Authored by Amanda Beccaria*
Abstract
Alcohol abuse has become a significant issue on college campuses, particularly heavy episodic drinking commonly known as binge drinking. Various factors have been studied in relation to the causal and subsequent factors of alcohol abuse on college campuses, including motives, contexts, and psychological conditions related to college students’ use of alcohol. One common impetus for college students to use alcohol is to deal with anxiety. One group of students who are particularly susceptible to experience anxiety are those who suffer from social anxiety. However, research lacks focus on the potential impact of social anxiety as a motivator for drinking behaviors. There were several significant findings related to Social Anxiety scores. A major finding was that the strongest relationship found was that students suffering from social anxiety utilize alcohol in the context of coping with their negative emotions. This is a new and important detail in understanding the ways in which those suffering from social anxiety try to cope with their negative emotions and their vulnerability to substance abuse. Significant gender differences also were obtained that indicated female students were more likely to drink to cope with negative emotions. In addition, findings indicated female students living off-campus reported higher levels of social anxiety than females living on-campus, and vice versa for males students. However, analyses do not permit tying these gender differences to differences in use of alcohol. Finally, there were differences between the women and men depending upon their employment status (i.e., full-time, part-time, unemployed). Trends in the analyses provided for implications of clinicians and offer direction in the construction of future research about social anxiety and alcohol use by college students. It appears that for students experiencing social anxiety, the relationships among social anxiety, use of alcohol for coping and various life situations in which students are living all interact to impact their use of alcohol.
Keywords: Social Anxiety; Alcohol, Coping; Employment; Campus housing
Introduction
Alcohol consumption has increased in recent decades internationally, with all or most of the increase occurring in developing countries [1]. It was also reported that people who begin drinking at a young age are at higher risk of developing alcoholrelated problems in the future. In the United States, over 18 million people are considered to suffer from alcohol dependence, more commonly referred to as alcoholism, or alcohol abuse (National Institute of Alcohol Abuse and Alcoholism [2]. The primary difference between alcohol abuse and alcohol dependence is that those who suffer from alcohol dependence have a physiological and/or psychological need to abuse the substance [3]. According to the United States Department of Health and Human Services [4] individuals are most likely to drink the heaviest in their late teens and early twenties.
Across the United States, alcohol abuse has become a significant issue on college campuses, particularly heavy episodic drinking commonly known as binge drinking. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about four out of five college students drink alcohol [2]. In addition, about half of college students who drink consume alcohol by binge drinking (National Institute of Alcohol Abuse and Alcoholism [2]. Binge drinking continues to have negative consequences nationally.
Approximately 1,825 college students between the ages of 18 to 24 die each year due to alcohol-related injuries, more than 690,000 college students are assaulted by another student who has been drinking, and approximately one million college students are affected by sexual abuse (e.g., sexual assault, date rape), unintentional injury, health problems, suicide attempts, and academic problems (e.g., missing class, poor performance) [2]. Understanding what may influence college students to binge drink will allow for preventative care against such negative consequences.
Multiple dimensions have been studied in relation to the causal and subsequent factors of alcohol abuse. In one study [5], the researchers identified multiple reasons for substance abuse. Such reasons may include social and recreational reasons, anger and frustration, getting away from problems, experimentation, among others. Another study [6], found that self-image goals, or goals in which people seek to construct, maintain, and defend positive selfviews, had a direct effect on alcohol-related problems of college students. The use of alcohol to deal with anxiety has also been investigated [7]. However, among the broad range of motives that have been assessed, the influence of social anxiety has typically been subsumed with other anxiety disorders and has lacked individual focus in the literature.
College campuses offer individuals unique academic and interpersonal experiences. College students are often in an entirely new environment, with little interpersonal connections and advancing academic pressures. It is not surprising that many students are often anxious about their academic performance and/ or social impressions and relationships. In a 2008 survey, it was found that anxiety disorders were one of the most common mental health issues among college students, including social anxiety, or social phobia [8].
