Social anxiety disorder goes beyond simply being a little shy or bashful.
The anxiety disorder, also known as social phobia, involves an intense fear of social situations.
For teenagers — who are going through a period of life particularly defined by social relationships — the disorder can be devastating and emotionally crippling. The symptoms can be serious enough to drive an adolescent to substance abuse and the need for dual diagnosis addiction treatment.
Social anxiety in teenagers
Anxiety disorders, like social phobia, often develop during childhood or adolescence. Teens with social phobia may seem quiet and withdrawn. If your teen has this mental health disorder, attending school can be downright painful. Imagine being fearful of answering questions in class, afraid to ask a teacher for help, or being paralyzed by the thought of speaking or performing in front of others. In serious cases, the fear can prompt a teen to drop out of school.
One of the hardest aspects of social anxiety in teens is that it hinders them from making or keeping friends, which is a critical part of this stage of life. Teens suffering from social anxiety may be afraid to participate in conversations or fear calling or texting other teens. Any type of social interaction can provoke significant anxiety. Teens with this disorder may appear to be loners or on the “fringe” of social circles. The anxiety can cause them to mumble or avoid eye contact with peers, which sadly only perpetuates the problem. Their social awkwardness often elicits teasing, making them even more self-conscious and anxious.
Social anxiety triggers physical symptoms as well. In some, the symptoms can be very embarrassing. Many individuals with social anxiety blush easily and often. Their anxiety may cause dizziness, racing heartbeat, chest tightness, and/or shortness of breath. They may engage in nail biting, hair twirling, finger picking, or fidgeting — behaviors that usually appear when they feel anxious and nervous. These physical and visible symptoms may not sound serious, but they can embarrass a teen who experiences them in the classroom or around peers, and that can create additional fear of social situations.
Social anxiety and substance abuse
Social anxiety disorder can lead to the development of drug or alcohol abuse for some teens. They may use substances, such as alcohol, to “loosen up” and feel more comfortable in social settings. The may also resort to alcohol or drugs to alleviate or “self-medicate” their anxiety and emotional pain. All too often, what starts as occasional use turns into a habit — and a serious problem that requires addiction treatment.
Studies have shown that approximately 20% of individuals with social anxiety struggle with abuse or addiction . One study found that adolescents with social anxiety started using marijuana around the age of 10.5 years. This is more than two years earlier than other teens with substance abuse disorders. Marijuana use also has been found to begin after the onset of social anxiety disorder, which suggests that the condition was more likely to trigger drug use, rather than the other way around.
Alcohol abuse is another frequent problem for teens with social anxiety disorder. Many teens believe that alcohol makes them feel freer and more comfortable in social situations, especially when they’re with their peers. However, this disinhibiting effect can backfire, leading to situations that create even more anxiety. For instance, a teen who gets drunk at a party may end up being the butt of a cruel joke. Some teens have had the horrifying experience of a peer snapping and distributing an embarrassing photo that was taken while they were intoxicated. Sadly, this makes them feel even more nervous in future social situations.
Why treatment is essential
The combination of social anxiety disorder and a substance abuse/addiction problem can be overwhelming. In addition to the well-known dangers of addiction, studies suggest that those living with social anxiety and substance abuse are more isolated than others. For example, they are less likely to get married, which is often due to their difficulties in developing close interpersonal relationships. Alcoholics with social anxiety disorder also have lower job status and less peer social support than alcoholics who don’t have the disorder.
Treating substance abuse and social anxiety
For adolescents who struggle with both conditions, dual diagnosis treatment may be in order. Treatment will focus on both the social anxiety as well as the substance abuse issue. Treatment programs may be either residential or outpatient, depending on the facility and the severity of the situation. Psychotherapy, also called talk therapy, will be the cornerstone of effective treatment. Therapy helps teens learn about the emotions and behaviors that contribute to their substance abuse. An addiction counselor will also teach them how to cope with their feelings in a healthier, more productive way.
Some alcohol and drug rehab programs now incorporate motivational enhancement therapy (MET). Combined with other treatments, MET is designed to help substance abusers use self-motivational strategies to change their behavior. It’s been found to be effective for alcohol and marijuana users, but it may not work as well in those who use other drugs, like heroin or cocaine. According to the Anxiety and Depression Association of America, it can be an effective alcohol addiction treatment method for those with social anxiety disorder.
It’s always important to consider the impact of social anxiety on those in alcohol or drug rehab. For example, 12 step meetings — which are social by nature — may be too much for a teen who’s struggling with social anxiety. Unless adequate coping skills have been learned, this could be a set-up for a relapse. Individual and/or very small group sessions, in which new skills can be practiced, may be a better route to go initially.
Treating the substance abuse problem alone will not eliminate social anxiety symptoms. Anxiety treatment is aimed at reducing a teen’s deeply-rooted negative emotions and fears. A mental health professional, such as a certified counselor or licensed psychologist may use cognitive behavioral therapy (CBT) as the basis for treatment. Depending on the teen, therapy for social phobia may last for several months.
During therapy, teens will learn to identify and change their negative thinking patterns. For example, many people with social anxiety have very negative, anxiety-provoking self-talk. “Everyone is going to laugh at me” and “those guys will think I’m stupid” are typical of the types of negative thoughts that appear at the mere idea of engaging socially. Therapy can help teens understand that these thoughts aren’t logical and that there are more positive and realistic ways to think about social situations. Changing those thoughts will help reduce the anxious feelings.
During treatment, teens will also learn practical techniques for lowering anxiety in real-world situations. Breath control is one such tool that is often taught. Anxiety propels the body into fight-or-flight mode, causing increased breathing and heart rate as well as symptoms such as dizziness or chest tightness. Breathing exercises will help teens control these symptoms so they can remain calmer. Other strategies, such as yoga, meditation, or progressive muscle relaxation may also be recommended as ways to alleviate anxiety.
Co-occurring social anxiety disorder and substance abuse can cause adolescents to feel lonely, ashamed, and powerless. Appropriate treatment for both disorders can help teens learn to manage both disorders, find healthy ways to cope, and lead a much more fulfilling life.