Drinking to cope: How social anxiety plays a role in university students’ alcohol consumption

By Jenna Vieira

While having a beer, glass of wine, or cocktail on occasion might be relatively low-risk, university students tend to drink a lot more alcohol than this on average.1 In fact, a 2019 national survey found that 33% of students had engaged in binge drinking in the past month and almost 9% were diagnosed with an alcohol use disorder.1 Since alcohol use is so common among students it’s important for clinicians, universities, and the general public to understand the reasons why they drink, so that the issue can be better addressed.

Figure 1: An anxious emoticon face with a thought bubble coming out of its head, containing the phrases “I feel like such an outcast..”, “They’re judging me..”, and “Everyone’s looking at me..” A group of their peers stands nearby. Graphic by Jenna Vieira, template from CANVA is licensed under a Free Media License Agreement.

One possible reason for university students’ drinking might have to do with social anxiety. At its core, social anxiety is an intense fear of being judged or evaluated when in social situations,2 like public speaking, ordering food at a restaurant, or meeting someone new. A person with this kind of anxiety is worried that they will “mess up” or do something that will cause others to think poorly of them. Although social anxiety is something that everyone experiences from time to time, it can be severe and persistent enough to be diagnosed as a mental disorder.3

Alcohol is known to have anxiety-reducing effects.4 This means that drinking alcohol might allow someone with social anxiety to feel more relaxed, comfortable, and able to socialize in situations that would normally cause them a lot of distress.

Interestingly, much of the university experience takes place in the form of social events, like living and hanging out with roommates, going to big parties, and visiting bars and clubs.5 What do all of these events tend to have in common? The presence of alcohol and the ability to trigger social anxiety. University students often find themselves in situations that present opportunities for both drinking and feeling socially anxious, and as mentioned, alcohol can reduce this anxiety.4 So, could it be that some students drink alcohol as a way of coping with their social anxiety?

What the research says

A number of studies have indeed found support for the idea that university students drink alcohol to cope with social anxiety. In one study, highly socially anxious university students reported greater drinking to cope with negative emotions, like sadness and anxiety, compared to students with lower levels of social anxiety.5 On top of this, highly socially anxious students tended to report drinking for conformity reasons, or in other words, to fit in with their peers. This suggests that these students drink not only to manage unpleasant emotions, but also uncomfortable experiences that might arise from being rejected and ridiculed by others around them.

Another study found that highly socially anxious university students were more likely to drink to cope with and reduce negative emotions, like nervousness and depression, compared to students with lower levels of social anxiety.5 In addition, they reported drinking more to increase positive emotions, like feeling good and having fun. Importantly, highly socially anxious students who reported drinking as a way to manage both negative and positive emotions were more likely to experience problems related to their alcohol use.

Figure 2: A sad face and a happy face next to three alcoholic drinks. Graphic by Jenna Vieira, template from CANVA is licensed under a Free Media License Agreement.

Some studies have even found evidence that university students drink alcohol as a way of coping with anticipatory social anxiety; in other words, anxiety about an upcoming social situation or event rather than one a person is already in. One such study found that highly socially anxious students were more likely to experience anxiety about an upcoming social event, which made them more likely to drink alcohol before that event in order to prepare for and manage their anxiety about it.7 It was also found that anticipatory anxiety, social anxiety, and pre-drinking were related to more drinking and feelings of intoxication during that social event.

To sum up, university students with social anxiety tend to drink alcohol, and sometimes greater amounts of alcohol, compared to their non-anxious peers. They appear to do this not only to cope with negative emotions (including anxiety), but also to feel more positive emotions and to prepare for situations in which they are afraid of being judged or rejected.

Why does this matter?

These findings show that a desire to cope with social anxiety is one reason behind university students’ alcohol use. They also suggest that drinking to cope with social anxiety might put university students at higher risk for alcohol-related problems, like developing an addiction.

Using alcohol as a strategy to manage and cope with emotions, whether positive or negative, is generally unhealthy.6 For socially anxious university students, it’s associated with drinking more in social situations7, which can make a person more likely to become very intoxicated, make impulsive and unsafe decisions, and be unable to remember what happened while they were drinking. 

It’s well-known that alcohol use can be unhelpful and dangerous in the long run. However, a socially anxious student might still continue to drink because it makes them feel better in the moment.8 If this drinking becomes severe enough that it’s difficult to control and gets in the way of the student’s ability to fulfill their everyday personal, social, and academic obligations, they might end up qualifying for a diagnosis of alcohol use disorder.3 Given that about 20% of people with social anxiety have an alcohol use disorder, this isn’t an unlikely possibility.9

So, the question is: how can socially anxious university students who drink alcohol be helped?

What clinicians and universities can do

It goes without saying that it’s unrealistic to ask students to simply stop drinking or going to social events, since these tend to be common and even meaningful parts of the university experience. However, there are a few different ways in which clinicians – such as psychologists, counsellors, and therapists – can approach supporting students who might be at risk.

Figure 3: A university student seeks support from a counsellor. A person sits and talks with a therapist. There are two thought bubbles with ellipses in them. Graphic by Jenna Vieira, template from CANVA is licensed under a Free Media License Agreement.

