializing in anxiety disorders can help. Such sessions, besides helping individuals overcome their social anxiety, can equip them with skills necessary to enroll in an alcohol treatment program in future. Past research shows that a combination of combination of cognitive-behavioral therapy (CBT) and motivational enhancement therapy (MET) may be successful in treating co-occurring SAD and alcohol use disorder.
Co-occurring disorders are complex, and often their diagnosis and treatment pose challenges. It is vital to treat both the disorders simultaneously for long-lasting recovery. Sovereign Health understands the plight of someone who is unable to discontinue substance use despite the negative mental health impact. Our customized recovery programs are designed to treat the person holistically. Call our 24/7 helpline to know about the most effective California dual diagnosis treatment programs. You can even chat online with one of our representatives to know more about our state-of-art residential treatment centers in California.
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