Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors

Nicoli Tamie Yoshimi,Maria Odete Simão,Albina Rodrigues Torres,Luana Moraes Campos,Ricardo Cezar Torresan

doi:10.1590/0047-2085000000112

Abstract

ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.

Highlights

Social anxiety disorder (SAD) is characterized by an excessive fear and avoidance of social situations in which the indivi dual believes his/her performance may be negatively evaluated by others[1]
Only a few studies explored the prevalence of social anxiety disorder (SAD) among individuals seeking treatment for alcohol dependence, and the rates described vary from 23% to 35%15,18-20
A cross-sectional study was conducted with 53 consecutive adult patients undergoing outpatient treatment for alcohol dependence at a Brazilian public university hospital (Unesp-Faculdade de Medicina de Botucatu (FMB))

Summary

Introduction

Social anxiety disorder (SAD) is characterized by an excessive fear and avoidance of social situations in which the indivi dual believes his/her performance may be negatively evaluated by others[1]. Previous studies demonstrated high rates of comorbid alcohol use disorders (AUD) among anxiety disorder patients in general[8,9,10,11,12] and SAD patients in particular[13]. Some individuals with SAD use alcohol recurrently to reduce the anxiety, tension and inhibition they feel in social situations, developing secondary dependence[13,14]. The diagnosis of SAD in alcohol-dependent patients may be hampered by its clinical similarity with withdrawal symptoms (e.g. anxiety, tremors, sweating, increased heart rate)[8,15] and by the fact that some persons with AUD may develop social anxiety symptoms due to the shame of their behaviors while intoxicated[16]. In two studies that included outpatients with alcohol and illicit drugs dependence the prevalence rates of SAD were high: 31% 21 and 37%22

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