A biopsychosocial model of social anxiety and substance use

Correlates of alcohol use and alcohol use disorder among individuals with DSM-5 social anxiety disorder: A population based study

Alcohol use disorder (AUD) commonly cooccurs with social anxiety disorder (SAD). With changes to diagnostic criteria of psychiatric disorders in the DSM-5, the present study sought to observe the associations between daily alcohol use, AUD, and social anxiety in a large sample of individuals with lifetime (N = 1255) and past-year (N = 908) SAD. The sample was derived from a large nationally representative study of adults in the United States. Of note, we found that at the symptom level, daily alcohol use and AUD were significantly related to panic attacks due to social anxiety, subjective distress, and impairment in relationships. Daily alcohol use and AUD were significantly associated with lifetime SAD severity; however, only past-year daily alcohol use was significantly related to past-year SAD severity. We also found that AUD was significantly related to greater treatment-seeking for SAD, and both AUD and daily alcohol use were significantly associated with lifetime history of suicide attempts even after covarying for SAD severity. The present study provides an updated investigation of alcohol use in individuals with DSM-5 SAD, and it underscores the significance of daily alcohol use as an important factor to consider in individuals with SAD.

Racial Differences in Biopsychosocial Pathways to Tobacco and Marijuana Use Among Youth

BACKGROUND

The influence of socioeconomic disparities and multidimensional stressors on youth tobacco and marijuana use is recognized; however, the extent of these effects varies among different racial groups. Understanding the racial differences in the factors influencing substance use is crucial for developing tailored interventions aimed at reducing disparities in tobacco and marijuana use among adolescents.

AIMS

This study aims to explore the differential effects of socioeconomic disparities and multidimensional stressors on tobacco and marijuana use between Black and White adolescents.

METHODS

Utilizing longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, this research includes a cohort of pre-youth, monitored from the age of 9-10 years for a period of up to 36 months. We examined the impact of various socioeconomic status (SES) indicators and multidimensional stressors, including trauma, financial stress, racial discrimination, and family stress, alongside baseline average cortical thickness and the subsequent initiation of tobacco and marijuana use over the 36-month follow-up.

RESULTS

Overall, 10,777 participants entered our analysis. This included 8263 White and 2514 Black youth. Our findings indicate significant differences in the pathways from SES indicators through stress types to cortical thickness between Black and White youths. Notably, cortical thickness's impact on the future initiation of tobacco and marijuana use was present in both groups.

CONCLUSION

The study suggests that compared to White adolescents, Black adolescents' substance use and associated cortical thickness are less influenced by stress and SES indicators. This discrepancy may be attributed to the compounded effects of racism, where psychosocial mechanisms might be more diminished for Black youth than White youth. These findings support the theory of Minorities' Diminished Returns rather than the cumulative disadvantage or double jeopardy hypothesis, highlighting the need for interventions that address the unique challenges faced by Black adolescents.

Clinical, demographic factors, and substance use among Hispanic and non-Hispanic young adult childhood cancer survivors

PURPOSE

The purpose of this study is to examine the protective and risk factors of substance use behaviors (tobacco, marijuana, e-cigarette, and alcohol) among young adult childhood cancer survivors. The study focused on clinical (receipt of cancer-related follow-up care, treatment intensity, late effects, depressive symptoms, self-rated health) and demographic (race/ethnicity, neighborhood socioeconomic status) factors and their associations with substance use.

METHODS

Participants were from the Project Forward cohort, a population-based study of young adult survivors of childhood cancers. Participants (N = 1166, Mage = 25.1 years) were recruited through the Los Angeles Cancer Surveillance Program (Cancer Registry covering Los Angeles County, California). Multivariate path analyses were performed with substance use as the outcome variables and clinical and demographic factors as independent variables. Covariates included age and sex.

FINDING

Substance use was positively associated with depressive symptoms, and inversely associated with cancer-related follow-up care, female sex, age, Hispanic ethnicity, treatment intensity, and self-rated health. Neighborhood SES was inversely associated with tobacco use, while being positively associated with binge drinking and e-cigarette use. The results highlight the interrelationship between the clinical and demographic variables and their associations with different substance use.

