Journal of Mental Health,
December 2006; 15(6): 671 – 682
Relations of social anxiety variables to drinking motives,
drinking quantity and frequency, and alcohol-related
problems in undergraduates
SHERRY H. STEWART1, ERIC MORRIS1, TANNA MELLINGS2, &
JENNIFER KOMAR3
1
Departments of Psychiatry, Psychology, and Community Health and Epidemiology, Dalhousie
University, Nova Scotia, 2A. T. Malcolm & Associates, Victoria, British Columbia, and 3Department
of Psychology, University of Waterloo, Ontario, Canada
Abstract
Background: The co-morbidity between social phobia and alcohol disorder is well established.
Aims: This study investigated the nature of the relationship between traits associated with these
disorders.
Method: A total of 157 undergraduate drinkers (112 women; 45 men) completed measures tapping
aspects of social phobia (i.e., the Social Avoidance and Distress Scale and the Brief Fear of Negative
Evaluation scale) and drinking behavior (i.e., the Drinking Motives Questionnaire – Revised, quantity
and frequency of alcohol consumption, and the Rutgers Alcohol Problem Index).
Results: Correlational analyses (controlling for gender) revealed that: (i) social avoidance and distress
was significantly negatively related to drinking frequency; (ii) fear of negative evaluation and social
avoidance and distress were both significantly positively related to drinking to cope with negative
emotions and to conform to peer pressure; and (iii) fear of negative evaluation was also significantly
positively related to drinking to socialize and to drinking problems. The relationship between fear of
negative evaluation and drinking problems was mediated by coping and conformity drinking motives.
Conclusions: Implications for developing effective integrated treatments for co-occurring social
anxiety and alcohol problems are discussed, as are preventative implications.
Keywords: Alcohol abuse, social anxiety, drinking behavior, negative evaluation sensitivity, social
avoidance and distress, drinking motives
Introduction
A number of studies have demonstrated a strong co-morbidity between social phobia (SP)
and alcohol use disorders (AUD) (e.g., Grant et al., 2004; Kessler et al., 1994). This
relationship has been seen whether one examines rates of AUDs in SP populations or vice
versa, and whether one examines the relationship in treatment seeking samples or in the
general population. For example, those with SP are 2 to 3 times more likely to develop an
AUD, than those without (Kushner et al., 1990). Similarly, those with an AUD are up to 10
times more likely to demonstrate SP than those who do not have an AUD (Kessler et al.,
1997).
Correspondence: Sherry H. Stewart, Psychiatry & Psychology, Life Sciences Centre, 1355 Oxford Street, Halifax, Nova Scotia,
B3H 4J1, Canada. E-mail: sstewart@dal.ca
ISSN 0963-8237 print/ISSN 1360-0567 online Ó Shadowfax Publishing and Informa UK Ltd.
DOI: 10.1080/09638230600998904
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Several theoretical models have been applied to account for the relationship between SP
and AUD (see Carrigan & Randall, 2003). Three of the most prominent are the TensionReduction Theory (Conger, 1956), the Stress Response Dampening model (Sher &
Levenson, 1982), and the Self-Medication Hypothesis (SMH; Khantzian, 1985). These
theories argue that alcohol reduces anxiety or arousal, providing negative reinforcement of
the drinking response. Social situations and internal anxiety symptoms are seen as conditioned cues that signal the onset of drinking and the rewarding consequences of anxiety relief
(see Morris et al., 2005). These models predict that social anxiety should be positively
correlated with alcohol use and misuse. However, when one examines the literature in nonclinical samples of undergraduates, the findings do not always support this prediction.
Some studies do support a significant positive relationship between social anxiety and
alcohol-related variables. For example, Lewis and O’Neill (2000) found that problem drinking
students had significantly higher scores on the Social Avoidance and Distress Scale and the Fear
of Negative Evaluation measure (SADS and FNE; Watson & Friend, 1969), but not on the
Shyness Scale (Cheek & Buss, 1981), compared with non-problem drinkers. Similarly,
Buckner et al. (in press) found scores on the Social Interaction Anxiety Scale (SIAS; Mattick &
Clarke, 1998) were significantly positively correlated with alcohol problems. Kidorf and Lang
(1999) demonstrated experimentally that undergraduates with high SADS scores drank more
alcohol prior to an anxiety-provoking social situation than those with low SADS scores.
However, other studies with undergraduates have failed to show a relationship between
social anxiety and alcohol-related variables, or have shown an inverse direction relation. For
example, Bruch et al. (1992) found no significant bivariate correlation between Shyness
Scale scores (Cheek & Buss, 1981) and drinking levels. Eggleston et al. (2004) showed that
SIAS scores (Mattick & Clarke, 1998) were significantly inversely related to drinking
frequency, but unrelated to alcohol problems. Ham and Hope (2005) similarly showed that
scores on the Interaction Anxiousness Scale (IAS; Leary, 1983a) were significantly inversely
related to drinking levels and unrelated to alcohol problems.
