Attention to social threat as a vulnerability to the development of comorbid social anxiety disorder and alcohol use disorders: an avoidance-coping cognitive model

Dynamic links between daily anxiety symptoms and young adults' daily well-being

BACKGROUND

Anxiety disorders are prevalent among youth and adults. Increasing studies examined the dynamic associations between momentary fluctuations of anxiety and well-being, primarily focusing on the severity of general anxiety. Scant research has explored the co-fluctuations between different anxiety symptoms and mental health outcomes.

METHOD

The current study evaluated the multi-level factor structure and assessed the subclinical symptoms of generalized anxiety disorder (GAD), social phobia (SP), and panic disorder (PD) in a sample of non-clinical young adults (N = 271, Mage = 18 years, 72% female, 68% non-White) who participated in a 30-day daily diary study.

RESULTS

Between persons, GAD, SP, and PD were positively correlated with depressive symptoms, stress, as well as emotional and peer problems. Within persons, both SP and PD were positively associated with stress, peer and emotional problems on the same day. Across days, there was positive reciprocal relation between PD and stress, whereas negative reciprocal link was observed between SP and emotional problems.

CONCLUSIONS

Current findings showed dynamic and distinct patterns in the associations between different anxiety symptoms and several mental health outcomes, which emphasizes the need to disentangle between- and within-person variation of anxiety symptoms with intensive longitudinal designs.

Understanding Momentary Alcohol Use Cognitions Through the Lenses of Momentary Socioeconomic Identification, Unfair Treatment, and Strain

BACKGROUND

Studies suggest that socioeconomic status (SES) is related to alcohol use. SES may impact alcohol use via exposures to financial stress, discriminatory experiences, identity threats, negative emotions, and perceived threats. These experiences could lead to alcohol use via increases in alcohol use willingness. However, there is little research using ecological momentary assessment (EMA) to illuminate temporal dynamics in the relationship between SES and alcohol use willingness during daily life moments. This is especially important to examine in emerging adults, given their unique developmental stage.

METHODS

A sample of 119 African American emerging adults (mean age = 24.82, 59% female, diverse educational levels) completed 4 d of EMA surveys reporting both SES-related experiences and alcohol use willingness on an hourly basis.

RESULTS

Higher perception of SES-based unfair treatment was found to be linked with a greater willingness to drink at the moment (p < .001, b = 0.66). Conversely, a positive view of one's own SES at the moment was associated with a lower willingness to drink (p < .001, b = -0.12). Additionally, a heightened perception of perceived threat at the moment was associated with a higher willingness to drink (p = .001, b = 0.05).

CONCLUSION

SES-based unfair treatment and positive identification are factors that influence spontaneous alcohol use interest among emerging adults. Clinicians should assess these SES factors when attempting prevention and treatment, especially momentary interventions. Further, research should investigate more mechanisms explaining associations between SES-based unfair treatment and willingness to use other substances.

Drinking Motives, Alcohol Misuse, and Internalizing and Externalizing Psychopathology across College: A Cross-Lagged Panel Study

Background: Drinking motives are strong proximal predictors of alcohol use behaviors and may represent a mediational mechanism by which different individual predispositions toward internalizing or externalizing psychopathology lead to the development of alcohol misuse. However, whether the association is due to a causal relationship or a shared etiology (i.e., confounding) is difficult to determine and may change across developmental periods. Methods: This study leveraged a cross-lagged panel design to disentangle the nature of the relationships between self-report measures of drinking motives, alcohol misuse, and internalizing and externalizing psychopathology in a 4-year longitudinal sample of college students (N = 9,889). Results: Results pointed to a putative causal effect of drinking motives on early binge drinking frequency, but the direction of effect later reversed, reflecting a possible developmental shift during college. On the other hand, the relationships between drinking motives and internalizing/externalizing psychopathology appeared to be driven by shared etiology rather than direct causal mechanisms. Conclusions: These findings highlight the distinct and important role of drinking motives in the etiology of alcohol misuse and have implications for the application of tailored prevention and treatment strategies.

Internalizing and externalizing subtypes of alcohol misuse and their relation to drinking motives

BACKGROUND

Several typologies have proposed two etiological pathways involved in the development of alcohol misuse which are associated with the internalizing and externalizing domains of psychopathology, respectively. This study's aim was to investigate this typology in a young adult sample, and test whether drinking motives, specifically drinking for negative or positive reinforcement, may provide a plausible mechanism characterizing these pathways.