For socially anxious students who have not yet shown signs of problematic drinking or drinking to cope, preventing these behaviours from developing might be the most important thing clinicians can help with. To do this, they can consider providing evidence-based treatments to students for their social anxiety, such as cognitive behavioural therapy (CBT). This type of therapy involves working with a client to help them change unhelpful thought patterns, beliefs, and behaviours about the situations that provoke their social anxiety.10 CBT has been found to be useful for reducing anxiety when delivered in both individual and group formats.7

For socially anxious students who already use alcohol to cope, clinicians can attempt to treat aspects of both their social anxiety and alcohol use together. One way in which they can do this is by helping a client to identify healthier ways of coping with their emotions in social situations.6 Given that drinking to cope is linked to drinking in larger quantities,6 they can also work with a client to plan safety behaviours that they can engage in when they are drinking in social situations; for example, switching between alcoholic and non-alcoholic drinks to avoid becoming too intoxicated.6

Universities also have a role to play in helping their students overcome problems with social anxiety and alcohol use. Ways in which they can support this initiative include using funding to provide therapy and counselling services to students; making these services accessible by offering them at a range of costs or allowing them to be covered under university health insurance; and spreading awareness about these services through posters, social media, and other avenues to reduce stigma and encourage students to seek help.

What you and I can do

As members of the general public, we can also do a few small but important things to support university students who are drinking to cope with their social anxiety, or facing mental health difficulties generally.

One way to do this is by spreading awareness about mental health resources using platforms that university students are likely to use, such as Instagram and Twitter. If you know someone who is struggling personally, you might even consider letting them know about these resources. Some example resources include free mental health- and therapy-focused apps, like MindBeacon (Ontario) and AbilitiCBT (Ontario, Manitoba), and even the counselling centre at the university you attend (for example, Ryerson University).

Another option is to share resources about alcohol use, again on social media and/or within your personal circles, so that students can become better educated about drinking and its potential harms. For example, this website provides a set of short, easy-to-read of free fact sheets about the effects that alcohol can have on a person’s body, how to calculate alcohol calories and blood alcohol content, and myths about alcohol.

Finally, if you’re a university student yourself, you might think about getting involved in a club or association at your school that is dedicated to mental health advocacy. If this doesn’t exist, consider taking the initiative and start one yourself!

In sum, the research findings discussed in this blog post are only as meaningful as we make them. In other words, uncovering even just one of the factors that encourage university students to drink – in this case, social anxiety – is the very first step in helping them to overcome their mental health struggles. It’s up to us as members of the public, clinicians, and policymakers to put this knowledge into practice and help university students who drink alcohol to cope with social anxiety to live healthier lives.

References

1. Substance Abuse and Mental Health Services Administration. (2019). Results from the 2019 national survey on drug use and health: Detailed tables. https://www.samhsa.gov/data/report/2019-nsduh-detailed-tables

2. Morrison, A. S., & Heimberg, R. G. (2013). Social anxiety and social anxiety disorder. Annual Review of Clinical Psychology9(1), 249-274. https://doi.org/10.1146/annurev-clinpsy-050212-185631

3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

4. Goodman, F. R., Stiksma, M. C., & Kashdan, T. B. (2018). Social anxiety and the quality of everyday social interactions: The moderating influence of alcohol consumption. Behavior Therapy49(3), 373-387. https://doi.org/10.1016/j.beth.2017.10.002

5. Terlecki, M. A., & Buckner, J. D. (2015). Social anxiety and heavy situational drinking: Coping and conformity motives as multiple mediators. Addictive Behaviors40, 77-83. https://doi.org/10.1016/j.addbeh.2014.09.008

6. Buckner, J. D., Lewis, E. M., & Walukevich-Dienst, K. (2019). Drinking problems and social anxiety among young adults: The roles of drinking to manage negative and positive affect in social situations. Substance Use & Misuse54(13), 2117-2126. https://doi.org/10.1080/10826084.2019.1637892

7. Buckner, J. D., Lewis, E. M., Terlecki, M. A., Albery, I. P., & Moss, A. C. (2020). Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing. Addictive Behaviors102, 106184-106184. https://doi.org/10.1016/j.addbeh.2019.106184

8. Kim, S., & Kwon, J. (2019). The impact of negative emotions on drinking among individuals with social anxiety disorder in daily life: The moderating effect of maladaptive emotion regulation strategies. Cognitive Therapy and Research44(2), 345-359. https://doi.org/10.1007/s10608-019-10045-8

9. Anxiety & Depression Association of America. (n.d.). Social anxiety disorder and alcohol abuse.https://adaa.org/understanding-anxiety/social-anxiety-disorder/social-anxiety-and-alcohol-abuse

10. Heimberg, R. G. (2002). Cognitive-behavioral therapy for social anxiety: Current status and future directions. Biological Psychiatry51(1), 101-108. https://doi.org/10.1016/S0006-3223(01)01183-0

Images

1. Canva (March 2021). [An anxious emoticon face with a thought bubble coming out of its head, containing the phrases “I feel like such an outcast..”, “They’re judging me..”, and “Everyone’s looking at me..”. A group of their peers stands nearby].

2. Canva (March 2021). [A sad face and a happy face next to three alcoholic drinks].

3. Canva (March 2021). [A university students seeks support from a counsellor. A person sits and talks with a therapist. There are two thought bubbles with ellipses in them].