CONCLUSION

Findings support the need for effective interventions targeting substance use behavior among CCS. This will help improve long-term outcomes and mitigate the risk for early morbidity.

Sociability Alcohol Expectancies Shape Predictions of Drinking Behavior and Anxiety in a Novel Affective Forecasting Task

Background: Existing work proposes that people with higher social anxiety symptoms and sociability alcohol expectancies believe alcohol can lower their anxiety. However, studies have primarily analyzed retrospective reports, not anticipatory motives. Since predictions of future emotion (i.e., affective forecasts) strongly influence behavior, it is critical to understand how people predict alcohol will influence their anxiety. Additionally, intolerance of uncertainty (IU) is related to the use of alcohol as a coping tool, but there is a dearth of work testing whether IU influences alcohol-related forecasts. Objectives: Utilizing a novel affective forecasting task, we tested the prediction that social anxiety symptoms, sociability alcohol expectancies, and IU would relate to predictions about alcohol use. In an initial study and preregistered replication, participants imagined themselves in stressful social scenarios and forecasted how anxious they would feel when drinking and when sober. In the replication, participants also forecasted whether they would drink in the imagined scenarios. Results: Contrary to hypotheses, social anxiety symptoms and IU did not significantly predict higher forecasted anxiety across studies, nor did they predict forecasted drinking. Exploratory analyses showed that participants with higher sociability alcohol expectancies forecasted being more likely to drink, and forecasted feeling less anxious when drinking (versus being sober). Even after statistically controlling for social anxiety, the effect of sociability expectancies remained significant in predicting forecasted anxiety and forecasted drinking. Conclusions: Clinicians could consider specifically targeting sociability expectancies for alcohol use difficulties, and future research should continue utilizing affective forecasting paradigms to test links between social anxiety, alcohol expectancies, and alcohol-use problems.

Cannabis use and social anxiety disorder in emerging adulthood: Results from a nationally representative sample

Cannabis use and social anxiety disorder (SAD) are prevalent during emerging adulthood. Previous work has demonstrated that SAD is related to cannabis use in adults; however, less is known about what correlates relate to this association in emerging adults. A subsample of individuals ages 18-25 years old from the NESARC-III (N = 5194) was used to (a) evaluate the association between cannabis use and SAD and (b) examine what correlates may be associated with cannabis use and SAD in emerging adulthood. Weighted cross-tabulations assessed sociodemographics and lifetime psychiatric disorder prevalence estimates among the emerging adult sample. Multinomial logistic regressions examined associations between sociodemographics and psychiatric disorders and four groups (i.e., no cannabis use or SAD; cannabis use only; SAD only; cannabis use + SAD). The prevalence of co-occurring cannabis use and SAD was 1.10%. Being White, a part-time student, or not a student were associated with increased odds of having co-occurring cannabis use + SAD (OR range: 2.26-3.09). Significant associations also emerged between major depressive disorder, bipolar I disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder and co-occurring cannabis use + SAD (AOR range: 3.03-19.05). Results of this study may have implications for better identifying and screening emerging adults who are at risk of co-occurring cannabis use and SAD.

Social anxiety disorder in Black American adolescents: Cultural considerations in conceptualization, assessment, and treatment

Social anxiety disorder (SAD) is characterized by significant distress and avoidance surrounding social and performance situations, with marked interpersonal and academic impairment. This review article highlights cultural considerations relevant to the conceptualization, identification, and treatment of SAD in Black youth. Research evaluating the utility of evidence-based measures to assess SAD suggests they are culturally relevant; however, gaps in knowledge regarding the psychometric properties of even the most widely used instruments are evident. In regard to intervention, cognitive behavioral therapy (CBT) approaches hold promise, yet there is a lack of research on the use of CBT with Black adolescents. Recommendations to incorporate cultural factors into CBT are provided, and future work investigating culturally adapted interventions is needed. Finally, given significant disparities in access and utilization of mental health services among Black youth, strategies to increase treatment engagement, such as school-based services, are important to consider.