METHOD

Mixture modeling was conducted on a set of internalizing (anxiety, depression, neuroticism), externalizing (antisocial behavior, conscientiousness, sensation seeking, drug use), and alcohol misuse items (binge drinking, alcohol use disorder symptoms [AUDsx]) measured by self-report in a sample of 9,807 college students. Linear regression and chi-square tests were used to determine how latent class membership was associated with drinking motives, demographics, and personality characteristics.

RESULTS

The model identified 3 latent classes: a Low Risk class (70%), an Internalizing class (19%) with elevated levels of internalizing traits/symptoms and AUDsx, and an Externalizing class (10%) with elevated levels of externalizing traits/symptoms and both binge drinking and AUDsx. All drinking motives were substantially elevated in the Internalizing and Externalizing (vs Low Risk) classes (p < 3.0E-10), while positive reinforcement motives were specifically elevated in the Externalizing (vs Internalizing) class (p < 2.0E-55). Personality comparisons further emphasized the relevance of class distinctions.

CONCLUSIONS

These findings provide additional support for both a specific internalizing and a broadband externalizing association with subtypes of alcohol misuse. Drinking motives may be useful intermediate indicators of these different risk processes.

Motives and Consequences of Alcohol Use in People With Social Anxiety Disorder: A Daily Diary Study

People with social anxiety disorder (SAD) are at increased risk for alcohol-related problems. Most research exploring social anxiety and alcohol use has examined negative drinking consequences, with less consideration of positive consequences-namely positive social experiences-that may reinforce alcohol use. In this daily diary study, we examined how adults diagnosed with SAD (N = 26) and a psychologically healthy control group (N = 28) experienced positive drinking consequences in naturally occurring drinking episodes during the study period. For 14 consecutive days, participants answered questions about alcohol use, motives for drinking, and positive consequences of drinking. On days when participants drank, those with SAD were more likely than healthy controls to perceive a reduction in anxiety, but the two groups did not differ in their likelihood of experiencing positive social drinking consequences. For both groups, on days when they were more motivated to drink to enhance social experiences (affiliation motives) or cope with distress (coping motives), they were more likely to obtain positive consequences from drinking. Compared to controls, participants with SAD endorsed stronger trait and daily coping motives (anxiety-coping, social anxiety-coping, and depression-coping). Results are discussed in the context of reinforcement mechanisms that may maintain social anxiety and alcohol use.

Social Threat Reduces Alcohol Consumption among College Students

Aims

Past research suggests that people report a greater desire to consume alcohol when they experience social threat—or threats to their social selves, such as social exclusion. Nevertheless, experimental research on the role of social threat in alcohol consumption is limited. The present study examined the causal relationship between social threat and wine consumption.

Methods

Undergraduate students (N = 83; Mage = 21.8 years old, SDage = 1.62 years old; 72.3% women; 61.4% Latinx/Hispanic) participated in a study under the pretense that they were in a focus group gauging students’ opinions of a bar being constructed at their university. During the study, participants and two confederate researchers completed a group activity in which they selected design elements for the bar. Participants were randomly assigned to one of two conditions. In the social threat condition, confederates rejected participants’ design choices and socially excluded them during a follow-up task. In the social acceptance condition, confederates supported participants’ choices and did not socially exclude them. All participants then completed a wine taste test.

Results

Contrary to predictions, an independent-samples t-test revealed that participants who experienced social threat consumed significantly less wine than those who were socially accepted, t(81) = −2.22, P = 0.03, d = −0.49. Furthermore, a linear regression test revealed that this effect persisted even when controlling for typical alcohol-consumption behavior, b = 56.09, t = −2.50, P = 0.02, d = −0.61.

Conclusion

The relationship between social threat and alcohol consumption may be more nuanced than anticipated. Discussion centers around two potential moderators including positive affect and identity.

Gender moderates the association between acute alcohol intoxication and facial emotion recognition in a naturalistic field study setting

BACKGROUND

Alcohol intoxication is associated with significant negative social consequences. Social information processing theory provides a framework for understanding how the accurate decoding and interpretation of social cues are critical for effective social responding. Acute intoxication has the potential to disrupt facial emotion recognition. If alcohol impairs the processing and interpretation of emotional cues, then the resultant behavioral responses may be less effective. The current study tested the association between alcohol intoxication and facial emotion recognition in a naturalistic field study of intoxicated participants.

