Social anxiety, alcohol expectancies, and self-efficacy as predictors of heavy drinking in college students

Burke and Stephens (1999) [Burke, R.S., Stephens, R.S. Social anxiety and drinking in college students: A social cognitive theory analysis. Clinical Psychology Review, 19, (1999) 513-530.] proposed a social cognitive theory of heavy drinking in college students. According to this theory, alcohol expectancies for social facilitation and self-efficacy for refusing heavy drinking in anxiety-producing social situations moderate the relationship between social anxiety and drinking. In the current study, a significant three-way interaction was observed among social anxiety, expectancies, and self-efficacy when amount and frequency of drinking was the dependent variable. As predicted by the model, socially anxious college students with low self-efficacy for avoiding heavy drinking in social situations and high positive expectancies for social facilitation reported more alcohol consumption than other socially anxious individuals.     

Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorders: An Avoidance-Coping Cognitive Model

Despite the frequent comorbidity of social anxiety disorder and alcohol use disorders, no theoretical model currently exists to explain the specific mechanisms underlying the comorbidity between these two disorders. An integration of existing theoretical models and empirical evidence across the social anxiety and alcohol use literatures is presented as the Avoidance-Coping Cognitive Model, which proposes that socially anxious individuals may be particularly vulnerable to the anxiolytic effects of alcohol through reductions in attention biases to social threat. The disproportionate reduction in anxiety may then make alcohol an attractive method of avoidance coping. Gaps in the empirical literature are reviewed in light of this model as future directions are suggested.     

Alcohol expectancies and social self-efficacy as mediators of differential intervention outcomes for college hazardous drinkers with social anxiety

The current pilot study examined the roles of two cognitive factors - positive alcohol expectancies of social anxiety reduction and drink refusal self-efficacy relevant to social situations - in mediating greater reduction in alcohol behaviors by the Brief Intervention for Socially Anxious Drinkers (BISAD; n = 21) compared to an alcohol psychoeducation (n = 20) in a sample of college hazardous drinkers with social anxiety. Mediation analysis results indicated that decreased positive alcohol expectancies and increased drink refusal self-efficacy relevant to social situations accounted for an average of 67% of the variance in treatment outcomes as measured by total quantity of alcohol consumption, heavy drinking days and problems related to alcohol use in the past month. Study results may enhance the understanding of cognitive factors' role in alcohol treatment outcomes, which could in turn improve the efficacy of interventions aimed to reduce hazardous drinking and comorbid social anxiety.     

Social anxiety and alcohol use: The role of alcohol expectancies about social outcomes

Though social anxiety disorder and alcohol use disorders commonly co-occur, the mechanisms involved in social anxiety and hazardous drinking among college students are not well understood. The current study contributes to the emerging literature on social anxiety and college drinking as the first known study to test how positive (e.g. “I would feel at ease in social situations”) and negative (e.g. “I would make a fool out of myself”) alcohol outcome expectancies (AOE) specific to social situations (social AOE) impact the association between social anxiety and hazardous alcohol use among 718 undergraduates (61% women; M_age?=?19.50, SD?=?1.45; 85% White). Results supported the mediation, but not the moderation models. There were positive indirect effects of social anxiety through positive social AOE and negative indirect effects of social anxiety through negative social AOE on both hazardous drinking outcomes (i.e. alcohol consumption and alcohol problems). Findings suggest that there could be competing pathways for increasing (positive social AOE) and decreasing (negative AOE) risk for hazardous alcohol use in socially anxious college students.     