One possible reason for these discrepant findings pertains to differences in the ways in which
social anxiety has been conceptualized and assessed across studies. Prior studies have often
failed to recognize that social anxiety is multifaceted and can be manifest in a variety of ways
(e.g., fear of negative evaluation vs. social avoidance and distress vs. social interaction anxiety vs.
shyness; see Leary, 1983a). As a consequence, most studies have erroneously treated social
anxiety as a uni-dimensional construct, assessed with a single measure. Prior studies have also
tapped very different aspects of drinking behavior, ranging from drinking quantity and
frequency to drinking problems. But different aspects of social anxiety may relate differentially
to the various aspects of drinking behavior. For example, Lewis and O’Neill’s (2000) finding
that fear of negative evaluation was positively related to drinking-related variables, while shyness
was unrelated to the same drinking variables, suggests that the trait of negative evaluation
sensitivity, rather than that of shyness, motivates alcohol misuse. As another example, although
social phobia may be positively related to alcohol problems (Lewis & O’Neill, 2000), it may be
inversely related to drinking frequency (Eggleston et al., 2004) – a pattern that could be
explained if socially phobic individuals tend to avoid social situations where alcohol is served,
but rely on alcohol to cope when they do attempt to face such feared situations.
Studies on the relationship between social anxiety and drinking have also largely failed to
consider the role of drinking motives (i.e., reasons for alcohol use). One prominent model
posits that motives for consuming alcohol can be organized across two primary dimensions
(valence and source) relating to the goals the individual desires to obtain from drinking
(Cooper, 1994). Valence refers to the type of reward that the individual hopes to achieve by
drinking: (i.e., positive or negative reinforcement). Source refers to the location of the
Social anxiety and drinking
673
expected reward: internal (e.g., change in emotional state) or external (e.g., change in social
situation). In crossing these two dimensions, four drinking motives emerge: (i) enhancement
motives (internal/positive) involve drinking to enhance one’s emotional state (e.g., ‘‘Because it
gives you a pleasant feeling’’); (ii) social motives (external/positive) involve drinking to achieve
positive social outcomes (e.g., ‘‘Because it helps you enjoy a party’’); (iii) coping motives
(internal/negative) involve drinking to reduce negative mood states (e.g., ‘‘Because you feel
more self-confident and sure of yourself’’); and (iv) conformity motives (external/negative)
involve drinking to avoid peer disapproval (e.g., ‘‘So you won’t feel left out’’). These four
motives show differential relationships with various aspects of drinking behavior: the internal
motives (i.e., coping and enhancement) are associated with heavier alcohol consumption, and
the negative reinforcement motives (i.e., coping and conformity) are directly associated with
alcohol problems even after controlling for drinking levels (Cooper, 1994).
A final limitation of much of the prior literature is the general failure to consider the
role of gender. Many of the observed relations between social anxiety variables and alcoholrelated variables appear to be moderated by gender (see Morris et al., 2005). Moreover, the
relationship between SP and AUD is stronger in women than men when compared to
gender-specific base-rates (Kessler et al., 1997). Thus, it is important for research in this
area to either test the moderating effect of gender, or at least control for gender effects.
This study was designed in the interest of advancing the understanding of the relationship
between social anxiety levels and drinking variables in a non-clinical sample of undergraduate drinkers. To overcome the limitations of prior work, we employed more than one
measure of social anxiety (i.e., social anxiety and distress vs. fear of negative evaluation), we
examined more than one aspect of drinking behavior (i.e., drinking quantity, drinking
frequency, and alcohol problems), we examined the role of various drinking motives in
Cooper’s (1994) model, and we controlled for the effects of gender. We expected positive
relationships between both social anxiety measures and the alcohol problems measure (cf.
Lewis & O’Neill, 2000). At the same time, we expected significant negative correlations
between the social anxiety measures and the drinking quantity and frequency measures since
socially anxious students less frequently attend social events, where heavy drinking is
normative among undergraduates (see Ham & Hope, 2005). There are reasons to expect
relations between social anxiety and certain drinking motives. First, the SMH would predict
that social anxiety levels should be strongly positively associated with self-reports of drinking
to cope with negative emotions. Second, those who experience distress in social situations
and who fear negative evaluation may be more prone than others to use alcohol to conform
to peers’ expectations in an attempt to ‘‘fit in’’ in social situations. For these reasons, we
expected significant positive correlations between the social anxiety measures and the
negative reinforcement drinking motives of coping and conformity. Finally, we examined
the potential mediating (i.e., intervening and explanatory) role of drinking motives in
contributing to the expected relationship between social anxiety and alcohol problems.
