Anxiety disorders are extremely common, with 18 percent to 28 percent of Americans experiencing the disorder in any given year. Of that group, about 40 percent of them will also have a substance use disorder, a common action in the attempt to manage the symptoms of anxiety. Anxiety disorders include a variety of manifestations including generalized anxiety disorder, phobias, post-traumatic stress disorder, panic disorder, obsessive-compulsive disorder, and social anxiety disorder.
There is a particularly strong connection between social anxiety disorders and cannabis (marijuana) dependence. When two disorders occur at the same time, it is called comorbidity, leading to a dual diagnosis. In the case of the combination of social anxiety disorder and cannabis dependence, the profound fear and discomfort experienced in social situations may lead some to cope with the excessive anxiety by using a substance such as marijuana and/or alcohol. This reflexive behavior can eventually lead to a dependence on the substance, resulting in greater impairment in overall mental health.
Data from an important study called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) confirms the fact that patients with cannabis use disorder have high rates of social anxiety disorder. The survey, conducted in 2002, conducted face-to-face interviews with 43,093 people who had reported drug problems consistent with cannabis use disorder at some point in their lives. Ten percent of the respondents confirmed having had clinically diagnosed social anxiety disorder. Over 80 percent of those reported that the social anxiety disorder preceded the cannabis use disorder.
It appears the two disorders feed upon each other with the more common path being increased dependence on marijuana use to mollify the stress caused by the social anxiety. Problems related to cannabis use disorder are exacerbated by the anxiety disorder, worsening them unlike those with only a cannabis use disorder and no co-occurring condition. When one is dependent on cannabis as a result of compulsive use, drug-related psychological and/or physiological problems result. There is also evidence that the use of marijuana can precipitate mental illness in people who are predisposed to them.
The NESARC data also suggest that patients with comorbid conditions of social anxiety disorder and cannabis use disorder have a high likelihood of another psychiatric condition present as well. More than 99 percent of the respondents who had both social anxiety disorder and cannabis use disorder reported symptoms meeting the criteria for a diagnosable psychiatric condition. Moreover, alcohol was an additional substance being abused by the patients with social anxiety disorder. As far as physical health, respondents with both conditions reported poorer overall health than those patients with just cannabis use disorder alone.
The treatment of individuals with comorbid social anxiety disorder and cannabis use disorder needs to address both conditions. Group therapy, 12-step programs such as A.A. or N.A. may pose a challenge, as they are group-oriented and therefore difficult for someone with social anxiety. Individual therapy, particularly cognitive behavioral therapy, would be more effective. Other treatment methods may include systematic desensitization, imaginal flooding, social skills training and graduated exposure. Currently, only one medication, the SSRI paroxetine, has received the FDA approval for the treatment of social anxiety disorder.
With regard to this dual diagnosis in adolescents, Dr. Naimah Weinberg from the National Institute on Drug Abuse (NIDA) stated,
“The relationships among anxiety disorders and substance use disorders are complex and merit this kind of attention, given how commonly they co-occur. This type of study, with the power to focus on a particular anxiety disorder and type of substance dependence, helps refine our understanding of these complex relationships. If the results can be replicated, particularly by prospective studies, this may offer an opportunity for intervention with high-risk youth to prevent the development of substance use disorders.”
Results from these types of studies help mental health and addiction professionals evaluate patients for the possibility of a dual diagnosis and fine tune treatment modalities accordingly, increasing a successful outcome.
Sovereign Health Group is a residential treatment program for substance and mental health disorders, with facilities across the nation. For more information about our dual diagnosis treatment programs, please call 866-524-5504.