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Terlecki MA, Buckner JD. Social anxiety and heavy situational drinking: coping and conformity motives as multiple mediators. Addict Behav 2015; 40:77-83. [PMID: 25233446 DOI: 10.1016/j.addbeh.2014.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. METHOD The current cross-sectional study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations among undergraduates (N=232). RESULTS Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. CONCLUSIONS Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that heavy situational drinking among undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny.
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Affiliation(s)
- Meredith A Terlecki
- School of Psychology, University of East London, Stratford, London E15 4LZ, United Kingdom.
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, United States
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Nicholls J, Staiger PK, Williams JS, Richardson B, Kambouropoulos N. When social anxiety co-occurs with substance use: does an impulsive social anxiety subtype explain this unexpected relationship? Psychiatry Res 2014; 220:909-14. [PMID: 25261335 DOI: 10.1016/j.psychres.2014.08.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/20/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
Abstract
Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.
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Affiliation(s)
- Julia Nicholls
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Petra Karin Staiger
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia.
| | - James Stephen Williams
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Ben Richardson
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Nicolas Kambouropoulos
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
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103
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Schry AR, Norberg MM, Maddox BB, White SW. Gender matters: the relationship between social anxiety and alcohol-related consequences. PLoS One 2014; 9:e115361. [PMID: 25541722 PMCID: PMC4277359 DOI: 10.1371/journal.pone.0115361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Identification of risk factors for alcohol-related consequences is an important public health concern. Both gender and social anxiety have been associated with alcohol-related consequences broadly, but it is unknown whether these variables are differentially related to specific types of alcohol-related consequences for American college students. METHODS In the present study, 573 undergraduate students (M(age) = 19.86 years, SD = 1.40; range 18 to 25; 68.9% female) completed an on-line assessment of social anxiety, alcohol use, and four types of alcohol-related consequences (personal, social, physical, and role). Poisson regressions were run to examine social anxiety, gender, and the interaction between social anxiety and gender as predictors of each type of alcohol-related consequences. RESULTS After controlling for alcohol use, social anxiety was positively associated with all four types of consequences, and females endorsed higher rates of physical, personal, and role consequences. The interaction between social anxiety and gender was statistically significant only for physical consequences, with social anxiety having a stronger effect for males. DISCUSSION AND CONCLUSIONS These findings, which diverge somewhat from those of a prior study with Australian college students, are discussed in the context of a biopsychosocial model of social anxiety and substance use problems. SCIENTIFIC SIGNIFICANCE This study highlights the importance of further investigating cultural differences in the relationships among social anxiety, gender, and alcohol-related consequences.
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Affiliation(s)
- Amie R. Schry
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, United States of America
- * E-mail:
| | - Melissa M. Norberg
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Brenna B. Maddox
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Susan W. White
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, United States of America
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104
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Ruglass LM, Lopez-Castro T, Cheref S, Papini S, Hien DA. At the crossroads: the intersection of substance use disorders, anxiety disorders, and posttraumatic stress disorder. Curr Psychiatry Rep 2014; 16:505. [PMID: 25224608 DOI: 10.1007/s11920-014-0505-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Lesia M Ruglass
- Department of Psychology, The City College of New York, 160 Convent Avenue, NAC Building, Rm 7/120, New York, NY, 10031, USA,
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105
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Buckner JD, Zvolensky MJ. Cannabis and related impairment: the unique roles of cannabis use to cope with social anxiety and social avoidance. Am J Addict 2014; 23:598-603. [PMID: 25196146 DOI: 10.1111/j.1521-0391.2014.12150.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/14/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Social anxiety appears to be a risk factor for cannabis-related problems. Socially anxious individuals are vulnerable to using cannabis to cope in social situations and to avoiding social situations if marijuana is unavailable. Yet, the relative impact of cannabis use to cope with social anxiety relative to use to cope with negative affect more broadly has yet to be examined. METHODS The present study used the Marijuana to Cope with Social Anxiety Scale (MCSAS) to examine the incremental validity of using cannabis use to cope in social situations (MCSAS-Cope) and avoidance of social situations if cannabis is unavailable (MCSAS-Avoid) in a community-recruited sample of 123 (34.1% female) current cannabis users. RESULTS After controlling for age of first cannabis use, gender, alcohol and tobacco use, other cannabis use motives, and cannabis expectancies, MCSAS-Cope remained significantly positively related to cannabis use frequency and cannabis-related problems. After controlling for age of first cannabis use, gender, alcohol and tobacco use, and experiential avoidance, MCSAS-Avoid remained significantly related to cannabis problems but not frequency. DISCUSSION AND CONCLUSIONS The present findings suggest that cannabis use to manage social forms of anxiety may be important to understanding cannabis use behaviors. SCIENTIFIC SIGNIFICANCE The current findings identify cognitive/motivational factors implicated in more frequent cannabis use and in cannabis-related impairment, which may be essential to inform efforts to further refine prevention and treatment efforts.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana
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106
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Faulkner B, Goldstein AL, Wekerle C. Pathways from childhood maltreatment to emerging adulthood: investigating trauma-mediated substance use and dating violence outcomes among child protective services-involved youth. CHILD MALTREATMENT 2014; 19:219-232. [PMID: 25287053 DOI: 10.1177/1077559514551944] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Longitudinal survey data were used to examine the relationship between two types of childhood maltreatment, abuse/neglect and exposure to intimate partner violence (IPV), and two outcomes, substance use and dating violence, within the past year. Participants were youth (N = 158, aged 16-19 at Time 3) involved with child protective services (CPS). A parallel multiple mediator model was used to test the hypothesis that trauma symptoms would mediate the relationship between both types of maltreatment and dating violence, marijuana, and alcohol use outcomes. Although both types of maltreatment were not directly associated with dating violence and substance use outcomes, the indirect effects of anxiety, anger, and dissociation on the relationship between maltreatment and substance use/dating violence were significant. Direct effects of both types of maltreatment on past year use of dating violence + alcohol use and dating violence + marijuana use were not significant, but results demonstrated a significant indirect effect for anger on the relationship between exposure to IPV and past year dating violence + marijuana use. No other indirect effects were significant. Findings highlight the negative effects of exposure to IPV and have implications for the development of prevention programming for youth transitioning out of CPS.