METHODS

114 participants (59.4% men; M_age  = 24.2 years) who had been consuming alcohol were recruited in the downtown area of a mid-size town surrounded by several drinking establishments in the mid-southern United States. Participants were shown images depicting 5 facial displays of emotions (happy, sad, anger, disgust, and no emotion) portrayed by 1 male and 1 female actor per emotion and breath alcohol concentration (BrAC) was measured by the field breathalyzer test (M = 0.078%, SD = 0.052).

RESULTS

BrAC was significantly negatively associated with emotion recognition accuracy when controlling for average alcohol use, B = -.35, t = -2.08, p < 0.05, F(3, 110) = 5.28, p < 0.01, R²  = 0.13. A significant BrAC × gender interaction was revealed, B = -0.39, t = -2.07, p = 0.04, ΔR²  = 0.033, p = 0.04, such that men (but not women) displayed a significant negative association between BrAC and emotion recognition accuracy.

CONCLUSIONS

Acute intoxication was associated with impaired facial emotion recognition, particularly for men, in a field study context. Findings support and extend some previous experimental laboratory-based research and suggest that intoxication can impair the decoding stage of social information processing.

Correlation of Alcohol Use Disorders with Common Mental Disorders and Its Association with Socio-demographic Characteristics Among Community in Ethiopia: A Cross-sectional Study

Background

Alcohol use disorders occurring together with common mental disorders are common and have been recognized worldwide as a crucial public health concern. However, there is a scarcity of data about the correlation of alcohol use disorders with common mental disorders and its association with socio-demographic characteristics among community in Ethiopia, especially in the study area. The aim of the study is to assess the correlation of alcohol use disordesr with common mental disorders and its association with socio-demographic characteristics among adults of selected woredas of the Ilu Aba Bor zone.

Methods

Community-based cross-sectional study was employed on 690 participants selected by using the multistage sampling technique. Data were collected by using the alcohol use disorder identification test (AUDIT) and self-reporting questionnaire (SRQ-20) scale. Data analysis were done using SPSS version 20. Pearson correlation was used to see the relation of two variables. The strength of the association was determined at p-value <0.005.

Results

14.1% of the study sample positive for alcohol use disorders and 27.2% for common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders, r(688)=0.314, p=0.001. From socio-demographic characteristics, multivariable logistic regression analysis revealed marital status being single, orthodox religion followers, and living in urban had a significant association with alcohol use disorders.

Conclusion

In the Ilu Aba Bor zone, 14.1% of participants reported alcohol use disorders, and 27.2% have a common mental disorders. There is a significant positive relationship between alcohol use disorders and common mental disorders. Being single, orthodox religion, and living in urban had a significant association with alcohol use disorders. Detection and treatment of people with alcohol use disorders and common mental disorders in the community have been recommended at the same time through integrated treatment.

Moderation effect of emotion regulation on the relationship between social anxiety, drinking motives and alcohol related problems among university students*

Background

Accumulated evidence suggests that individuals with social anxiety disorder (SAD) are at particular risk of developing alcohol use disorder (AUD). Yet, little is known about the mechanisms under this high comorbidity. This study aimed to elucidate the process of the development of alcohol related problems among individuals with elevated social anxiety. We investigated the moderation effect of difficulties in emotion regulation on the relationship between symptoms of social anxiety, coping and conformity motives and alcohol related problems.

Methods

In a sample of university students (N = 647) in South Korea, we examined whether cognitive (fear of negative evaluation), behavioral (social avoidance), and physiological symptoms (concerns over physiological symptoms) of social anxiety affect alcohol related problems with the mediation of coping and conformity motives. Furthermore, difficulties in emotion regulation were hypothesized to moderate each mediational path.

Results

Results showed that the fear of negative evaluation and concerns over physiological symptoms were associated with alcohol related problems with the mediation of conformity and coping motives, respectively. As hypothesized, each path was moderated by difficulties in emotion regulation.

Conclusions

Findings suggest that coping and conformity motives to cope with cognitive and physiological symptoms of social anxiety were related to alcohol related problems. In addition, individuals with high levels of difficulties in emotion regulation were prone to exhibit more alcohol related problems.

