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Social anxiety reduces participation in treatment among youth

Addiction issues among youth today are often found closely associated with their need to fit in. A study looked deeper into the influence of social anxiety disorder (SAD) on addiction and its treatment, as a persistent fear of social humiliation caused many to avoid participation in treatment.

Fifteen million American adults struggle with SAD and the majority begins to exhibit signs in childhood or early adolescence. More than one-third of this population waits 10 years or longer to seek help. About 20 percent of those with SAD also abused drugs and/or alcohol, according to the National Institute on Alcohol Abuse and Alcoholism.

The study discovered almost half of the patients entering treatment struggled with persistent social anxiety. However, helping others through service activities greatly enhanced their recovery.

Results were published in the journal Alcoholism: Clinical & Experimental Research.

“Socially anxious adolescents quickly figure out that alcohol and drugs can provide ease and comfort in social situations that are anxiety provoking,” explained Maria E. Pagano, associate professor in the department of Psychiatry at Case Western Reserve University and corresponding author for the study. “Reaching for a substance to change how you feel can quickly become a knee-jerk reaction, develop into an addiction, and rob youth of learning how to tolerate interpersonal differences and uncomfortable feelings, develop emotional maturity, and cultivate self-acceptance.”

John F. Kelly, associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School, agreed. “If adolescents do not know about other forms of help for their social anxiety or if are not made available to them, then alcohol can become a predominant form of coping.”

Furthermore, adolescents who feared criticism by their peers were less likely to speak up in group therapies during treatment, constraining their benefits of therapy. “There is a lot of healing that comes from sharing your insides with others,” Pagano said. “Socially anxious patients may not get this healing or let others really get to know who they are and give input to their lives.”

Researchers assessed 195 adolescents, aged 14 to 18, court-referred to residential treatment. Data were collected through reports, assessments and records over the course of admission, discharge, and six months after treatment discharge.

“During residential treatment, in general, SAD and non-SAD youths did not differ on the degree to which they engaged in other 12-step activities or treatment duration, however, SAD youth were more likely to be involved in 12-step service activities,” added Kelly. “At six months after treatment, those with SAD and those engaging in 12-step service work were associated with better outcomes — with evidence of 12-step service work partially explaining the effect of SAD’s positive relationship to abstinence.”

“There are many real-world applications for the findings from this study,” said Pagano. “Adolescents could benefit from knowing that most people feel like they do not fit in and that it is a lifelong journey to become comfortable in your own skin. Parents, teachers, and other positive adults in the lives of adolescents can provide education about this and the role and long-term costs that alcohol and other drugs might have in the pursuit of short-term relief. While learning to tolerate feeling different and letting other people have their opinions about you takes practice, it gets easier.”

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