Consistent with predictions derived from the SMH, we hypothesized that drinking to cope
would mediate the social anxiety – alcohol problems relation.
Methods
Participants
One-hundred-and-seventy-six undergraduates at Dalhousie University completed study
measures. Of the original sample, 157 students (71% women) were ‘‘drinkers’’ (i.e., had
consumed alcohol in the past year). The 19 ‘‘non-drinkers’’ were excluded. The average age
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S. H. Stewart et al.
of the drinkers was 21.4 years (SD ¼ 3.5; range ¼ 19 – 54) and their average university
education level was 2.7 years (SD ¼ 0.8; range ¼ 2 – 4 years).
Measures
The Brief FNE (FNE-B; Leary, 1983b) scale is a truncated version of the original FNE
(Watson & Friend, 1969). It is comprised of 12 items tapping concerns about the
opinions of others (e.g., ‘‘I am afraid that others will not approve of me’’). The 5-point
scoring system ranges from 1 (‘‘Not at all characteristic of me’’) to 5 (‘‘Extremely
characteristic of me’’). It is highly correlated with the original FNE and demonstrates
good internal consistency and validity (Collins et al., 2005; Leary, 1983b; McWilliams
et al., 2000).
The Social Avoidance and Distress Scale (SADS; Watson & Friend, 1969) is a 28item true/false scale. Half of the items pertain to social avoidance (e.g., ‘‘I try to avoid
situations which force me to be very sociable’’) and the other half tap distress in social
situations (e.g., ‘‘I often find social occasions upsetting’’). Half are reverse keyed. The
SADS has excellent internal consistency and good one-month test-retest reliability
(Watson & Friend, 1969). We used the corrected scoring suggested by Hofmann et al.
(2004).
The Drinking Motives Questionnaire Revised (DMQ-R; Cooper, 1994) is a 20-item selfreport scale designed to examine drinking in relation to the four distinct motives in Cooper’s
model, each tapped by a 5-item subscale. Participants record their relative frequency of
drinking for each indicated reason on a 5-point scale, ranging from 1 (‘‘never/almost never’’)
to 5 (‘‘always/almost always’’). The DMQ-R has high internal consistency, good structural
validity, and good criterion-related validity (Cooper, 1994).
The Rutgers Alcohol Problems Index (RAPI; White & Labouvie, 1989) is a 23-item selfreport measure that can be used with both clinical and non-clinical adolescents and young
adults. Participants report on a 5-point scale, ranging from 0 (‘‘never’’) to 4 (‘‘more than 10
times’’), the number of times over the past 3 years they have experienced each indicated
alcohol-related problem (e.g., getting into fights, acting bad or doing mean things, not being
able to do homework or study for a test).
An author-compiled demographics questionnaire was used to record age, gender, and the
current year of university. Drinking quantity and frequency measures were embedded in this
measure to decrease their salience (see Sobell & Sobell, 1990). Participants were asked
about their drinking frequency in terms of the number of occasions they usually drank
alcohol per week. Those participants who did not usually consume alcohol at least once per
week were asked to provide an estimate of their monthly or yearly frequency. Drinking
quantity was measured by asking participants how many standard drinks they usually
consume per occasion, with one ‘‘drink’’ defined as 12 oz beer, 4 oz wine, or 1 oz hard
liquor (cf. Stewart et al., 2000).
Procedure
Participants completed questionnaires in a group format during a 50 minute class period.
Informed consent was obtained prior to completion of measures. Questionnaires were
ordered randomly and completed anonymously to help preserve participants’ confidentiality
while completing the measures in a group setting. Participants were compensated with
course credit.
Social anxiety and drinking
675
Results
Mean scores (and SDs) are reported for all study variables in Table I as a function of gender.
Sample means compare well to scores previously reported for university students on these
measures. Coefficient alphas are also presented in Table I. Study measures showed adequate
to excellent internal consistencies.
Correlations between measures of similar constructs
The correlation between the FNE-B and the SADS was significant (r ¼ .60, p 5 .001).
Drinking quantity and frequency were significantly correlated (r ¼ .33, p 5 .001). The RAPI
was significantly correlated with the drinking quantity and frequency (r’s ¼ .43 and .57,
respectively, p’s 5 .001). The subscales of the DMQ-R were all significantly intercorrelated, with correlation coefficients ranging from r ¼ .17, p 5 .05 (conformity with
enhancement) to r ¼ .61, p 5 .001 (social with enhancement). Finally, with only one
exception, the subscales of the DMQ-R were all significantly correlated with drinking
quantity (r ¼ .13, n.s. for conformity to r ¼ .45, p 5 .001 for enhancement), drinking
frequency (r ¼ .17, p 5 .05 for conformity to r ¼ .43, p 5 .001 for enhancement), and the
RAPI (r ¼ .37, p 5 .001 for social to r ¼ .52, p 5 .001 for coping).