Lifetime patterns of comorbidity in eating disorders: An approach using sequence analysis

OBJECTIVE

Eating disorders (EDs) have high rates of psychiatric comorbidity. This study aimed to characterize longitudinal patterns of comorbidities in adults with EDs.

METHODS

Sequence analysis and hierarchical clustering were applied to ages of onset and recency for select eating, substance, mood, and anxiety disorders from the 479 participants in the Collaborative Psychiatric Epidemiology Surveys with lifetime DSM-IV bulimia nervosa, binge eating disorder, or anorexia nervosa. External validators were compared across clusters using chi-square tests.

RESULTS

Five clusters were identified among individuals with any lifetime ED based on longitudinal sequence of psychiatric disorder onset and remission, characterized as: (1) multi-comorbid with early onset of comorbid disorder (46%); (2) moderate preeminent anxiety with moderate comorbidity and low ED persistence (20%); (3) late ED onset with low comorbidity (15%); (4) early onset, persistent ED with low comorbidity (14%); and (5) chronic, early onset depression (5%). Clusters were well differentiated by significant differences in age, body mass index, race, and psychiatric indicators.

CONCLUSIONS

This study demonstrates a new method to assess clustering of comorbidity among individuals with lifetime EDs. Having a psychiatric diagnosis prior to an ED was associated with greater psychopathology and illness duration. Information on timing of diagnoses may allow for more refined comorbidity classification.

Posterior Cingulate Cortical Response to Active Avoidance Mediates the Relationship between Punishment Sensitivity and Problem Drinking

Many people drink to alleviate negative affect, reflecting an avoidance strategy which can lead to alcohol misuse. Individuals with heightened sensitivity to punishment (SP) are especially susceptible to problem drinking via this maladaptive coping mechanism. As imaging studies have largely focused on sensation-seeking traits and approach behavior, the neural substrates underlying behavioral avoidance as well as their relationship with punishment sensitivity and alcohol use remain unclear. Here, we examined in humans the cerebral correlates of response inhibition to avoid a penalty in relation to both problem drinking and SP, as evaluated by the Alcohol Use Disorders Identification Test and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, respectively. Seventy nondependent female and male drinkers performed a reward go/no-go task with approximately two-thirds go and one-third no-go trials. Correct go and no-go responses were rewarded, and incorrect responses were punished. The results showed that SP and Alcohol Use Disorders Identification Test scores were both positively correlated with brain activations during response inhibition, and these activations overlapped in the posterior cingulate cortex (PCC). Thus, the PCC may represent a shared neural substrate for avoidance, punishment sensitivity, and problem drinking. Mediation analyses further suggested that PCC response to avoidance completely and bidirectionally mediated the relationship between SP and hazardous alcohol use. These findings substantiated the role of the PCC in behavioral avoidance and its link to problem drinking in punishment-sensitive nondependent drinkers.SIGNIFICANCE STATEMENT Many people drink to alleviate negative affect, reflecting an avoidance strategy that can lead to alcohol misuse. Individuals with heightened punishment sensitivity (SP) trait are particularly vulnerable to this maladaptive coping mechanism. The current study examined the neural substrates underlying behavioral avoidance and their relationship with SP and problem drinking. Using a reward go/no-go task, we showed both SP and drinking severity were positively correlated with the posterior cingulate cortex (PCC) activation during action inhibition. Thus, the PCC may represent a shared neural substrate for avoidance behavior, punishment sensitivity, and problem drinking. Further, PCC response to avoidance mediated the relationship between SP and alcohol use. These findings substantiated the neural processes linking avoidance tendency to alcohol misuse in punishment-sensitive drinkers.

Longitudinal association between social anxiety disorder and incident alcohol use disorder: results from two national samples of US adults

This study assessed the association between subclinical social fears and a 12-month diagnosis of Social Anxiety Disorder (SAD) at baseline and the risk of incident Alcohol Use Disorder (AUD) at follow-up, compared to those without subclinical social fears and a 12-month diagnosis of SAD. We performed an individual participant meta-analysis based on data from two national longitudinal surveys. Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted in 2001-2002 in a sample of 43,093 adults and Wave 2 was conducted in 2004-2005 in 34,653 of the original respondents. Wave 1 of the National Comorbidity Survey was conducted in 1990-1992 in a sample of 8098 respondents and Wave 2 was conducted in 2001-2002 in 5001 of the original respondents. Binary logistic regression analyses were performed independently in each study and then the effect estimates were combined using random-effects meta-analysis. Neither subclinical social fears nor 12-month SAD at baseline were associated with incident AUD at follow-up. These findings conflict with reports of previous studies that a diagnosis of SAD is a risk factor for AUD in adults, and suggest that subclinical social fears are not associated with differential risk of incident AUD.