Motivations for Cannabis Use in Individuals with Social Anxiety Disorder (SAD)

Social anxiety disorder (SAD) is a debilitating psychiatric condition. Consequently, it is common for those affected to resort to cannabis to cope with their symptoms. The primary objective of this study was to understand the differences between motivations for cannabis use in adults with and without SAD. We employed convergent, mixed methods to collect the data. Twenty-six individuals (age: 27.9 ± 7.3 years; 54% female) with and twenty-six (age: 27.4 ± 6.7 years; 50% female) without SAD were administered Marijuana Motives Measure (MMM). Motivations to initiate, continue, and maintain cannabis use were assessed in 12/26 participants in both groups using in-depth interviews. Cannabis weekly consumption was 3.8-fold and frequency 1.3-fold higher in the SAD group. Coping (F = 10.02; p <0.001; η2 = 0.46) and social (F = 2.81; p = 0.036; η2 = 0.19) motivations were also higher in the SAD group, after controlling for age, sex, and current CUD. The need to cope with symptoms of SAD may have been the driving force for repeated cannabis consumption. Psychoeducational programs educating children about the risk of using cannabis to cope with SAD should be implemented in vocational settings early on.

College Student Alcohol Use: Understanding the Role of Alcohol Expectancies, Social Anxiety, Social Connectedness, and Need to Belong

ObjectiveCollege students consume more alcohol and engage in binge drinking more frequently than their non-college attending peers, and prevalence of alcohol-related consequences (e.g., drinking and driving; taking avoidable risks) has not decreased proportionally with decreases in consumption. Social anxiety and alcohol expectancies, or beliefs about the effects of alcohol, have been found to be significantly related to alcohol use and account for significant variance in alcohol use and related consequences. Few studies, however, have examined how other social variables such as need to belong and social connectedness may fit into existing models of increased and risky alcohol use. Methods: Students at a large state university (n = 1,278) completed an online survey measuring alcohol expectancies, need to belong, social anxiety, and social connectedness. Mean age of participants was 19.65 years, and 59.5% self-identified as female, 39.8% male, and 0.7% identified as transgender. Structural equation modeling supported hypothesized relationships between need to belong, social anxiety, social connectedness, alcohol expectancies, and alcohol use, a mean centered variable that included binge drinking, drinking frequency, and amount of consumption. Results: Positive alcohol expectancies related to tension reduction, sociability, and sexuality, were positively related to drinking, such that increased alcohol expectancies were associated with increased drinking. Alcohol expectancies mediated the relationship between need to belong and increased alcohol use, as well as social connectedness and increased alcohol use. Similarly, social anxiety also mediated these relationships. No direct relationships were found between need to belong or social connectedness and alcohol use, suggesting previous research exploring these relationships may have excluded control variables (e.g., biological sex, race/ethnicity) that better explain the impact of need to belong and social connectedness on alcohol use. Conclusion: Prevention and intervention efforts might be more effective in reducing alcohol use if social factors are more broadly targeted.

Implications of Social Anxiety Symptoms in Adults with Autism Spectrum Disorder: Is There a Predictive Role of Interpersonal Sensitivity and Substance Abuse?

Social anxiety disorder (SAD) has been frequently reported by subjects with Autism Spectrum Disorder (ASD). However, interestingly, the overlap between social anxiety and autistic traits may sometimes impede ASD diagnosis in subjects without intellectual or language impairment. The aim of the present work was to evaluate the presence and correlates of social phobic features among subjects with ASD, with a specific focus on evaluating which social anxiety symptoms may be statistically predictive of an ASD diagnosis. With this purpose, 48 subjects with ASD and 48 gender- and age- matched healthy controls (HCs) were recruited and assessed with the SHY-SV and the AdAS Spectrum questionnaires. Results highlighted higher scores in all SHY-SV Spectrum domains and total scores for the ASD group. Moreover, AdAS Spectrum scores were significantly correlated with all SHY-SV domain and total scores. A logistic regression analysis highlighted the SHY-SV Interpersonal sensitivity and Substance Abuse domains scores as significant positive predictors of an ASD diagnosis. These results confirm the link between ASD and SAD. Because of this association, particular attention should be paid to subjects with high interpersonal sensitivity traits and substance abuse problems.