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107
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Buckner JD, Zvolensky MJ, Jeffries ER, Schmidt NB. Robust impact of social anxiety in relation to coping motives and expectancies, barriers to quitting, and cessation-related problems. Exp Clin Psychopharmacol 2014; 22:341-347. [PMID: 24978348 PMCID: PMC4116795 DOI: 10.1037/a0037206] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although social anxiety is related to smoking and nicotine dependence, few researchers have sought to identify factors that contribute to these relations. The current study examined whether social anxiety was associated with cognitive vulnerability factors related to smoking: perceived barriers for quitting, cessation-related problems, negative-affect-reduction-outcome expectancies, and negative-affect-reduction motives. Further, we tested whether social anxiety was robustly related to these factors after controlling for cigarettes smoked per day, gender, alcohol-use frequency, lifetime cannabis-use status, panic attack frequency, anxiety sensitivity, and negative affectivity. The sample consisted of 580 (38.6% female) treatment-seeking smokers. Social anxiety was associated with perceived barriers for quitting, cessation-related problems, negative-affect-reduction-outcome expectancies, and negative-affect-reduction motives. After controlling for covariates, social anxiety was robustly related to perceived barriers for quitting, cessation-related problems, and negative-affect-reduction-outcome expectancies. Social anxiety was robustly related to negative-affect-reduction motives among men, but not women. Results indicate that social anxiety is robustly related to cognitive vulnerability factors associated with poorer cessation outcomes, suggesting that social anxiety may be an important therapeutic target during smoking cessation.
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Affiliation(s)
- Julia D. Buckner
- Corresponding author: Julia D. Buckner, Ph.D., Department of
Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70803, USA;
Tel.: 1-225-578-4125; fax: 1-225- 578-4125;
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108
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Buckner JD, Farris SG, Schmidt NB, Zvolensky MJ. Direct and indirect associations between social anxiety and nicotine dependence and cessation problems: multiple mediator analyses. Nicotine Tob Res 2014; 16:807-14. [PMID: 24492021 PMCID: PMC4015096 DOI: 10.1093/ntr/ntt285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/20/2013] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Little empirical work has evaluated why socially anxious smokers are especially vulnerable to more severe nicotine dependence and cessation failure. Presumably, these smokers rely on cigarettes to help them manage their chronically elevated negative affect elicited by a wide array of social contexts. METHODS The current study examined the direct and indirect effects of social anxiety cross-sectionally in regard to a range of smoking processes among 466 treatment-seeking smokers. Negative affect and negative affect reduction motives were examined as mediators of the relations of social anxiety with nicotine dependence and cessation problems. RESULTS Social anxiety was directly and robustly associated with perceived barriers to smoking cessation and problems experienced during past quit attempts. Social anxiety was also associated with greater nicotine dependence and smoking inflexibility indirectly through negative affect and negative affect smoking motives. Negative affect and smoking to reduce negative affect mediated these relations. CONCLUSIONS These findings document the important role of negative affect and negative affect reduction motives in the relationships of social anxiety with nicotine dependence and cessation problems.
