Social Anxiety Disorder Increases the Risk for Alcohol Use Disorder

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Compared with other anxiety disorders, social anxiety disorder has a plausible direct influence on alcohol use disorder.

Social anxiety disorder (SAD) is a likely causal influence on alcohol use disorder (AUD), and prevention and treatment of SAD may have a beneficial effect on reducing the risk for AUD, according to the results of a study published in Depression & Anxiety.

Fartein Ask Torvik, PhD, from the Department of Mental Disorders and the Centre for Fertility and Health, Norwegian Institute of Public Health, and the Department of Psychology, University of Oslo, Norway, and colleagues used data from the Norwegian Institute of Public Health Twin Panel and identified twins through the national Medical Birth Registry. Interviews conducted between 1999 and 2004 assessed the presence of psychiatric disorders among 2801 twins born between 1967 and 1979.

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The investigators conducted a second round of interviews between 2010 and 2011 with 2284 of those patients who responded to the first interviews to determine diagnoses of AUD and SAD, as well as generalized anxiety disorder, panic disorder, agoraphobia, and specific phobias using the Composite International Diagnostic Interview.

AUD was more common in men than in women. In contrast, all 5 anxiety disorders were more common in women. AUD was considerably more common in those with SAD; the combined data from both rounds of interviews found that 15% of individuals with SAD had AUD compared with only 6% in those without SAD. Men with SAD were more likely than women with SAD to have AUD (26% vs 13%, respectively). The mean age of onset for SAD was 14.2 years, and for AUD, 19.4 years. For participants with both lifetime SAD and AUD, 81% developed SAD before AUD. The odds ratio for AUD in those with SAD was 4.68.

Investigators noted several study limitations. They could not model environmental confounders and direct paths simultaneously, and they could not model interactions among genetic, environmental, and direct effects. They also could not distinguish between alcohol abuse and alcohol dependence. Furthermore, the interviews were retrospective, and many individuals dropped out between the first and second interviews.

The interviewers concluded that early intervention and prevention or treatment of SAD may reduce the risk for AUD, although interventions for other anxiety disorders are unlikely to have a similar effect.


Torvik FA, Rosenstrom TH, Gustavson K, et al. Explaining the association between anxiety disorders and alcohol use disorder: a twin study [published online March 5, 2019]. Depress Anxiety. doi: 10.1002/da.22886