You knew him from school. He used to be shy and quiet, always kept to himself. Hanging ’round the corners, not really trying to speak to anyone. Sometimes he looked like he was depressed, but usually, he was just distant.

He did alright in class, but when some teacher would call him out to speak in front of everyone, his eyes would start running wild. His voice would tremble and so would his hands. After a few seconds of what seemed like agony, he would clench his fists, pick himself up, and carry on as best as he could, sometimes steering up waves of giggles in the classroom.

Ten years later, you run into him in a pub. He recalls who you are and is unusually happy to see you. He buys you a pint. You talk about how life has been treating you. You exchange more words with him that night than in all those years of being in the same class. Now he’s a friendly lad, just chatting, laughing, looking people in the eye. He seemed to have grown out of his issues. You buy him a pint too.

As the night goes on, you notice that he drinks quite a lot. One beer turns into five. And still, he looks like a completely conscious, outgoing, friendly individual. He obviously manages to stop before he gets heavily drunk.

You keep seeing him occasionally at the same pub, and as months, and then years go by, it becomes obvious he has developed a problem. He would start as usual, but by the end of the night, he would get pale as a ghost, still friendly, but unable to speak out one reasonable, coherent sentence. You find out one night from the bartender that his average is now 10 beers a night.

Shaken, you can’t help but think about that withdrawn boy from the class. Could it be that he tried to “cure himself” of his apparent social panic with alcohol, inevitably slipping into alcoholism?

Stories like the one above are common. And the link between social anxiety disorder, or sociophobia, runs deep. About 20 percent of people with social anxiety disorder also suffer from alcohol abuse or dependence, and a recent study found that the two disorders have a stronger connection among women[1].

Social Anxiety Disorder – The What and The Why

Social anxiety disorder is usually triggered by social situations in which emotions like fear or embarrassment may arise. Symptoms of social anxiety disorder include[2]:

• Highly self-conscious feelings while in the company of others (backed up by the voice of “internal criticizer”)
• Difficulty talking to people
• Fear of judgement of others
• Excessive worrying about upcoming social events
• Physical sensations such as trembling and nausea.

Reasons for the occurrence of sociophobia are complex. After all, a mild sociophobia is a part of our very instinct. Healthy fear is there to keep us from trouble. Babies exhibit fearful reactions to strangers; adults feel fear when faced with conflicts, uncontrollable circumstances, and can feel afraid of people and situations which somehow seem “wrong”.

But with people suffering from anxiety, that internal alarm which informs us that something doesn’t feel right is sort of broken. It turns on in inappropriate, ordinary, unthreatening situations. And with social anxiety, those situations involve the presence of other people.

Interestingly, although symptoms of social anxiety are well studied, and so are the drug therapies that are offered to treat the condition, the roots of the disorder are still elusive. There are indications that genetics might play a role – a German study discovered that the expression of serotonin transporter gene “SLC6A4” is correlated with someone’s odds of suffering from anxiety disorder[3]. Initial attachment with parents is thought to play a significant role[4], and some experimental evidence shows that excessive fear of the unknown might be a learned behavior – children soak in the fearful reactions of their parents[5]. There is also an edgy theory that social anxiety is a trait which was positively selected in the population – that people that like to keep to themselves and stay at home are more likely to survive than an average member of the crowd.

It may slightly increase your chance of survival in the long run, but social anxiety can cripple your everyday life in a number of ways. In severe cases, it might influence your ability to get and hold a job, form friendships, meet a partner, all in all – lead a normal, satisfying human life. Since humans are social creatures by nature, having a disorder that impairs your ability to socialize can make your life feel hellish.

That’s where the link between anxiety and drinking lies.

How Alcohol Does (Not) Help Anxiety

Alcohol interferes with synapses in the brain[6]. It increases serotonin levels, and as we’ve learned previously, anxiety disorder is related to serotonin pathways in the brain. So alcohol temporarily acts as a sedative, which drives many socially anxious people to reach for the bottle when they’re surrounded by people. After all, “social drinking” is completely culturally accepted, and even encouraged.