Social Anxiety and the Quality of Everyday Social Interactions: The Moderating Influence of Alcohol Consumption

Most research on the link between social anxiety and alcohol consumption has examined problematic outcomes without consideration of potential adaptive functions. Alcohol is an anxiolytic that has the short-term benefit of reducing anxiety; consumption may act as a social lubricant that facilitates higher quality social interactions. Using experience-sampling methodology, we examined how consuming alcohol attenuates the adverse effects of social anxiety in naturally occurring social interactions. Participants (N = 160) completed demographic and trait measures, then completed daily assessments for 14 consecutive days. Results from multilevel model analyses revealed that during face-to-face social interactions, state social anxiety was inversely related to 10 indicators of healthy social interactions (e.g., enjoyment, laughter, feelings of acceptance). Alcohol consumption moderated seven of these associations, such that when participants consumed alcohol in social situations, state social anxiety was no longer associated with social interaction quality. The quantity of alcoholic drinks consumed moderated two of these associations. Furthermore, we found evidence for directionality, such that social anxiety in a given social interaction predicted alcohol consumption in a subsequent social interaction, but not the reverse (i.e., alcohol consumption did not prospectively predict state social anxiety). In social situations that involved alcohol, experiences of social anxiety no longer thwarted one's ability to derive social benefits. These results should be interpreted in the context of a participant sample with relatively low levels of trait social anxiety and frequency of alcohol use. Nonetheless, obtaining social rewards may be a reinforcement mechanism that maintains the link between social anxiety and alcohol consumption.

Childhood adversities, bonding, and personality in social anxiety disorder with alcohol use disorder

Social anxiety disorder (SAD) is frequently associated with alcohol use disorders (abuse/dependence). However, there has been little research on the characteristics of this subgroup so far. In the current study we investigated individuals with SAD and comorbid alcohol use disorder (AUD) with regard to socialization experiences and personality. The sample comprised 410 individuals diagnosed with SAD by the Structured Clinical Interview of DSM-IV. 108 participants with comorbid AUD were compared to 302 participants without comorbid AUD concerning traumatic experiences during childhood and adolescence (Adverse Childhood Experiences Questionnaire; ACE), parental bonding (Parental Bonding Instrument; PBI), and personality (Temperament and Character Inventory; TCI). MANCOVA with covariates sex and depression displayed that individuals with SAD plus AUD reported significantly more traumatic events during childhood and adolescence, lower levels of maternal care, as well as lower cooperativeness. Our results highlight that adverse childhood experiences and unfavourable maternal bonding characterize individuals suffering from SAD plus AUD. These experiences might be reflected in a personality-based tendency to distance themselves from others, which corresponds to low scores on the character dimension cooperativeness. A deeper understanding of personality and specific socialization experiences is necessary to develop new treatment options in this clinically challenging subgroup.

The association of Social Anxiety Disorder, Alcohol Use Disorder and reproduction: Results from four nationally representative samples of adults in the USA

Social Anxiety Disorder (SAD) and Alcohol Use Disorder (AUD) are highly prevalent and frequently co-occur. The results of population studies suggest that SAD tends to precede AUD, and the results of laboratory studies suggest that alcohol use facilitates social behaviors in socially anxious individuals. Therefore, we posited that, in a modern context, a tendency to consume alcohol may be positively selected for among socially anxious individuals by its effect on the likelihood of finding a partner and reproducing. We tested the hypothesis that a higher proportion of individuals with a lifetime diagnosis of SAD and AUD reproduce (i.e., have at least one child) relative to individuals with SAD absent AUD in an individual participant meta-analysis based on over 65,000 adults derived from four nationally representative cross-sectional samples. We then cross-validated these findings against the results of a 10-year follow up of one of these surveys. Lifetime history of SAD was not associated with reproduction whereas lifetime history of AUD was positively associated with reproduction. There was no statistically detectable difference in the proportion of individuals with a lifetime history of SAD with or without AUD who reproduced. There was considerable heterogeneity in all of the analyses involving SAD, suggesting that there are likely to be other pertinent variables relating to SAD and reproduction that should be delineated.