Social Anxiety is currently defined as “a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others” [9]. These situations may include social interactions, performing in front of others, and being observed. The individual must also fear that “he or she will act in a way or show anxiety symptoms that will be negatively evaluated… and will lead to rejection or offend others” [9].The criteria for diagnosis includes that the social situation also “almost always provokes fear or anxiety,” and, thus, it is often “avoided or endured with intense fear or anxiety” [9].
In any given year, about 15 million United States adults are diagnosed with Social Anxiety Disorder. According to the Anxiety and Depression Association of America (ADAA), it is not unusual for individuals diagnosed with Social Anxiety Disorder to drink excessively to cope with or escape their symptoms. In fact, about 20 percent of people with Social Anxiety disorder also suffer from either alcohol dependence or abuse [8]. One study found that the lifetime prevalence for individuals with comorbid social anxiety disorder and alcohol-use disorder was 2.4 percent, and in 79.7% of comorbid cases, social anxiety occurred before alcohol dependence developed [10].
Utilizing alcohol, or any substance, to cope with or escape from psychological symptoms reflects the self-medication model for the co-morbidity of alcohol-use disorders and anxiety [2]. This model suggests that individuals with anxiety disorders attempt to relieve their symptoms by drinking alcohol, which may eventually lead to alcohol-use disorders. The individual is thought to be motivated to drink based on the expectation that drinking will lead to more positive affective consequences than if they chose not to drink [11]. Investigators with the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that the highest rates of alcohol-based self-medication were among participants with generalized anxiety disorders, social phobia (or social anxiety), and panic disorder with agoraphobia [2].
Statement of the Problem
Within the clinical population, it is important to recognize how psychological disorders and the co- morbidity of alcohol abuse are associated. Students across college campuses are facing significant social and academic pressures. Binge drinking has become a growing problem across college campuses, and it comes with significant risk. Young students who participate in binge drinking may suffer sexual abuse (e.g., sexual assault, date rape), unintentional injury, health problems, suicide attempts, and academic problems (e.g., missing class, poor performance [2]. Unfortunately, a majority of the literature regarding drinking motives on college campuses has only examined social influence as a dominant factor in increasing alcohol abuse.
However, additional psychological factors such as social anxiety may contribute to an individual’s decision to use or abstain from use of alcohol or susceptibility to social pressure.
The purpose of this study was to quantitatively investigate how aspects of social anxiety may affect a college student’s drinking behaviors. The goal was to investigate these variables by having the students rate their experience of social anxiety, including feared social situations, fear of acting in an embarrassing manner, and fear of rejection and/ or scrutiny. The students also rated their alcohol-use behaviors, including frequency (e.g., how many times a week) and intensity (e.g., how many drinks, ability to control). Thus, this study permitted a detailed analysis of specific aspects of social anxiety and the relationship to the use of alcohol to cope with specific sources of anxiety.
Social anxiety and binge drinking remain consistent mental health and behavioral issues for students across universities, colleges, and various institutions. In addition to the self-medication model, there are additional models that suggest no causal relationships between the two disorders (i.e., The Common Factor Model) and that Social Anxiety Disorder is a result of alcohol withdrawal and recent abstinence (Substance- Induced Anxiety Model) [2]. Although these models are accepted among various investigators, there is limited research that directly addresses social anxiety and the influence of alcohol-use behaviors in college students. By investigating the relationship between social anxiety and alcohol abuse, the information may aid in the treatment and understanding of this frequent co-morbidity among the college population.
Null hypotheses
Null hypothesis 1: There is no significant difference between male participants’ and female participants’ alcohol consumption, level of social anxiety, drinking motives, and drinking context.
Null hypothesis 2: There is no significant association between social anxiety scores and the participant’s alcohol consumption, nor with drinking motives, nor drinking context.
Methods
Participants
Participants were recruited through purposive, convenience, and snowball sampling. A flyer was developed containing a brief description of the study, inclusion criteria, and a link to Qualtrics. com, an online tool for survey administration. This flyer was distributed via snowball sampling. It was distributed via e-mail and social network platforms (i.e., facebook.com) by the researcher and her colleagues to recruit participants in the college population. The recruited individuals were asked to then forward the flyer through e-mail or sharing on their social media site to individuals who also appeared to meet the inclusion criteria.
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