Anxiety disorders are the most common mental health issue in the US. According to the National Institute on Mental Health, more than 30 percent of American adults will deal with an anxiety disorder at some point in their lives.
Anxiety disorders are also associated with an increased risk of developing substance use issues and research shows that in about 75 percent of cases, the substance use disorder comes after the anxiety disorder, indicating that many people begin using drugs and alcohol as a way of coping with anxiety. This is often the case with people who suffer from social anxiety disorder. Social anxiety disorder is a condition characterized by extreme fear of being judged or rejected in social situations. People with social anxiety disorder may freeze, panic, or become visibly anxious when interacting with others. Their fear becomes so intense that they often go to great lengths to avoid social interaction. When they can’t avoid it, they may rely on drugs or alcohol to calm them down so they can act more “normally” around others. According to the Anxiety and Depression Association of America, about 20 percent of people with social anxiety disorder also have an alcohol use disorder.
If you have social anxiety and a substance use issue, it’s important to address both together. Otherwise, the social anxiety is likely to make it much harder to control addictive behavior. The following are some healthy ways to handle social anxiety.
The first and best option when dealing with any mental health challenge is to talk to a therapist. This helps you better understand what you’re dealing with and gives you a structured approach to recovery. Typically, therapy for social anxiety has two main components: exposure and challenging cognitive distortions. Exposure therapy is simply making a list of things that make you anxious, ranking them from least bad to worst, then actually engaging in each of those situations in ascending order of difficulty. For example, for someone with social anxiety disorder, the most manageable challenge might be to ride the bus and the most difficult challenge might be to go to a party where you don’t know anyone. By gradually increasing the difficulty you desensitize yourself to anxiety.
The other component is challenging cognitive distortions. This is based on the central idea of cognitive-behavioral therapy, which is that we don’t respond emotionally to events themselves but rather to our beliefs about events. This part of treatment helps you identify your distorted beliefs and challenge them rather than letting them control you. So for example, someone with social anxiety disorder may think something like, “I have to behave perfectly in social situations, otherwise I’ll be totally humiliated and it will be awful.” In reality, no one is perfect and believing you have to be perfect is self-limiting. What’s more, even if you do commit a serious faux pas, it’s not likely to be catastrophic. People with social anxiety are typically held back far more by their fear than by their social skills or personalities. A therapist can provide some helpful tools and some much-needed perspective.
Medication is often helpful for controlling many anxiety disorders, including social anxiety. Benzodiazepines, such as Xanax, are often prescribed for this purpose but if you have a history of substance use issues, it’s better to avoid them. Benzodiazepines are extremely addictive and you can become dependent on them in as little as two weeks of regular use. SSRIs, on the other hand, are non-addictive and are better for controlling anxiety in the long term. Side effects are typically minimal and many people can stop taking them once they get their anxiety under control with therapy.
One of the worst things about social anxiety is that your body seems to have a mind of its own. Even if you know, rationally, that a social situation is nothing to worry about, your heart may start pounding, you may start sweating and shaking, and you may totally freeze up. Something deep in your brain identifies the social situation as a threat and initiates the “fight or flight” response, which is controlled by the sympathetic nervous system.
You can’t control your heart rate or sweat but you can control your breathing. Deep breathing stimulates the vagus nerve, which activates the parasympathetic nervous system, the “rest and digest” system that counteracts the sympathetic nervous system. These two systems are like a teeter-totter–both ends can’t be up at once. The parasympathetic nervous system is activated most strongly while exhaling. Therefore, when you feel anxious and your heart is beating fast, one way to calm down quickly is to take some deep breaths and focus on a long exhale. So you might, for example, inhale for a count of four and exhale for a count of six or eight. Do this five or ten times and you should start to feel much calmer. It may also be a good idea to practice deep breathing daily so it feels more natural when you have to use it in a social setting.
One final strategy for keeping social anxiety under control is to practice focusing on others instead of yourself. Social anxiety typically comes from a runaway fear that everyone is judging you. Instead of feeling like you’re standing in the spotlight, focus your attention on other people. When in doubt, focus on being curious and being kind. Doing something nice for someone else takes the focus of your own anxiety and makes you feel better about yourself. Expressing genuine curiosity about others is a great way to start a conversation and feel less self-conscious. “What do you do for fun?” is always a good place to start.
If you have a loved one who is struggling with addiction, Hired Power and our team of dynamic, experienced recovery professionals are here to guide you every step of the way. We offer many services, including helping you choose the best treatment program and transitional services, including interventions, sober monitoring, and personal recovery assistants. Call us today for information on our recovery services: 800.910.9299.