The effects of social anxiety on alcohol and cigarette use across adolescence: Results from a longitudinal twin study in Finland

Conflicting reports exist on the direction of the relationship between social anxiety (SA) and alcohol/cigarette use (AU/CU) and alcohol/nicotine dependence (AD/ND), with both positive and negative associations reported. A prospective, longitudinal sample of Finnish twins (n = 1,906) was used to test potential explanations for these discrepancies. Specifically, this study used peer, parent, and teacher ratings of SA, and a clinical interview screening item for social anxiety disorder (SAD-Sc) to examine associations between SA and AU/CU and AD/ND from early adolescence into young adulthood. Peer-rated SA was negatively associated with AU, CU, and AD from age 14 through age 22, implying a protective effect (β = -0.01 to -.03). Teacher- and parent-rated SA associations were in the same directions but weaker or nonsignificant, indicating that aspects of SA that are recognizable by peers may be most relevant to AU/CU. Self-reported SAD-Sc was also negatively associated with AU, but positively associated with AD symptoms in young adulthood (β = 0.38). Our findings partially support the existence of different associations between SA and AU versus AD, but only in the context of SAD-Sc rather than trait SA. Neither trait SA nor SAD-Sc significantly predicted ND symptoms, although SAD-Sc was associated with both cigarette abstinence and daily smoking. These findings suggest that adolescent SA is modestly associated with lower AU/CU, although there may be some individuals with more severe SA who develop alcohol problems later in life. There was little evidence of a common underlying liability contributing to both SA and alcohol/cigarette use. (PsycINFO Database Record

Randomized controlled trial of attention bias modification in a racially diverse, socially anxious, alcohol dependent sample

OBJECTIVE

Attention biases may be an important treatment target for both alcohol dependence and social anxiety. This is the first ABM trial to investigate two (vs. one) targets of attention bias within a sample with co-occurring symptoms of social anxiety and alcohol dependence. Additionally, we used trial-level bias scores (TL-BS) to capture the phenomena of attention bias in a more ecologically valid, dynamic way compared to traditional attention bias scores.

METHOD

Adult participants (N = 86; 41% Female; 52% African American; 40% White) with elevated social anxiety symptoms and alcohol dependence were randomly assigned to an 8-session training condition in this 2 (Social Anxiety ABM vs. Social Anxiety Control) by 2 (Alcohol ABM vs. Alcohol Control) design. Symptoms of social anxiety, alcohol dependence, and attention bias were assessed across time.

RESULTS

Multilevel models estimated the trajectories for each measure within individuals, and tested whether these trajectories differed according to the randomized training conditions. Across time, there were significant or trending decreases in all attention TL-BS parameters (but not traditional attention bias scores) and most symptom measures. However, there were not significant differences in the trajectories of change between any ABM and control conditions for any symptom measures.

CONCLUSIONS

These findings add to previous evidence questioning the robustness of ABM and point to the need to extend the effects of ABM to samples that are racially diverse and/or have co-occurring psychopathology. The results also illustrate the potential importance of calculating trial-level attention bias scores rather than only including traditional bias scores.

At the crossroads: the intersection of substance use disorders, anxiety disorders, and posttraumatic stress disorder

The co-occurrence of substance use disorders with anxiety disorders and/or posttraumatic stress disorder has been widely documented and when compared to each disorder alone, consistently linked to increased risk for a host of negative outcomes including greater impairment, poorer treatment response, and higher rates of symptom relapse. This article focuses on recent advances in the understanding and effective treatment of this common and highly complex comorbidity. Prevalence and epidemiological data are introduced, followed by a review of contemporary models of etiology and associative pathways. Conceptualizations of effective treatment approaches are discussed alongside evidence from the past decade of clinical research trials. Highlighted are ongoing questions regarding the benefit of sequential, parallel, and integrated approaches and the necessity of further investigation into the mechanisms underlying treatment efficacy. Lastly, recent contributions from neuroscience research are offered as a promising bridge for the development and testing of novel, interdisciplinary treatment approaches.

Systematic review of ERP and fMRI studies investigating inhibitory control and error processing in people with substance dependence and behavioural addictions

BACKGROUND

Several current theories emphasize the role of cognitive control in addiction. The present review evaluates neural deficits in the domains of inhibitory control and error processing in individuals with substance dependence and in those showing excessive addiction-like behaviours. The combined evaluation of event-related potential (ERP) and functional magnetic resonance imaging (fMRI) findings in the present review offers unique information on neural deficits in addicted individuals.