Social anxiety and alcohol consumption: The role of alcohol expectancies and reward sensitivity

Although the relationship between social anxiety and alcohol consumption has been the subject of extensive exploration, previous studies have failed to draw consistent conclusions about the nature of this relationship.Gray [Gray, J.A. (1970). The psychophysiological basis of introversion–extraversion. Behaviour Research and Therapy, 8, 249–266] suggested that individuals who are sensitive to reward are likely to place themselves in potentially rewarding environments (e.g. pubs and clubs). As such these individuals will have a greater chance to experience and vicariously observe the effects of alcohol in these environments, leading to the formation and modification of alcohol expectancies. Consequently, reinforcement sensitivity theory and alcohol expectancies are inherently related, yet have remained disparate areas of research. In this study, a total of 454 young adults responded to a questionnaire assessing social anxiety, alcohol consumption, reward sensitivity and alcohol expectancies. Regression analyses revealed a positive relationship between reward sensitivity, expectations of tension reduction and increased confidence, and alcohol consumption. Expectations of tension reduction were observed to moderate the relationship between social anxiety and alcohol consumption. In addition, three-way relationships between reward sensitivity, alcohol expectancies and social anxiety were observed to predict alcohol consumption. Overall, these results suggest that both reward sensitivity and alcohol expectancies play a role in the relationship between social anxiety and alcohol consumption, and that inclusion of these constructs in further research may aid in further clarifying the mechanisms underlying comorbid social anxiety and alcohol abuse.     

The relationship between cognitive preoccupation with alcohol and alcohol use in male and female college students

This research examined the relationship between self-reported cognitive preoccupation with drinking and self-reported and ad lib measures of alcohol consumption in male and female college students. Fifty undergraduates rated their degree of preoccupation with drinking using the Cognitive and Emotional Preoccupation scale and then participated in an individualized taste-rating task, an unobtrusive laboratory measure for determining ad lib alcohol consumption. Regression results showed that individual differences in emotional preoccupation with alcohol predicted self-reported consumption and actual laboratory alcohol consumption, only for women and not for men. This research shows that emotional preoccupation with alcohol appears to be an important factor in determining rates of drinking in college-age women and may be an important factor in identifying those individuals at risk of future problems with alcohol.     

Gender differences in the relationship between alcohol use and anxiety symptoms among Nigerian college students

Few studies have addressed the effect of gender on the relationship between alcohol and anxiety. Students in a Nigerian university, grouped into five separate categories of alcohol use completed the Zung's Self Rating Anxiety Scale. Although a non-linear "J shaped" relationship was found between alcohol use and anxiety symptoms among males, a linear relationship was found among females. Women tend not to share the positive effect moderate alcohol use confers on anxiety status. This gender difference may be an important consideration when planning preventive strategies for alcohol related problems in Nigerian youths.     

The relationship between alcohol use and cigarette smoking in a sample of undergraduate college students

During the decade of the 1990s, smoking prevalence increased nearly 30% in the college student population. Although most college students initiate smoking before the age of 18, recent evidence suggests a sizable minority of undergraduates report starting smoking while in college. This study examined the concurrent use of alcohol and tobacco as well as the relationship between alcohol use and smoking initiation among a sample of undergraduate students attending a large public university in the southwestern United States. We defined three categories of smoking status for this study: never smokers (n=777), experimenters (n=158), and smokers (n=178). Both experimenters and smokers reported consuming significantly more drinks per occasion in the past 28 days and more drinks on one occasion in the past 2 weeks compared to never smokers; however, there was no significant difference between experimenters and smokers on either of these measures of consumption. The results of two multinomial logistic regression models showed that measures of alcohol consumption and drinking frequency were significantly associated with being an experimenter or smoker after controlling for demographic and other drug use covariates. Results of a logistic regression analysis revealed a significant relationship between past year drinking frequency and smoking initiation among respondents who reported that they were not smoking at all 12 months prior to their survey participation. The influence of alcohol consumption on smoking initiation among college students is discussed.     

Daily marijuana use and suicidality: the unique impact of social anxiety

Despite a clear relationship between marijuana use and suicidality, little is known about psychological vulnerability factors that may interact with marijuana use to increase suicidality among this high-risk group. The present study examined the moderational impact of social anxiety on the relationship between marijuana use status (current users vs abstainers) and suicidality among 343 community adults. We also examined whether social anxiety moderated the relation between more frequent use (daily vs less frequent) among the 134 current marijuana users. Although social anxiety did not moderate the relation between use status and suicidality, it did moderate the relation between daily use status and suicidality after controlling for a wide range of relevant variables (e.g., demographics, depression, negative affect, and other types of anxiety). The overall model accounted for 59% of the variance in suicidality such that daily marijuana users with elevated social anxiety reported the highest suicidality. Findings highlight the importance of considering social anxiety in efforts to understand and prevent suicidality among this high-risk population.     