Investigating the Relation between Anxiety Sensitivity and Substance Use: What Are the Roles of Social Anxiety and Outcome Expectancies?

Objective: Research on the association between anxiety sensitivity (AS) and substance use is mixed, with some studies showing a positive association and others showing no association. Other relevant variables, such as social anxiety and outcome expectancies, may help us understand how and for whom AS is linked to substance use. This study tested (a) the associations between AS and alcohol use, cannabis use, and drinking games and pregaming behaviors among young adults, and (b) the mediating role of social anxiety and moderating role of outcome expectancies in these associations. Method: Participants (N = 199, 69% women) were young adults (19 to 25 years) who completed a 30-minute online self-report questionnaire on their substance use. Results: Results revealed significant negative associations between AS and drinking game and pregaming participation. AS was not directly associated with other substance use outcomes. The association between AS and hazardous cannabis use was moderated by relaxation and tension reduction expectancies, but outcome expectancies did not moderate any of the other associations between AS and substance use outcomes. Social anxiety mediated the associations between AS and hazardous cannabis use and both drinking game and pregaming participation. Conclusions: Findings highlight the complex association between AS and different substance use outcomes. Outcome expectancies and social anxiety may help explain how AS is associated with hazardous cannabis use and drinking game/pregaming participation, respectively. More effective interventions can be developed by understanding the relation between AS and substance use.

Prevalence and correlates of cannabis use among individuals with DSM-5 social anxiety disorder: Findings from a nationally representative sample

Cannabis use disorder (CUD) and frequency of use are highly related to social anxiety disorder (SAD). With updates to diagnostic criteria of psychiatric disorders and recent changes in cannabis laws, the present study sought to explore the relationships between cannabis use, CUD, and social anxiety in a large nationally representative sample of individuals with lifetime (N = 1255) and past-year SAD (N = 980). Notably, we found that at the symptom level, at least weekly cannabis use was significantly related to fear or avoidance of social situations interfering with relationships in both samples. Weekly + cannabis use and CUD were significantly associated with lifetime SAD symptom severity, but only weekly + cannabis use was related to SAD severity in the past-year sample. We also found that weekly + cannabis use but not CUD was related to greater odds of seeking treatment for SAD and suicide attempt history. Overall, these data provide an updated examination of cannabis use and SAD using DSM-5 criteria and a large nationally representative sample and also highlight the importance of weekly + cannabis use as a marker of severity and suicide risk in individuals with SAD.

Social anxiety disorder is a risk factor for alcohol use problems in the National Comorbidity Surveys

BACKGROUND

According to the self-medication and biopsychosocial models, individuals with social anxiety disorder (SAD) are at increased risk of developing an alcohol use disorder (AUD) as alcohol represents a maladaptive coping mechanism for some sufferers of SAD. The SAD-to-AUD causation was earlier supported in Norwegian longitudinal twin data and later questioned using longitudinal data from the USA.

METHODS

We re-analyzed partly the same USA-based data (National Comorbidity Surveys, n = 5001), conducting theoretical and simulation analyses on different formulations of temporality and using real-data Logistic regression analysis to investigate whether baseline SAD was associated with AUD at the follow-up.

RESULTS

Upon proper analysis of temporality, SAD preceded AUD. Specifically, SAD was the only one of the seven anxiety disorders that predicted 10-year later AUD after adjusting for all other anxiety disorders and AUD at the baseline (odds ratio was 1.70% and 95% confidence interval 1.12-2.57). SAD was also associated with incident AUD (OR = 1.64, 95% CI = 1.14-2.37). We provide formal, simulation-based, and data-based arguments on how certain flawed models of incidence attenuate the temporal association.

CONCLUSIONS

We demonstrated temporality and specificity in SAD-to-AUD association, which are considered signs of causation. We further identified and discussed problems in previous statistical analyses with different conclusions. Our findings add support for models positing causal effects of SAD on AUD, such as the self-medication and biopsychosocial models. The available evidence suggests that treating SAD should incur better chances of preventing AUD compared to treating other anxiety disorders, which lack comparable evidence on causation.