METHODS

We selected 19 ERP and 22 fMRI studies using stop-signal, go/no-go or Flanker paradigms based on a search of PubMed and Embase.

RESULTS

The most consistent findings in addicted individuals relative to healthy controls were lower N2, error-related negativity and error positivity amplitudes as well as hypoactivation in the anterior cingulate cortex (ACC), inferior frontal gyrus and dorsolateral prefrontal cortex. These neural deficits, however, were not always associated with impaired task performance. With regard to behavioural addictions, some evidence has been found for similar neural deficits; however, studies are scarce and results are not yet conclusive. Differences among the major classes of substances of abuse were identified and involve stronger neural responses to errors in individuals with alcohol dependence versus weaker neural responses to errors in other substance-dependent populations.

LIMITATIONS

Task design and analysis techniques vary across studies, thereby reducing comparability among studies and the potential of clinical use of these measures.

CONCLUSION

Current addiction theories were supported by identifying consistent abnormalities in prefrontal brain function in individuals with addiction. An integrative model is proposed, suggesting that neural deficits in the dorsal ACC may constitute a hallmark neurocognitive deficit under lying addictive behaviours, such as loss of control.

Polysubstance use, social anxiety, and length of treatment for alcohol use disorders

OBJECTIVE

The purpose of the present study was to examine the interactive effects of social anxiety and psychosocial factors (i.e., group attendance, polysubstance use) on substance use treatment for men with a primary diagnosis of alcohol use disorder. Social anxiety and alcohol use disorders often co-occur, but it is currently unclear how having high social anxiety might affect aspects of substance use treatment, such as group participation and length of stay.

METHODS

This study compared men with alcohol use disorder only versus those with alcohol plus other drug disorders in a residential treatment facility. Measures included demographics, self-reported social anxiety, self-reported drug history, attendance at treatment groups, and total number of days in treatment.

RESULTS

Of 128 participants, 39 (30.5%) used only alcohol, while 89 (69.5%) used alcohol and other substances. Hierarchical linear regression showed only one significant interaction with social anxiety and length of treatment: people who used alcohol only or alcohol in addition to other substances (p < .05). Simple effects analyses revealed a positive relationship between social anxiety and length of stay among men who used only alcohol, but not among men who used more than one substance.

CONCLUSIONS

Currently, the distinction between those who use only alcohol and those who use other substances as well is not often examined in the literature. However, the present study shows that this assumption of homogeneity may be inaccurate, given the differential relationships that these groups may have with factors such as social anxiety.

Understanding the relationship between social anxiety and alcohol use in college students: a meta-analysis

Many college students use alcohol, and most of these students experience problems related to their use. Emerging research indicates that socially anxious students face heightened risk of experiencing alcohol-related problems, although the extant research on alcohol use and social anxiety in this population has yielded inconsistent findings. This meta-analysis was conducted to examine the relationship between social anxiety and alcohol variables in college students. A literature search was used to identify studies on college students that included measures of social anxiety and at least one of the alcohol variables of interest. All analyses were conducted using random effects models. We found that social anxiety was negatively correlated with alcohol use variables (e.g., typical quantity and typical frequency), but significantly positively correlated with alcohol-related problems, coping, conformity, and social motives for alcohol use, and positive and negative alcohol outcome expectancies. Several moderators of effect sizes were found to be significant, including methodological factors such as sample ascertainment approach. Given that social anxiety was negatively related to alcohol use but positively related to alcohol-related problems, research is needed to address why individuals high in social anxiety experience more problems as a result of their alcohol use. Avoidance of social situations among socially anxious students should also be taken into account when measuring alcohol use. The primary limitation of this study is the small number of studies available for inclusion in some of the analyses.

