Observation Anxiety Influences Alcohol Recovery

observation anxiety and alcohol useDo you feel anxious when you’re in the spotlight or under scrutiny?

According to a recent study from researchers at Yale University and Florida State University, social anxiety – and fear of scrutiny, specifically – appears to serve as a risk factor for alcohol use disorders (Buckner & Schmidt, 2009). Future research into how observation anxiety can lead to excessive alcohol use will likely provide useful guidance for alcohol recovery. For now, it appears that individuals with both observation anxiety and excessive alcohol use will likely need to learn to manage their observation anxiety in order to achieve a stable alcohol recovery.

Social anxiety disorder (SAD) and alcohol use disorders (AUD) are highly comorbid. According to one study, 48 percent of individuals with a lifetime diagnosis of SAD also meet criteria for a lifetime diagnosis of AUD (Grant et al., 2005). Such comorbidity often leads to more severe symptoms of both disorders. Several models posit that people with SAD use alcohol to manage their anxiety and that such a use of alcohol increases the risk of AUD.

The recent study from Buckner and Schmidt examined social anxiety as a risk factor for AUD. The researchers also examined different social anxiety first order factors as predictors of AUD. By using both the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS), researchers were able to assess different components of social anxiety (social interaction fears, observation fears, and fears that others will notice the anxiety). Researchers also utilized the Spielberger Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) to assess trait anxiety and depression, respectively.

A sample of 404 healthy young adults free from current or past Axis I psychopathology was followed for over two years. The study found that social anxiety (but not depression or trait anxiety) predicted subsequent alcohol use disorders. SAD correlated with AUD and preceded the onset of AUD even after controlling for other variables such as depression and gender.

Further, this study examined specific components of social anxiety and found that the fear of scrutiny (observation anxiety) appears to be a particularly important risk factor in the development of AUD. Notably, AUD was significantly related to observation anxiety and fear that others will notice anxiety, but AUD was not significantly related to social interaction anxiety.

The study did not rule out the possibility that problematic alcohol use may result in increased anxiety for some individuals; in fact, previous research suggests that the onset of AUD occurs before SAD. Therefore, for some individuals, the use of alcohol may increase social anxiety.

More research is needed to understand the complex interplay between AUD and SAD. Many people seem to get stuck in a vicious cycle where they use alcohol to manage social anxiety, only to experience increased social anxiety because of the alcohol use.

Early alcohol treatment that focuses on overcoming social anxiety and observation-related fears could potentially prevent the development of AUD among high-risk individuals. Exposure-based cognitive therapy, for example, may alleviate fears of scrutiny that drive some individuals to use alcohol excessively. Whatever the findings ultimately show, it seems likely that individuals who wish to achieve a stable alcohol recovery will need to improve their skills for managing anxiety.


Buckner, J. D. & Schmidt, N.B. Understanding social anxiety as a risk for alcohol use disorders: Fear of scrutiny, not social interaction fears, prospectively predicts alcohol use disorders. J Psych Research 2009; 43, 477-483.

Grant BF, Hasin DS, Blanco C, Stinson FS, Chou SP, Goldstein RB, et al. The epidemiology of social anxiety disorder in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiat 2005; 66: 1351–61.