Social impressions while drinking account for the relationship between alcohol-related problems and social anxiety

Individuals with elevated social anxiety appear particularly vulnerable to experiencing alcohol-related problems; yet we know little about factors that may account for this relationship. One possibility is that socially anxious individuals hold beliefs about the impressions they make on others while drinking and these beliefs play an important role in their drinking behaviors. The present study used exploratory factor analysis among participants with clinically elevated social anxiety (n=166) to develop a measure, the Social Impressions while Drinking Scale (SIDS), to assess beliefs regarding others' impressions of drinking behaviors that may be particularly relevant to socially anxious individuals. A valuations scale was also developed to assess the importance of each belief. Empirically-derived subscales were identified with adequate reliability. Among socially anxious participants, the Gregarious and Sexual Facilitation subscales were uniquely related to drinking problems and frequency respectively. Individuals with clinically meaningful social anxiety achieved higher scores on all SIDS subscales compared to those with lower social anxiety (n=166). Several SIDS scales mediated the relations between social anxiety group status and drinking problems (Interaction Fears, Observation Fears, Aggression, Gregariousness). Results highlight the importance of examining beliefs specific to high-risk populations in assessing their alcohol-related behaviors.     

The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use

Background: The aim of the current study was to examine the associations between the specific mindfulness skills of observing, describing, awareness, nonjudgment, and nonreactivity in terms of anxiety sensitivity (AS), distress tolerance (DT), and intolerance of uncertainty (IU) among college students with problematic alcohol use. Methods: Participants were 202 (69.3% male; M_age = 18.96, SD = 2.24, range = 18–45 years) undergraduate college students with problematic alcohol use who completed self-report measures for course credit. Results: Results indicated that after controlling for the effects of gender, smoking status, marijuana use status, and negative affectivity, greater use of the mindfulness skill of observing was associated with higher AS, greater describing was associated with lower AS and higher DT, greater nonjudgment was associated with lower AS and IU and higher DT, and greater nonreactivity was associated with increased DT. Awareness did not significantly predict any of the examined risk factors. Conclusions: These results suggest that specific mindfulness skills are associated with a greater tolerance of physiological, emotional, and uncertain states. An important next step will be to examine whether mindfulness skills are associated with decreased problematic alcohol use due to improvements in these anxiety-related risk factors.     

The relationship between parental alcohol use and college students' alcohol-related cognitions

This study examined how parental and cognitive factors are structurally related to college students' intention to drink alcohol as well as possible gender differences in these relationships. Multiple-group comparison was used in structural equation modeling to assess data-to-model fit of the hypothesized model. Perceived parental alcohol use, positive expectancies, abstinence self-efficacy in social situations, and intent to drink alcohol were structurally modeled and examined in 714 college students based on self-report measures. Results showed good fit of the hypothesized model in both men and women. Invariance of model fit was found across genders, although a more detailed analysis of the results suggested gender-specific influence of parental alcohol use over students' cognitions. Perceptions of greater parental alcohol use were associated with higher positive expectancies for alcohol use, which, in turn, were significantly related to lower drink refusal self-efficacy. Both higher expectancies and lower refusal self-efficacy were related to the intention for future use. Results of the study shed light on the development of alcohol-related cognitions in male and female college students and contribute to our understanding of the structural relationship between expectancies and self-efficacy in alcohol use.     