Correlations between social anxiety measures and drinking variables
Partial correlations were computed between the social anxiety measures and the drinking measures, with gender as a covariate (see Table II). Three of the four DMQ-R
drinking motives were, significantly, positively related to the FNE-B, with coping
motivated drinking demonstrating the strongest relationship, followed by conformity
motivated drinking, and finally socially motivated drinking. A similar pattern was noted for
the SADS which was significantly positively correlated with both coping and conformity
motives.
Table I. Means and standard deviations for the men and women drinkers on study variables.
FNE-B
SADS
DMQ-R Social
DMQ-R Enhancement
DMQ-R Coping
DMQ-R Conformity
Drinking Frequency
Drinking Quantity
RAPI
Internal
Consistency (a)
Possible
Range
(min. – max.)
0.96
0.93
0.86
0.87
0.81
0.78
–
–
0.92
12 – 60
0 – 28
1–5
1–5
1–5
1–5
–
–
0 – 92
Men
(n ¼ 45)
M (SD)
29.98
4.84
3.17
2.67
1.61
1.42
0.93
7.20
37.69
(10.99)
(5.28)
(0.96)
(0.87)
(0.74)
(0.51)
(0.76)
(3.45)
(14.81)
Women
(n ¼ 112)
M (SD)
33.34
6.62
3.12
2.79
1.70
1.34
0.75
4.97
34.02
(11.88)
(6.87)
(1.00)
(1.10)
(0.69)
(0.58)
(0.66)
(3.06)
(11.01)
Notes: SADS ¼ Social Avoidance and Distress Scale (Watson & Friend, 1969); FNE-B ¼ Brief Fear of Negative
Evaluation scale (Leary, 1983b); RAPI ¼ Rutgers Alcohol Problem Index (White & Labouvie, 1989); DMQR ¼ Drinking Motives Questionnaire Revised (Cooper, 1994); Drinking Frequency ¼ drinking occasions per week;
Drinking Quantity ¼ number of drinks per drinking occasion. Internal consistency and possible range not presented
for Drinking Frequency and Drinking Quantity because these are open-ended single item measures.
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S. H. Stewart et al.
Table II. Partial correlations between the social anxiety measures (FNE-B and SADS) and the drinking measures
(DMQ-R subscales, drinking quantity and frequency, and RAPI) with gender controlled.
FNE-B
DMQ-R Social
DMQ-R Enhancement
DMQ-R Coping
DMQ-R Conformity
Drinking Frequency
Drinking Quantity
RAPI
.210**
.150
.427**
.254**
.019
7.014
.179*
SADS
.122
7.034
.221**
.160*
7.204**
7.046
.026
Notes: SADS ¼ Social Avoidance and Distress Scale (Watson & Friend, 1969); FNE-B ¼ Brief Fear of Negative
Evaluation Scale (Leary, 1983b); RAPI ¼ Rutgers Alcohol Problem Index (White & Labouvie, 1989); DMQ-R ¼
Drinking Motives Questionnaire Revised (Cooper, 1994); Drinking Frequency ¼ number of drinking occasions per
week; Drinking Quantity ¼ number of standard alcoholic beverages consumed per drinking occasion. *p 5 0.05;
**p 5 0.01.
With regard to drinking behavior, only the SADS was significantly, negatively related to
drinking frequency. Neither social anxiety measure was related to drinking quantity. With
regard to alcohol problems, only the FNE-B was significantly positively related to RAPI
scores (see Table II).
Mediator analysis
To further delineate the mechanisms underlying the significant relationship between the
FNE-B and the RAPI, mediator analyses were conducted. Although coping motives were
the only hypothesized mediator, conformity and social motives from the DMQ-R were
chosen as additional potential mediator variables because they were also significantly
correlated with FNE-B scores. We followed steps outlined by Baron and Kenny (1986) for
testing mediation.
First, a multiple regression analysis was conducted using gender and FNE-B scores
(predictor) to predict RAPI scores (criterion). The regression equation was significant,
R2 ¼ .049, adjusted R2 ¼ .037, F (2, 155) ¼ 4.018, p 5 .05. Both male gender (b ¼ .163,
p 5 .05) and higher FNE-B scores (b ¼ .175, p 5 .05) independently predicted greater
scores on the RAPI.