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Affiliation(s)
- Julia D. Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA
| | | | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
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Buckner JD, Zvolensky MJ, Schmidt NB, Carroll KM, Schatschneider C, Crapanzano K. Integrated cognitive behavioral therapy for cannabis use and anxiety disorders: rationale and development. Addict Behav 2014; 39:495-6. [PMID: 24290210 PMCID: PMC3951405 DOI: 10.1016/j.addbeh.2013.10.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/20/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Michael J Zvolensky
- University of Houston, United States; University of Texas MD Anderson Cancer Center, United States
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110
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Staiger PK, Kyrios M, Williams JS, Kambouropoulos N, Howard A, Gruenert S. Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety. BMC Psychiatry 2014; 14:43. [PMID: 24533512 PMCID: PMC3936994 DOI: 10.1186/1471-244x-14-43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residential drug rehabilitation is often seen as a treatment of last resort for people with severe substance abuse issues. These clients present with more severe symptoms, and frequent psychiatric comorbidities relative to outpatients. Given the complex nature of this client group, a high proportion of clients seeking treatment often do not enter treatment, and of those who do, many exit prematurely. Given the highly social nature of residential drug rehabilitation services, it has been argued that social anxieties might decrease the likelihood of an individual entering treatment, or increase the likelihood of them prematurely exiting treatment. The current paper reports on the protocol of a Randomised Control Trial which examined whether treatment of social anxiety prior to entry to treatment improves entry rates and retention in residential drug rehabilitation. METHOD/DESIGN A Randomised Control Trial comparing a social skills treatment with a treatment as usual control group was employed. The social skills training program was based on the principles of Cognitive Behaviour Therapy, and was adapted from Ron Rapee's social skills training program. A permutated block randomisation procedure was utilised. Participants are followed up at the completion of the program (or baseline plus six weeks for controls) and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment). DISCUSSION The current study could potentially have implications for addressing social anxiety within residential drug treatment services in order to improve entry and retention in treatment. The results might suggest that the use of additional screening tools in intake assessments, a focus on coping with social anxieties in support groups for clients waiting to enter treatment, and greater awareness of social anxiety issues is warranted. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY Australian New Zealand Clinical Trials Registry (ACTRN) registration number: ACTRN12611000579998.
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Affiliation(s)
- Petra K Staiger
- Deakin University, School of Psychology, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Burwood, Australia.
| | - Michael Kyrios
- Swinburne University, Brain and Psychological Sciences Research Centre, Hawthorn, Australia
| | - James S Williams
- Deakin University, School of Psychology, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Burwood, Australia
| | - Nicolas Kambouropoulos
- Deakin University, School of Psychology, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Burwood, Australia
| | - Alexandra Howard
- Deakin University, School of Psychology, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Burwood, Australia
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111
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Galbraith T, Heimberg RG, Wang S, Schneier FR, Blanco C. Comorbidity of social anxiety disorder and antisocial personality disorder in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). J Anxiety Disord 2014; 28:57-66. [PMID: 24384071 PMCID: PMC3951602 DOI: 10.1016/j.janxdis.2013.11.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/21/2013] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
Social anxiety disorder (SAD) and antisocial personality disorder (ASPD) are not often thought of as being comorbid. However, recent research suggests the existence of a SAD subtype with characteristics atypical of SAD but common to ASPD. Thus, we explored two competing hypotheses: (1) SAD and ASPD represent opposite ends of a single dimension, or (2) SAD and ASPD exist on two separate dimensions that may be positively correlated. Data were obtained from the National Epidemiological Survey on Alcohol and Related Conditions. SAD-ASPD was related to greater impairment and psychiatric comorbidity than either disorder alone. The SAD-ASPD group was also more likely to seek treatment for their SAD symptoms and to drink before/during antisocial acts than the SAD only group. The presence of SAD for individuals with ASPD (and vice versa) does not appear to provide any "protective benefits." SAD and ASPD appear to be two separate but correlated disorders.
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Affiliation(s)
| | | | - Shuai Wang
- New York State Psychiatric Institute, Columbia University, United States
| | | | - Carlos Blanco
- New York State Psychiatric Institute, Columbia University, United States
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112
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Guzman-Parra J, Paulino-Matos P, de Diego-Otero Y, Perez-Costillas L, Villena-Jimena A, Garcia-Encinas MA, Bergero-Miguel T. Substance use and social anxiety in transsexual individuals. J Dual Diagn 2014; 10:162-7. [PMID: 25392291 DOI: 10.1080/15504263.2014.930658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study examined social anxiety and use of cannabis and cocaine among transsexuals. METHODS A total of 379 transsexuals seeking treatment or consultation participated in this study, providing data on sociodemographics, substance use, and anxiety. Analyses were based on (a) lifetime but not current use versus never used and (b) current use only versus no current use (lifetime only or never used). RESULTS Lifetime only cannabis users (n = 72, 19%) and lifetime only cocaine users (n = 36, 9.8%) were older, had more victimization, and received more mental health treatment that those who never used. Current cannabis users (n = 47, 12.4%) had higher scores on fear of negative evaluation and social avoidance than those not currently using (p <.01). Multivariate analysis showed that social avoidance and fear of negative evaluation were associated with current cannabis use (p <.05), but not cocaine. Further, being single was associated with current cannabis use, after controlling for social avoidance and fear of negative evaluation (p <.05). CONCLUSIONS Transsexuals' levels of anxiety and cannabis/cocaine use are comparable to those in the general population. Cannabis may be used to control anxiety and can have detrimental clinical implications for transsexuals.
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Affiliation(s)
- Jose Guzman-Parra
- a Mental Health Department , University General Hospital of Malaga , Malaga , Spain
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