“I Have Mixed Drinks about Feelings” Examining Multiple Social Anxiety-Related Psychosocial Mechanisms of Alcohol Misuse

Background: Social anxiety and alcohol use disorders are often comorbid. Researchers have identified several psychosocial factors that often maintain social anxiety, such as fear of negative and positive evaluation, post-event processing, and difficulties with emotion regulation. Although evidence suggests that social anxiety disorder and alcohol-related risks are indirectly related via greater anxiety alcohol coping motives, the roles of maintaining psychosocial factors have not yet been tested in a comprehensive model. Therefore, the current cross-sectional study investigated the extent to which these psychosocial mechanisms were related to alcohol use and related problems through social anxiety and anxiety coping-motived drinking. Methods: 476 undergraduate students and community members completed an online survey measuring social anxiety symptoms, psychosocial mechanisms, and alcohol use problems. Results: We conducted a multivariate path analysis and examined eight indirect pathways within this model. Findings support that complex indirect relationships exist between psychosocial factors and alcohol outcomes via social anxiety and coping motives. While difficulties with emotion regulation only demonstrated partial mediation effects, all other psychosocial factors were differentially related to all alcohol-related risks through a combination of indirect-only and inconsistent mediation effects. Implications: These findings support self-medication and biopsychosocial models of social anxiety disorder and highlight the importance of considering the intricate underlying relationships between psychosocial factors, social anxiety symptoms, coping motives, and alcohol-related risks. Moreover, they can help inform evidence-based interventions for comorbid social anxiety and alcohol use disorders by identifying pertinent treatment targets.