Next, a set of multiple regressions were conducted using gender and FNE-B scores
(predictor) to predict each of the three DMQ-R scale scores (mediators), in turn. In the case
of coping motives, the regression equation was significant, R2 ¼ .184, adjusted R2 ¼ .174,
F (2, 155) ¼ 17.530, p 5 .001. Only higher FNE-B scores (b ¼ .430, p 5 .001) independently predicted greater coping motives. In the case of conformity motives, the regression
equation was significant, R2 ¼ .068, adjusted R2 ¼ .056, F (2, 155) ¼ 5.616, p 5 .005. Only
higher FNE-B scores (b ¼ .253, p 5 .005) independently predicted greater conformity
motives. In the case of social motives, the regression equation was significant, R2 ¼ .044,
adjusted R2 ¼ .032, F (2, 155) ¼ 3.589, p 5 .05. Again, only higher FNE-B scores (b ¼ .210,
p 5 .01) independently predicted greater social motives.
Third, a further multiple regression analysis was conducted where coping, conformity,
and social motives scores along with gender were entered simultaneously (mediators) in the
prediction of RAPI scores (criterion). The linear combination of the drinking motives
and gender was significantly related to RAPI scores, R2 ¼ .375, adjusted R2 ¼ .359,
F(4, 153) ¼ 22.966, p 5 .001. Both male gender (b ¼ .138, p 5 .05) and higher coping
Social anxiety and drinking
677
(b ¼ .395, p 5 .001) and conformity (b ¼ .247, p 5 .001) motives scores independently
predicted greater scores on the RAPI.
The final multiple regression analysis involved simultaneously regressing gender, coping
motives, conformity motives, social motives (potential mediators) and FNE-B scores
(predictor) onto the RAPI scores (criterion). The linear combination of these five predictors
was significantly related to RAPI scores, R ¼ .384, R2 ¼ .364, F (5, 152) ¼ 18.966, p 5 .001.
In this equation, only coping (b ¼ .436, p 5 .001) and conformity (b ¼ .260, p 5 .001)
motives scores independently predicted RAPI scores. The relationship between FNE-B and
RAPI scores was no longer significant after accounting for coping and conformity motives
(see Figure 1). Overall, these results demonstrate that the relation between fear of negative
evaluation and alcohol problems was mediated not only by coping motives (as hypothesized)
but also by conformity motives – both negative reinforcement drinking motives.
Discussion
Although it is well established that SP and AUDs are highly co-morbid, little is known about
the nature of the relations between these disorders. Moreover, there have been very
Figure 1. The mediating role of negative reinforcement drinking motives in explaining the relationship of fear of
negative evaluation to drinking problems. FNE-B ¼ Brief Fear of Negative Evaluation scale (Leary, 1983b);
RAPI ¼ Rutgers Alcohol Problem Index (White & Labouvie, 1989); DMQ-R ¼ Drinking Motives Questionnaire
Revised (Cooper, 1994). Values presented are standardized beta weights (b). All regressions controlled for gender,
and regressions with drinking motives as predictors controlled for social drinking motives.
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S. H. Stewart et al.
inconsistent findings regarding the direction of the relation between social anxiety and
drinking measures in undergraduates with some studies suggesting positive relations and
other studies suggesting inverse relations (Morris et al., 2005). The present results help
resolve these discrepancies in the literature by suggesting that the direction of the
relationship depends on the specific aspect of social anxiety, as well as the specific alcoholrelated variable, in question. As expected, social anxiety was significantly positively related
to drinking problems, but this was only true for the fear of negative evaluation aspect of
social anxiety, at least in undergraduates. Also as expected, social anxiety was significantly
negatively related to drinking frequency, but this was only true for social avoidance and
distress. These results highlight the importance of separate assessment of social anxiety subcomponents, including social avoidance and distress, and sensitivity to negative evaluation
(Watson & Friend, 1969). The findings also highlight the importance of separate assessment
of drinking levels versus drinking problems (McCreary & Sadava, 1998).
Our finding that fear of negative evaluation on the FNE-B was significantly correlated
with levels of drinking problems on the RAPI is consistent with the recent work of Buckner
et al. (in press) showing a relationship between social interaction anxiety and drinking
problems. Our finding also replicates and extends the prior findings of Lewis and O’Neill
(2000), who showed that problem drinking undergraduates had higher scores on the original
FNE than non-problem drinking students. However, this prior study further showed that
the problem drinkers also scored higher on the SADS than did the non-problem drinkers – a
relationship that was not replicated in the present study. This discrepancy could be due to
differences in the measures of drinking problems employed across studies (Lewis & O’Neill
used the Rutgers Collegiate Substance Abuse Screening Test [Bennett et al., 1993] whereas
we used the RAPI), or to the fact that they selected and compared extreme groups of
problem and non-problem drinkers while we used an unselected sample of drinkers.