Chernobyl cleanup workers from Estonia: follow-up for cancer incidence and mortality

This study examined cancer incidence (1986-2008) and mortality (1986-2011) among the Estonian Chernobyl cleanup workers in comparison with the Estonian male population. The cohort of 4810 men was followed through nationwide population, mortality and cancer registries. Cancer and death risks were measured by standardised incidence ratio (SIR) and standardised mortality ratio (SMR), respectively. Poisson regression was used to analyse the effects of year of arrival, duration of stay and time since return on cancer and death risks. The SIR for all cancers was 1.06 with 95% confidence interval 0.93-1.20 (232 cases). Elevated risks were found for cancers of the pharynx, the oesophagus and the joint category of alcohol-related sites. No clear evidence of an increased risk of thyroid cancer, leukaemia or radiation-related cancer sites combined was apparent. The SMR for all causes of death was 1.02 with 95% confidence interval 0.96-1.08 (1018 deaths). Excess mortality was observed for mouth and pharynx cancer, alcohol-related cancer sites together and suicide. Duration of stay rather than year of arrival was associated with increased mortality. Twenty-six years of follow-up of this cohort indicates no definite health effects attributable to radiation, but the elevated suicide risk has persisted.

A biopsychosocial model of social anxiety and substance use

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction-based theories) to understand SAD-SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance-related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD-SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance-related behaviors.

Exploring the comorbidity of anxiety and substance use disorders

Anxiety disorders and substance use disorders are highly comorbid, and such comorbidity complicates treatment and worsens prognosis. The mechanisms underlying the relationship between anxiety and substance use disorders are poorly understood. This paper reviews recent research attempting to explain these associations. Cognitive factors, such as attentional bias, expectancies, and anxiety sensitivity, appear to impact on the relation between anxiety and substance misuse. Temporality of the anxiety and substance use disorder may also indicate whether the substance use disorder is primary (anxiety may be a result of use) or secondary (substances may be used to self-medicate). Social phobia has been predominantly identified as a primary disorder preceding substance use, while the temporality of other anxiety and substance use disorders is less clear. The efficacy of concurrent treatment compared with separate treatment of either anxiety or substance use disorder is unclear and requires further research.

Social anxiety and cannabis use: an analysis from ecological momentary assessment

Individuals with elevated social anxiety appear especially vulnerable to cannabis-related problems, yet little is known about the antecedents of cannabis-related behaviors among this high-risk population. The present study used ecological momentary assessment (EMA) to examine the relations among social anxiety, cannabis craving, state anxiety, situational variables, and cannabis use in the natural environment during ad-lib cannabis use episodes. Participants were 49 current cannabis users. During the two-week EMA period, social anxiety significantly interacted with cannabis craving to predict cannabis use both cross-sectionally and prospectively. Specifically, individuals with higher social anxiety and craving were most likely to use cannabis. There was a significant social anxiety x state anxiety x others' use interaction such that when others were using cannabis, those with elevations in both trait social anxiety and state anxiety were the most likely to use cannabis.

Social anxiety disorder: radio electric asymmetric conveyor brain stimulation versus sertraline

PURPOSE

Social anxiety disorder (SAD) is a disabling condition that affects almost 5% of the general population. Many types of drugs have shown their efficacy in the treatment of SAD. There are also some data regarding psychotherapies, but no data are available today about the efficacy of brain stimulation techniques. The aim of the study is to compare the efficacy of noninvasive brain stimulation neuro psycho physical optimization (NPPO) protocol performed by radio electric asymmetric conveyor (REAC) with that of sertraline in adults with SAD.

PATIENTS AND METHODS

Twenty SAD patients on sertraline were compared with 23 SAD patients who refused any drug treatment and who chose to be treated with NPPO-REAC brain stimulation. This was a 6-month, open-label, naturalistic study. Patients on sertraline received flexible doses, whereas NPPO-REAC patients received two 18-session cycles of treatment. Clinical Global Improvement scale items "much improved" or "very much improved" and Liebowitz Social Anxiety Scale total score variation on fear and avoidance components were used to detect the results. The statistical analysis was performed with t-test. All measures <0.05 have been considered statistically significant.

RESULTS

Ten of 23 subjects on NPPO-REAC and six of the 20 taking sertraline were much improved or very much improved 1 month after the first NPPO-REAC cycle (t1). Sixteen of the subjects on NPPO-REAC and ten of the subjects taking sertraline were much improved or very much improved 1 month after the second NPPO-REAC cycle (t2). In respect of the Liebowitz Social Anxiety Scale, at t1 NPPO-REAC resulted in statistically more efficacy for sertraline on both fear and avoidance total scores. At t2, NPPO-REAC resulted in statistically more efficacy for sertraline on fear but not on avoidance.

CONCLUSION

NPPO-REAC is an effective treatment for SAD, allowing substantial and clinically meaningful reductions in symptoms and disability in comparison with sertraline.