Social Anxiety a Trigger for Cannabis Dependence?

Deborah Brauser

June 14, 2012

June 14, 2012 — Social anxiety disorder and cannabis use disorders (CUDs) appear to be linked, and patients with both conditions have significantly greater impairment than those with either 1 alone, new research suggests.

In new analysis from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), investigators also found that cannabis dependence was significantly more likely than cannabis abuse to be related to social anxiety disorder.

In addition, for the majority of the patients who had comorbidity, social anxiety disorder preceded the onset of a CUD.

"Our findings have several clinical implications," Julia D. Buckner, PhD, from the Department of Psychology at Louisiana State University in Baton Rouge, and colleagues write.

They note that clinicians "should be encouraged to assess for and attend to" co-occurring social anxiety disorder during CUD treatment, and, similarly, that they should assess for cannabis use and cannabis-related problems during treatment for anxiety.

Because many of the study participants with both disorders also reported using alcohol to manage their social fears, the investigators also recommend not only monitoring for alcohol use but also helping patients to acquire skills that will enable them to better manage their social anxiety.

The study is published in the July issue of Drug and Alcohol Dependence.

Coping Mechanism?

For this analysis, the investigators assessed data from Wave 1 of NESARC, a representative sample study conducted from 2001 to 2002. It consisted of face-to-face interviews with 43,093 adults.

The participants selected for the current study had a CUD without social anxiety disorder (n = 2957), social anxiety disorder without a CUD (n = 1643), or both conditions (n = 340).

Results showed that social anxiety disorder was significantly more likely to be related to cannabis dependence than to cannabis abuse (odds ratio [OR], 2.91; 95% confidence interval [CI], 2.10 - 4.03). This relationship remained significant after controlling for sex, race, and other psychiatric disorders.

Other anxiety disorders (including generalized anxiety disorder, panic disorder, and specific phobia), nicotine dependence, alcohol use disorder, and any mood or any psychotic disorder were also significantly related to cannabis dependence.

However, the relationship between other anxiety disorders and cannabis dependence was no longer statistically significant after controlling for the demographic and psychiatric variables.

For those with both social anxiety disorder and a CUD, 81.5% reported that the onset of social anxiety disorder occurred first.

In addition, men with social anxiety disorder "transitioned from first use to CUD approximately 8 months faster" than men with other anxiety disorders, report the researchers. There were no significant differences among the women.

Although the men with social anxiety disorder had significantly greater odds of having comorbid CUD than the women with social anxiety disorder, the men with CUD were less likely to also have social anxiety disorder.

All participants with both disorders were significantly more likely to use alcohol to help them cope with their social fears or to avoid social situations than were those with social anxiety disorder only (OR, 7.07; 95% CI, 3.72 - 13.44).

Other Psychiatric Disorders

Finally, 99.21% of those with both conditions also had at least 1 other psychiatric disorder. Of these, 98.99% had at least 1 Axis 1 disorder (the most common being other substance use disorders, followed by mood disorders and other anxiety disorders). A total of 73.71% had at least 1 Axis II disorder (the most common being obsessive-compulsive disorder, followed by paranoid, avoidant, and antisocial disorders).

Limitations cited include the study's cross-sectional design, the reliance on self-reported information, and the fact that age-of-onset data were based on retrospective recall.

"Our reliance on retrospective recall may be particularly problematic given poorer recall among cannabis users," write the investigators.

Also, because the data were collected between 2001 and 2002, "replication with more recent data is necessary to confirm study findings," they add.

The study was supported by grants from the National Institutes of Health and by the New York State Psychiatric Institute. One of the study authors reported having received speaking funds from GlaxoSmithKline. The other study authors have disclosed no relevant financial relationships.

Drug Alcohol Depend. 2012;124:128-134. Abstract

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