Nonetheless, even in the Lewis and O’Neill study, the magnitude of the relationship of
alcohol problems to fear of negative evaluation was much larger than the magnitude of its
relationship to social avoidance and distress.
Our finding that social avoidance and distress was inversely related to drinking frequency
is consistent with an emerging body of data suggesting that social anxiety may actually
predict lesser alcohol consumption (e.g., Eggleston et al., 2004; Ham & Hope, 2005), at
least in undergraduates (see Morris et al., 2005). One possible explanation is that socially
anxious individuals drink less heavily because they are concerned about negative social
evaluation due to intoxication. Another possibility is that socially anxious individuals drink
less often because their social avoidance leads to fewer social opportunities where alcohol is
involved. The observed pattern is more consistent with the latter explanation because the
finding was for a relationship between social avoidance and distress (not fear of negative
evaluation) with drinking frequency (not drinking quantity).
How can fear of negative evaluation be related to drinking problems without also being
associated with heavier drinking behavior? To explain this apparently paradoxical pattern,
one must consider that maladaptive reasons for drinking can be as strongly predictive of
drinking problems as heavy drinking behavior itself. In fact, Cooper’s (1994; Cooper et al.,
1992) work has demonstrated that the negative reinforcement motives of coping and
conformity are related to alcohol problems, even after controlling usual consumption levels.
Individuals who drink to avoid negative outcomes may come to rely on alcohol as a coping
strategy, thereby increasing risk for alcohol-related problems, regardless of how much
alcohol they usually consume.
Our study also examined relations of social anxiety to the various drinking motives in
Cooper’s (1994) model of reasons for drinking. The results were supportive of our
Social anxiety and drinking
679
hypotheses, in that both coping and conformity motivated drinking demonstrated significant
relationships with both the FNE-B and SADS. This pattern of findings is consistent with
recent findings of Buckner et al. (in press) linking social anxiety (specifically, social
interaction anxiety) to drinking in situations involving unpleasant emotions and conflict with
others. The observed relationship of the social anxiety variables with coping and conformity
drinking motives in undergraduates is also highly consistent with recent findings from a
controlled study of community-recruited socially anxious adults, which concluded that these
individuals deliberately drink alcohol in social interaction situations to cope with their social
fears (Thomas et al., 2003).
Unexpectedly, fear of negative evaluation was also correlated (albeit relatively weakly)
with social motives which are commonly considered quite normative and a relatively
‘‘healthy’’ reason for drinking. One possible explanation is that those who fear negative
evaluation may find it hard to affiliate in social interaction situations without the use of
alcohol. If this is the case, then one would expect social motives to relate quite differently to
indices of drinking behaviors and problems among those who fear negative evaluation
compared to the relatively benign drinking profile associated with social motives in the
general population (Cooper, 1994; Cooper et al., 1992).
The inclusion of an assessment of drinking motives in the present study allowed for an
interesting test of potential mechanisms to explain the observed relation between fear of
negative evaluation and alcohol problems. Mediator analyses demonstrated that the relation
between fear of negative evaluation and alcohol problems was explained by the increased
tendency of individuals sensitive to negative evaluation to drink to avoid negative outcomes
(i.e., by their increased coping and conformity motives). A very different pattern of mediation
was observed in a recent study by Buckner et al. (in press) where enhancement drinking
motives (and not coping or social motives) mediated the relation between social interaction
anxiety and alcohol problems. It is possible that social interaction anxiety may share more in
common with depression than does fear of negative evaluation; thus, those with high social
interaction anxiety may be particularly likely to drink to increase positive affect (enhancement
motives) which in turn puts them at risk for problem drinking (Buckner et al., in press).
Several study limitations should be acknowledged. First, since the present study focused
on undergraduates, the results may not be generalizable to older adults or to clinical samples
of individuals with co-morbid SP – AUD. Future studies should examine whether the
findings can be replicated in a clinical sample. A second limitation pertains to our use of selfreport questionnaires where results might be influenced by common method variance,
which could inflate the correlations between the variables. Future research should make use
of alternative methodologies (e.g., experimental methods; cf., Abrams et al., 2002) to test
relations between various aspects of social anxiety and drinking motives and behavior.
Third, the cross-sectional, correlational design precludes causal interpretations of the
findings. For example, it is possible that drinking problems cause increased sensitivity to
negative evaluation rather than the other way around. Thus, longitudinal studies are
required. Fourth, although we did control for the influences of gender, the number of men
in the sample was insufficient to allow for adequate testing of possible moderating effects of
gender – an issue that should be investigated in future studies. Finally, many of the observed
relations, although significant, were relatively small in magnitude. Thus, future research
should examine potential moderator variables (cf. Tran et al., 1997) to see if subgroups of
those who fear negative evaluation may be particularly prone to alcohol problems.