Alcohol subdues that almost sadistic internal voice of sociophobia sufferers, the one which always nags how faulty they are compared to other people. When a socially anxious person takes to drinking, it almost feels like a true cure – it relaxes the muscles and the mind, removes inhibitions, makes it easier to talk to others, and do courageous things, such as asking someone on a date.

But somewhat like the Cinderella’s potion, alcohol’s effects are not long-lasting, and soon turn sour. As alcohol gets filtered out by your liver, the now-disturbed brain chemistry starts to affect mood, causing the very thing alcohol helped to alleviate – anxiety. That’s why anxious drinkers get the overwhelming urge to continue drinking as soon as the initial effect starts decreasing, which in time leads to increased tolerance, addiction, and physical illness.

As it is nicely noted here[7], it is ironic that we’re culturally conditioned to “have a drink to calm our nerves”, when in reality, beyond the initial relaxation, our “nerves” get even more agitated when consuming alcohol. Anxiety is actually one of the first symptoms of alcohol withdrawal, starting about 8 hours after the last drink[8]. That explains why the first thing many alcoholics will do upon waking up is to have a drink, even if on an empty stomach.

Anxiety-driven drinking has even more unique features. It’s often the case (as with the man from our opening story) that when the anxiety sufferers get really drunk, to other people they seem fairly normal. For example, you might be surprised to learn that your friend, who sounded perfectly sober, was actually experiencing a blackout at the time you talked to him/her. That’s why it’s often the case that social anxiety sufferers’ drinking problem is ignored by their friends, and even partners, because at the beginning they seem truly better off with a few drinks. Unfortunately, it usually takes a turn to worse quickly.

What can you do?

If you’re suffering from anxiety yourself, and you’ve just discovered the “benefits” of alcohol – stop before you end up in a vicious cycle. Anxiety is nothing to be ashamed of – it’s just a natural survival mechanism gone a bit wrong, and it’s none of your fault. There are better ways to treat social anxiety issues, and they don’t have to include drug therapies.

If you have somebody close who is socially withdrawn and dabbling in alcohol, try to gently make them pay attention. Don’t blame, don’t criticize – social anxiety sufferers already hear plenty of that in their own minds. You don’t have to be direct. You can approach the issue from a third-person perspective/example, for instance. Be aware that your ability to influence might be very limited, but just don’t deny that there is no problem at all.

The only way to successfully treat alcohol addiction in anxiety disorder sufferer is to treat the root disorder along with the addiction. The good news is that although a large number of people are suffering from anxiety-related alcoholism, many have found a way out of it. Counseling and therapy have come a long way and are more successful than ever in treating both addiction and anxiety.

[1]Social Anxiety Disorder and Alcohol Abuse. Anxiety And Depression Association Of America. https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse

[2] The Connection between Anxiety and Alcohol. American Addiction Centers. https://americanaddictioncenters.org/alcoholism-treatment/anxiety/

[3] Genetics Play a Role in Social Anxiety Disorder Study Finds. Psychology Today. https://www.psychologytoday.com/blog/the-athletes-way/201703/genetics-play-role-in-social-anxiety-disorder-study-finds

[4] Social Anxiety: Mapping Its 7 Key Components. Psychology Today. https://www.psychologytoday.com/blog/theory-knowledge/201605/social-anxiety-mapping-its-7-key-components

[5] New Research Reveals Neural Roots of Social Anxiety. Psychology Today. https://www.psychologytoday.com/blog/fulfillment-any-age/201612/new-research-reveals-neural-roots-social-anxiety

[6] How Does Alcohol Affects Anxiety? Anxiety and Alcohol. Drinkaware UK. https://www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/mental-health/alcohol-and-anxiety/#alcohol%20affects/

[7] 6 Reasons Why you Can Suffer From Alcohol Anxiety & What To Do About It. Calmer You. https://www.calmer-you.com/alcohol-anxiety/

[8] Alcohol Withdrawal Treatment, Symptoms, and Timeline. American Addiction Centers. https://americanaddictioncenters.org/withdrawal-timelines-treatments/alcohol/