Psychological Medicine

Original Articles

Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions

F. R. Schneiera1a2, T. E. Foosea1a2, D. S. Hasina1a2a3, R. G. Heimberga4, S.-M. Liua1, B. F. Granta5 c1 and C. Blancoa1a2

a1 New York State Psychiatric Institute, New York, New York, USA

a2 Departments of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA

a3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA

a4 Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA

a5 Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA


Background To assess the prevalence and clinical impact of co-morbid social anxiety disorder (SAD) and alcohol use disorders (AUD, i.e. alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States.

Method Data came from a large representative sample of the US population. Face-to-face interviews of 43093 adults residing in households were conducted during 2001–2002. Diagnoses of mood, anxiety, alcohol and drug use disorders and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version.

Results Lifetime prevalence of co-morbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence [odds ratio (OR) 2.8] and alcohol abuse (OR 1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of co-morbid cases, but co-morbidity status did not influence age of onset for either disorder. Co-morbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with co-morbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking.

Conclusions Co-morbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional co-morbidity, but remaining largely untreated. Future research should clarify the etiology of this co-morbid presentation to better identify effective means of intervention.

(Received August 07 2008)

(Revised July 28 2009)

(Accepted August 01 2009)

(Online publication September 15 2009)


† These authors contributed equally to this work.