There are currently no empirically validated interventions for treating individuals with comorbid SP – AUD (see review by Randall et al., in press). Randall et al. (2001) examined
whether cognitive behavioral treatment of those with co-morbid SP – AUD was more
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S. H. Stewart et al.
successful in a combined social anxiety and alcohol treatment, relative to an alcohol-only
treatment control. Directly contrary to hypothesis, at the end of treatment, those in the
combined treatment were drinking more alcohol, more often, than those in the alcohol-only
treatment group. Given these disappointing early results, additional research is needed to
develop more effective integrated interventions for the treatment of this form of comorbidity. Presuming the present findings can be replicated in a clinical sample, the results
may be useful in informing the content of such future intervention efforts. Our findings
suggest that catastrophic thoughts related to concerns about negative social evaluation
should be a central focus in cognitive behavioral approaches because this aspect of social
anxiety appears most closely tied to alcohol problems. Our findings also suggest that a focus
on reducing negative reinforcement drinking motives (both coping and conformity) should
be an important part of the intervention process (see Conrod et al., 2006, for sample
techniques).
Although the present findings suggest that undergraduates with high levels of social
avoidance may be at low risk for alcohol problems due to their infrequent drinking behavior,
it should be cautioned that this could change as these individuals challenge their social
avoidance over the course of exposure treatment. In fact, Randall et al. (in press) have
speculated that one of the reasons for the poorer outcome on drinking measures of their
combined treatment in the Randall et al. (2001) randomized controlled trial was that the SP
individuals began drinking more frequently as their social avoidance decreased (i.e., due to
increased exposure to situations like parties where drinking is normative). This is an
interesting possibility deserving of future study.
Our findings also have preventative implications. Recently, Kendall et al. (2004) have
reported longitudinal data showing that early effective treatment of SP (and other childhood
anxiety disorders) is associated with decreased substance misuse in adolescence. The
present findings suggest that preventative interventions would be best targeted toward
individuals with high levels of fear of negative evaluation, as this trait appears to be robustly
related to drinking problems.
References
Abrams, K., Kushner, M., Medina, K., & Voight, A. (2002). Self-administration of alcohol before and after a public
speaking challenge by individuals with social phobia. Psychology of Addictive Behaviors, 16, 121 – 128.
Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research:
Conceptual, strategic, and statistical considerations. Journal of Personality & Social Psychology, 51, 1173 – 1182.
Bennett, M. E., McCrady, B. S., Frankenstein, W., Laitman, L. A., Van Hyorn, D. H. A., & Keller, D. S. (1993).
Identifying young adult substance abusers: The Rutgers Collegiate Substance Abuse Screening Test. Journal of
Studies on Alcohol, 54, 522 – 527.
Bruch, M., Heimberg, R., Harvey, C., McCann, M., Mahone, M., & Slavkin, S. (1992). Shyness, alcohol
expectancies, and alcohol use: Discovery of a suppressor effect. Journal of Research in Personality, 26, 137 – 149.
Buckner, J. D., Schmidt, N. B., & Eggleston, A. M. (in press). Social anxiety and problematic alcohol consumption:
The mediating role of drinking motives and situations. Behavior Therapy.
Carrigan, M., & Randall, C. (2003). Self-medication in social phobia: A review of the alcohol literature. Addictive
Behaviors, 28, 269 – 284.
Cheek, J., & Buss, A. (1981). Shyness and sociability. Journal of Personality and Social Psychology, 41, 330 – 339.
Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the Fear
of Negative Evaluation Scale. Journal of Anxiety Disorders, 19, 345 – 359.
Conger, J. (1956). Reinforcement theory and the dynamics of alcoholism. Quarterly Journal of Studies on Alcohol, 17,
296 – 305.
Conrod, P. J., Stewart, S. H., Comeau, M. N., & Maclean, M. (2006). Efficacy of cognitive behavioral
interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child and Adolescent
Psychology, 35, 550 – 563.
Social anxiety and drinking
681
Cooper, M. L. (1994). Motivations for alcohol use among adolescents: Development and validation of a four-factor
model. Psychological Assessment, 6, 117 – 128.
Cooper, M. L., Russell, M., Skinner, J. B., & Windle, M. (1992). Development and validation of a threedimensional measure of drinking motives. Psychological Assessment, 4, 123 – 132.
