Exploring: Social Anxiety Disorder and Substance Use

“Into the dark night

Resignedly I go,

I am not so afraid of the dark night

As the friends, I do not know,

I do not fear the night above

As I fear the friends below.”

In a world that walks on influencers and presentation, it is almost impossible to survive without ever taking the spotlight for yourself. While it might come naturally to a lot of people, there is a huge ratio of individuals who struggle with this on a daily basis.

Everyone might have had moments of awkwardness or even fear in certain social situations.

Sweaty hands right before an important presentation or freezing on the stage while speaking in public, are all common evidence of this feeling of uncomfortableness in certain situations.

In fact, being in the light in a room full of strangers is not a comfortable let alone enjoyable situation for most people. But, the majority can get through it somehow or the other.

In the case of a social anxiety disorder (SAD), the stress of being in these social situations becomes almost impossible to handle without external help.

This leads to one avoiding common social situations, such as making small talk, as it makes them feel uncomfortable and stressed.

What is Social Anxiety Disorder?

Social anxiety disorder (SAD) or social phobia, is one of the most common mental health disorders to date. It can define as intense, irrational, and persistent fear of social situations.

It can lead to significant distress and hence prevent participation in social situations. Usually, such social situations are either avoided completely or endured dreadfully.

  • Symptoms
  • It is normal to feel nervous or even dread in certain social situations. Then how does one differentiate between the normal feelings of nervousness and social anxiety disorder? Social anxiety disorder has certain physiological and psychological symptoms which are way more intense than usual feelings of shyness or nervousness.
  • Physiological Symptoms:
  • Palpitation
  • Tightness in chest
  • Increased heart rate
  • Difficulty in speaking
  • Muscle tension
  • Trembling
  • Nausea

Psychological Symptoms:

  • Intense fear in a social situation
  • Intense worrying weeks or days before the social event
  • Extreme feeling of embarrassment during social interaction
  • Avoidance of interaction with people
  • Analyzing one’s own performance after social situations
  •  situations

Social Anxiety Disorder and Substance Abuse

  • Alcohol Abuse/Dependency
  • According to the Anxiety and Depression Association of America, around 20 percent of people with SAD also suffer from alcohol dependency or abuse. While alcohol consumption can temporarily reduce symptoms of social anxiety, it is definitely not a permanent solution. In fact, Murray Stein and John Walker in Triumph over Shyness: Conquering Social Anxiety Disorder stated that alcohol can increase anxiety, irritability, and/or depression in the long run. Even a moderate level of alcohol consumption can affect one’s mood and anxiety level.
  • Signs of Alcoholism:
  • Drinking four or more times a week
  • Making excuses to drink
  • Prioritizing drinking over one’s responsibilities and obligations
  • Feeling uncomfortable when not drunk
  • Drinking in secrecy
  • Feeling guilty after drinking
  • Temporary blackouts or memory loss
  • Isolating oneself from friends and family

The probability of addiction increases especially when one uses alcohol to suppress the symptoms of social anxiety or any other mental disorder temporarily. This will not just lead to addiction but also worsen the intensity of one’s anxiety. Hence, it is important to identify the symptoms of alcohol dependency as early as possible and to get the necessary treatment.

  • Drug Use
  • It is fairly common to self-medicate to alleviate anxiety and other discomforts when dealing with SAD. The study published by Drug and Alcohol Dependence in 2012 focused on ‘The Relationship between Cannabis Use Disorder (CUD) and Social Anxiety Disorder (SAD) in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). It found that although there is a relationship between CUD and SAD, the relation between SAD and cannabis dependence is stronger. In fact, the co-occurrence of both disorders can lead to greater impairment in the long run than either one of the disorders.
  • Signs of Drug Dependency:
  • Recurring intake of drugs
  • One feels like they need to intake an increased amount to feel the same effect (tolerance)
  • Feels uncomfortable physically and emotionally when the drugs wear off.
  • Have a hard time setting a limit on the intake of the drug
  • Have trouble doing daily tasks
  • Isolate from friends and family
  • Usage of drugs can lead to a temporary sensation of pleasure which is vastly different from the feeling of fear and dread one feels when dealing with SAD. While both prescribed drugs like Xanax or Ativan, as well as commercial drugs like cocaine or heroin, can give a temporary sense of relief, it comes with a high risk of drug abuse.
  • Social anxiety in itself is a vicious disorder, but when paired with drug use, the severity is increased tenfold. It puts a huge amount of burden on the victim both physically and psychologically. Hence, when suffering from drug dependency or abuse, it is important to get the necessary treatment as soon as possible.

Treatment of Social Anxiety Disorder

Social Anxiety Disorder can be treated through psychotherapy and/or medication. Cognitive Behavioral Therapy (CBT) through exposure-based activities like roleplaying are the most effective treatment for social anxiety disorder.

Furthermore, medications like Selective Serotonin Reuptake Inhibitors (SSRIs) are most commonly prescribed for SAD. Zoloft, Paxil, SNRIs, or Effexor X R can also be used to treat social anxiety disorder.


As someone who has been dealing with social anxiety since childhood, I will be presenting a letter I wrote regarding the same as the conclusion.

This is in hopes that you as a reader can understand a bit about the feelings of people like me who struggle on a daily basis to do things that others might consider normal.

Dear Social Anxiety,

Adeline. Chinstrap. Emperor. Gentoo.

As I stood on the stage with my heart in my mouth and hands on my chest, I realized that my legs weren’t trembling because I was to perform on a stage, in fact, that was one of the good parts. No, my labored breathing was an after-effect of conversations with people, people who wanted to give their best wishes for my performance.

That was the first time I recognized you. Don’t get me wrong, you were always there, clawing at my heart, not letting me bleed but making sure I felt death, or as close to it as one can feel without actually dying.

But I would just tell myself to shut up because I have to right? You sound like me, and my mom, my dad, my brother, my friends, my neighbor, the shopkeeper, the cute guy from my favorite ice cream place.

You sound like everything and nothing. I tried everything, I shouted at you to shut up, I tried to lovingly ask you to calm down. You would for some time, before starting again.


Adeline. Chinstrap. Emperor. Gentoo.

The four species of arctic penguins.
In a show I watched, this boy calms himself down by repeating these words out loud. They don’t help me. But knowing that it helped someone, even in fiction, makes me happy.

It helps me remember that you might be strong but you choose me, so I should be able to handle you right? I don’t know how to yet.

But I will get there at some point. I know this letter says nothing that’s useful, it’s not a message of awareness or empowerment. It’s just a letter to say hi, to you. To tell you that you might have successfully made people a lot more scary for me than they should be. But that’s okay. Because –

Anxiously yours.



What do you think?

501 Points

Written by Niranjana

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