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      Social Anxiety Disorder and Alcohol Use

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          Abstract

          Social anxiety disorder—an excessive fear of social situations, such as eating or speaking in public—affects 2 to 13 percent of the U.S. population. About one-fifth of patients with social anxiety disorder also suffer from an alcohol use disorder (AUD) (i.e., alcohol abuse or dependence). One theory to explain the comorbidity between social anxiety disorder and AUDs is the tension reduction theory, which posits that people with social anxiety use alcohol to alleviate their fears. This expectation that alcohol reduces anxiety may motivate alcohol consumption even if pharmacological studies do not support that assumption. Social anxiety disorder is treatable with both pharmacotherapy and psychotherapy, and some of those treatments also would be expected to be effective for patients with comorbid AUDs. Evaluation of patients seeking alcoholism treatment for coexisting social anxiety disorder is important for improving treatment outcome.

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          Most cited references20

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          Cognitive-behavioral therapy for social anxiety disorder: current status and future directions.

          Cognitive-behavioral therapy (CBT) is the most thoroughly studied nonpharmacologic approach to the treatment of social anxiety disorder, and its efficacy has been demonstrated in a large number of investigations. This article summarizes the data on the efficacy of CBT for the treatment of the symptoms of social anxiety disorder and impaired quality of life. The relative efficacy of various CBT approaches, both in the short-term and over extended follow-up periods, is reviewed. Factors associated with more or less positive response to CBT among patients with social anxiety disorder are examined. Special attention is given to the comparison of CBT with pharmacologic approaches to the treatment of social anxiety disorder and the potential utility of combining these approaches. Future directions in the application of combinations of CBT and pharmacotherapy to the treatment of social anxiety disorder are discussed.
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            Social phobia subtypes in the National Comorbidity Survey.

            This article presents epidemiologic data on the distinction between social phobia characterized by pure speaking fears and that characterized by other social fears. The data come from the National Comorbidity Survey (N = 8,098). Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Latent class analysis showed that the brief set of social fears assessed in the survey can be disaggregated into a class characterized largely by speaking fears and a second class characterized by a broader range of social fears. One-third of the people with lifetime social phobia exclusively reported speaking fears, while the other two-thirds also had at least one of the other social fears assessed. The vast majority of the latter had multiple social fears including, in most cases, both performance and interactional fears. The two subtypes were similar in age at onset distribution, family history, and certain sociodemographic correlates. However, the social phobia characterized by pure speaking fears was less persistent, less impairing, and less highly comorbid with other DSM-III-R disorders than was social phobia characterized by other social fears. Further general population research assessing more performance and interaction fears is needed to determine whether social phobia subtypes can be refined and whether the subtypes are better conceptualized as distinct disorders. In the meantime, people who have social phobia with multiple fears, some of which are nonspeaking fears, appear to have the most impairment and should be the main focus of prevention and intervention efforts.
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              Cognitive behavioral group therapy vs phenelzine therapy for social phobia: 12-week outcome.

              This article presents results of the acute treatment phase of a 2-site study comparing cognitive behavioral group therapy (CBGT) and treatment with the monoamine oxidase inhibitor phenelzine sulfate for social phobia. One hundred thirty-three patients from 2 sites received 12 weeks of CBGT, phenelzine therapy, pill placebo administration, or educational-supportive group therapy (an attention-placebo treatment of equal credibility to CBGT). The "allegiance effect," ie, the tendency for treatments to seem most efficacious in settings of similar theoretical orientation and less efficacious in theoretically divergent settings, was also examined by comparing responses to the treatment conditions at both sites: 1 known for pharmacological treatment of anxiety disorders and the other for cognitive behavioral treatment. After 12 weeks, phenelzine therapy and CBGT led to superior response rates and greater change on dimensional measures than did either control condition. However, response to phenelzine therapy was more evident after 6 weeks, and phenelzine therapy was also superior to CBGT after 12 weeks on some measures. There were few differences between sites, suggesting that these treatments can be efficacious at facilities with differing theoretical allegiances. After 12 weeks, both phenelzine therapy and CBGT were associated with marked positive response. Although phenelzine therapy was superior to CBGT on some measures, both were more efficacious than the control conditions. More extended cognitive behavioral treatment and the combination of modalities may enhance treatment effect.
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                Author and article information

                Journal
                Alcohol Res Health
                Alcohol Res Health
                Alcohol Research & Health
                National Institute on Alcohol Abuse and Alcoholism
                1535-7414
                1930-0573
                2002
                : 26
                : 2
                : 130-135
                Affiliations
                Sarah W. Book, M.D., is an assistant professor and Carrie L. Randall, Ph.D., is a professor in the Department of Psychiatry at the Center for Drug and Alcohol Programs and Alcohol Research Center, Medical University of South Carolina, Charleston, South Carolina
                Article
                130-135
                6683821
                1b4c7e34-5800-4306-a63a-2efb93c8e28a
                Copyright @ 2002

                Unless otherwise noted in the text, all material appearing in this journal is in the public domain and may be reproduced without permission. Citation of the source is appreciated.

                History
                Categories
                Articles

                comorbidity,anxiety,social phobia,aodu (alcohol and other drug use),alcoholic beverage,tension reduction theory of aodu,diagnostic criteria,prevalence,positive aod (alcohol and other drug) expectancies,drug therapy,psychotherapy,monoamine oxidase,benzodiazepines,serotonin uptake inhibitors,literature review

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