Eggleston, A. M., Woolaway-Bickel, K., & Schmidt, N. B. (2004). Social anxiety and alcohol use: Evaluation of the
moderating and mediating effects of alcohol expectancies. Journal of Anxiety Disorders, 18, 33 – 49.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, P., Dufour, M. C., Compton, W., et al. (2004). Prevalence
and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from
the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 61,
807 – 816.
Ham, L. S., & Hope, D. A. (2005). Incorporating social anxiety into a model of college problematic drinking.
Addictive Behaviors, 30, 127 – 150.
Hofmann, S. G., DiBartolo, P. M., Holaway, R. M., & Heimberg, R. G. (2004). Scoring error of Social Avoidance
and Distress Scale and its psychometric implications. Depression and Anxiety, 19, 197 – 198.
Kendall, P., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in
adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical
Psychology, 72, 276 – 287.
Kessler, R., Crum, R., Warner, L., Nelson, C., Schulenberg, J., & Anthony, J. (1997). Lifetime co-occurrence of
DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Co-morbidity
Survey. Archives of General Psychiatry, 54, 313 – 321.
Kessler, R., McGonagle, K., Zhao, S., Nelson, C., Hughes, M., Eshelman, S., et al. (1994). Lifetime and 12-month
prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Co-morbidity
Study. Archives of General Psychiatry, 51, 8 – 19.
Khantzian, E. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine
dependence. American Journal of Psychiatry, 142, 1259 – 1264.
Kidorf, M., & Lang, A. (1999). Effects of social anxiety and alcohol expectancies on stress-induced drinking.
Psychology of Addictive Behaviors, 13, 134 – 142.
Kushner, M. G., Sher, K., & Beitman, B. (1990). The relation between alcohol problems and the anxiety disorders.
American Journal of Psychiatry, 147, 685 – 695.
Leary, M. R. (1983a). Social anxiousness: The construct and its measurement. Journal of Personality Assessment, 47,
66 – 75.
Leary, M. R. (1983b). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology
Bulletin, 9, 371 – 375.
Lewis, B., & O’Neill, K. (2000). Alcohol expectancies and social deficits relating to problem drinking among
college students. Addictive Behaviors, 25, 295 – 299.
Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and
social interaction anxiety. Behaviour Research and Therapy, 36, 455 – 470.
McCreary, D. R., & Sadava, S. W. (1998). Stress, drinking, and the adverse consequences of drinking in two
samples of young adults. Psychology of Addictive Behaviors, 12, 247 – 261.
McWilliams, L. A., Stewart, S. H., & MacPherson, P. S. R. (2000). Does the social concerns component of the
Anxiety Sensitivity Index belong to the domain of anxiety sensitivity or the domain of negative evaluation
sensitivity? Behaviour Research and Therapy, 38, 985 – 992.
Morris, E. P., Stewart, S. H., & Ham, L. (2005). The relationship between social anxiety disorder and alcohol use
disorders: A critical review. Clinical Psychology Review, 25, 734 – 760.
Randall, C., Thomas, S., & Thevos, A. (2001). Concurrent alcoholism and social anxiety disorder:
A first step toward developing effective treatments. Alcoholism: Clinical and Experimental Research, 25, 210 –
220.
Randall, C., Book, S. W., Carrigan, M. H., & Thomas, S. E. (in press). Treatment of co-occurring alcoholism and
social anxiety disorder. In S. H. Stewart & P. J.Conrod (Eds.), Co-morbid anxiety and substance use disorders:
Theoretical and treatment issues. New York: Springer.
Sher, K., & Levenson, R. (1982). Risk for alcoholism and individual differences in the stress-response-dampening
effect of alcohol. Journal of Abnormal Psychology, 91, 350 – 367.
Sobell, L. C., & Sobell, M. B. (1990). Self-report issues in alcohol abuse: State of the art and future directions.
Behavioral Assessment, 12, 77 – 90.
Stewart, S. H., Angelopoulos, M., Baker, J. M., & Boland, F. (2000). Relations between dietary restraint and
patterns of alcohol use in young adult women. Psychology of Addictive Behaviors, 14, 77 – 82.
Thomas, S. E., Randall, C. L., & Carrigan, M. H. (2003). Drinking to cope in socially anxious individuals:
A controlled study. Alcoholism: Clinical and Experimental Research, 27, 1937 – 1943.
682
S. H. Stewart et al.
Tran, G., Haaga, D., & Chambless, D. (1997). Expecting that alcohol use will reduce social anxiety moderates the
relation between social anxiety and alcohol consumption. Cognitive Therapy & Research, 21, 535 – 553.
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting & Clinical
Psychology, 33, 448 – 457.
White, H., & Labouvie, E. (1989). Towards the assessment of adolescent problem drinking. Journal of Studies on
Alcohol, 50, 30 – 37.