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Social anxiety can sabotage treatment success for youths

April 23, 2015
by Gary A. Enos, Editor
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Group modalities of treatment make much sense from a cost-effectiveness standpoint, but how can individuals plagued by a feeling of “never fitting in” hope to benefit from these therapies?

A recent study conducted by Case Western Reserve University researchers offers some reason for hope, in the form of a time-honored tradition found in 12-Step support meetings. Looking at a group of 195 teens who were receiving court-mandated residential treatment services, the study found that high levels of helping activities in their 12-Step support meetings (such as making coffee or setting up chairs) had a protective effect against relapse and incarceration six months after treatment.

The study's lead researcher tells Addiction Professional that these basic, highly accessible activities appear to counteract a sense of “social misfit syndrome” that she has come across in numerous interviews with treatment-seeking individuals over the years, both adolescent and adult.

“The closest thing we have in psychiatry to this is social anxiety disorder,” says Maria Pagano, PhD, psychiatry professor at Case Western Reserve. “Social anxiety is the most common comorbid anxiety disorder with addiction.” This helps to explain why the prospect of making progress in group therapy settings can be so terrifying to some individuals with substance use disorders.

Details of study

To be published in the May 2015 issue of Alcoholism: Clinical and Experimental Research, the study assessed youths ages 14 to 18 at treatment admission, discharge, and six months post-discharge. A total of 42% of the young people reported a persistent fear of being scrutinized or humiliated in social situations, and 15% met diagnostic criteria for social anxiety disorder.

For the majority of those meeting criteria for social anxiety, this issue preceded the advent of substance use problems for them. “It is not a fallout condition,” Pagano says.

Those in the study who met criteria for social anxiety disorder presented for treatment with greater clinical severity, including earlier age of first use of substances and greater lifetime poly-substance use. “They are looking for how to put the uncomfortable feelings on ice,” says Pagano, in reference to the substance-using behavior.

In terms of these study participants' involvement in 12-Step support along with primary treatment, the study found little difference in involvement between youths with and without social anxiety, except that those with social anxiety participated more in the service activities seen in Alcoholics Anonymous (AA) and related support groups. In turn, the higher participation in these activities served to reduce the risk of post-treatment relapse and incarceration by half.

“For those with social anxiety, this was a way to get to know people and form new sober friendships in a natural way,” Pagano says in reference to activities such as serving as a greeter or making coffee. “They were not going to be put on the spot, and feel naked somewhat.” This also can be the type of activity that convinces a reluctant participant to keep showing up, she says.

Pagano summarizes the study's findings by saying, “The message is: Service saves.”

The worst post-treatment outcomes among participants in this study were seen among low-helping individuals with social anxiety, says Pagano. She adds that the research team next will examine whether the helping behaviors that were exhibited among some study participants carry over after treatment is completed.

A Case Western Reserve news release states that Pagano recommends “a full diagnostic evaluation of youths entering addiction treatment who appear to be socially anxious. These evaluations may lead to a definitive diagnosis of social anxiety disorder and an opportunity to treat affected adolescents with medication.”