Reactivity to conspicuousness and alcohol use among college students: the moderating effect of alcohol expectancies

The analysis of self-report data from 147 college undergraduates suggested that alcohol expectancies moderate the effect of a dispositional susceptibility to embarrassment elicited by undesired conspicuousness [center-of-attention-induced embarrassability (CAE)] on drinking behavior. Individuals unlikely to experience embarrassment when they engage in behaviors that make them stand out in a crowd, a common occurrence when one drinks to excess, drank heavily if they expected alcohol to make them more assertive socially. Students with similar beliefs about the effects of alcohol on social interaction who were high in CAE consumed substantially less alcohol than the latter individuals. Their overall levels of drinking were more comparable to those of the low-expectancy participants, suggesting that the disdain for conspicuousness characteristic of people with a susceptibility to CAE may counteract the desire for social disinhibition that often motivates alcohol consumption.     

Marijuana effect expectancies: relations to social anxiety and marijuana use problems

High social anxiety is related to marijuana problems, yet the nature of this relation remains unclear. We examined relations between marijuana effect expectancies, social anxiety, and marijuana among undergraduates (N=337). Social anxiety was related positively to Negative Expectancies and negatively to Tension Reduction Expectancies. Among socially anxious individuals, greater belief that marijuana produces Cognitive and Behavioral Impairment was associated with greater marijuana use rates. Negative Expectancies mediated the social anxiety-marijuana problems link. These data provide new insight into problematic marijuana use among this high-risk group.     

The moderating role of social networks in the relationship between alcohol consumption and treatment utilization for alcohol-related problems

Many individuals wait until alcohol use becomes severe before treatment is sought. However, social networks, or the number of social groups an individual belongs to, may play a moderating role in this relationship. Logistic regression examined the interaction of alcohol consumption and social networks as a predictor of treatment utilization while adjusting for sociodemographic and clinical variables among 1,433 lifetime alcohol-dependent respondents from wave 2 of the National Epidemiologic Survey on Alcohol Related Conditions (NESARC). Results showed that social networks moderate the relationship between alcohol consumption and treatment utilization such that for individuals with few network ties, the relationship between alcohol consumption and treatment utilization was diminished, compared to the relationship between alcohol consumption and treatment utilization for individuals with many network ties. Findings offer insight into how social networks, at times, can influence individuals to pursue treatment, while at other times, influence individuals to stay out of treatment, or seek treatment substitutes.     

Severity of anxiety in mental health versus addiction treatment settings when social anxiety and substance abuse are comorbid

There is increasing interest in the co-occurrence of social anxiety and addiction. Each investigation has a specific vantage point, e.g. the effect social anxiety has in a population with addiction or that of addiction in a population with social anxiety, which could create unique findings. Among comorbid individuals, is social anxiety more severe in people seeking treatment for anxiety, as compared to those seeking treatment for addiction? This report compares social anxiety severity between subjects in two studies—one involving socially anxious individuals (n = 38) seeking treatment for addictions; the other (n = 41) subjects with social anxiety and an alcohol use disorder, seeking treatment for social anxiety. Baseline severity scores on the Liebowitz Social Anxiety Scale for social anxiety were compared between the groups. No significant differences were found. For both groups, social anxiety was largely in the severe range. The results suggest that clinicians should attend to social anxiety symptom severity in patients with co-occurring social anxiety and addiction, regardless of the condition for which treatment is sought.     

An examination of the tension reduction hypothesis: the relationship between anxiety and alcohol in college students

The Tension Reduction Theory posits that alcohol is consumed to achieve tension reduction. The drinking patterns of high anxiety college students differed from low anxiety college students. Eighty-one students completed the Trait scale of the State-Trait Anxiety Inventory and the Khavari Alcohol Test (KAT). Several indices of alcohol use derived from the KAT were used to assess patterns of alcohol use. Five two-way analyses of variance were conducted using gender and anxiety as factors. Hypothesis One predicted that there would be a significant difference in alcohol consumption between high and low anxiety students when a comprehensive measure of alcohol use was used. This hypothesis was supported. Hypothesis Two predicted that frequency alone would not differentiate between anxiety levels; this was also supported. The Third Hypothesis was that volume measures of beer, wine and liquor would differentiate between the high and low anxiety levels; this hypothesis was partially supported--beer volume did differentiate between groups, while wine and liquor volume did not. The final hypothesis was that there would be an interaction between gender and anxiety; this was not supported.