Biopsychosocial analysis of antibiotic use for the prevention or management of COVID-19 infections: A scoping review

BACKGROUND

The novelty and complexity of the COVID-19 pandemic has resulted in various coping mechanisms adopted by individuals as a means of averting the perceived fatalities of the pandemic. The use of antibiotics in the management of COVID-19 is clinically recommended under specific conditions. However, there are increasing trends of non-adherence to the recommended criteria resulting in the unwarranted use of antibiotics as an adaptative approach to the ongoing pandemic.

OBJECTIVE

The objective was to identify and classify factors associated with the unwarranted use of antibiotics in the management of COVID-19 from published literature and the perspectives of key stakeholders along a Biopsychosocial model.

METHODS

Literature was searched in the following databases: PubMed/MEDLINE, Scopus, Embase and Google Scholar for studies published between 31st December 2019 and 31st January 2022. The Arskey and O'Malley framework modified by Levac in the six-stage methodological process was adopted for this review and included: a) identification of research questions, b) identification of relevant research articles, c) selection of studies, d) data charting and synthesis, e) summary, discussion and analysis, and f) stakeholder consultations.

RESULTS

Out of 10,252 records identified from all sources, 12 studies were selected for inclusion in this scoping review. The selected articles reflected both antibiotic use and COVID-19 whilst capturing the biological (medical) and psychosocial perspectives. Most of the studies reported the overuse or abuse of Azithromycin especially in hospital settings. Common themes across the review and stakeholder consultations included fear, anxiety, media influences and deficits in public knowledge.

CONCLUSION

The findings of the study highlight the complexity of antibiotic control especially in the context of a pandemic. The identified determinants of antibiotic use provide the necessary framework to simulate health emergencies and be better positioned in the future through the development of targeted and comprehensive policies on antibiotic stewardship.

Towards a dispositionalist (and unifying) account of addiction

Addiction theorists have often utilized the metaphor of the blind men and the elephant to illustrate the complex nature of addiction and the varied methodological approaches to studying it. A common purported upshot is skeptical in nature: due to these complexities, it is not possible to offer a unifying account of addiction. I think that this is a mistake. The elephant is real-there is a there there. Here, I defend a dispositionalist account of addiction as the systematic disposition to fail to control one's desires to engage in certain types of behaviors. I explain this position, defend the inclusion of desires and impaired control, and flesh out the notion of systematicity central to my account. I then illustrate how my dispositionalist framework can unify the disparate and seemingly incompatible accounts of addiction (and their respective methodological approaches). I close with a brief plan to extend and implement my account.

Magnitude and Associated Factors of Psychoactive Substance Use among Youths at Selected Administrative Towns of North Shewa Zone, Amhara Region, Ethiopia

Youth and adolescent psychoactive substance use is a major public health problem worldwide which affects the health of individuals, families, and the community as a whole. This study was aimed at assessing the level of psychoactive substance use and the associated factors among the youths of North Sowa zone, Amhara region, Ethiopia, 2020/21. Community based cross-sectional study design with a multistage sampling technique was used. A total of 632 youths were involved in the study. Linear logistic regression analysis was used for both bivariate and multivariate analysis. The prevalence of life time and current psychoactive substance use was found to be 66.1% and 65%, respectively. Male sex and history of substance use from family members and friends were significantly associated with psychoactive substance use. In this study, the prevalence of life time and current psychoactive substance use was high as compared to other studies conducted in Ethiopia.

Self-Reported Sleep during the COVID Lockdown in a Sample of UK University Students and Staff

The link between disturbed sleep and the extended lockdown period resulting from COVID-19 is well established. Data from an online survey of 2341 of university students (n = 1972, 84.2%) and staff were reported. Overall (n = 1710, 73.1%) were female and the mean age for the sample was 29.26 (SD = 12.86). 1799 (76.8%) provided self-reported data from the Nottingham Health Profile (NHP) Sleep Subscale that allowed sleep to be compared prior to the lockdown period and during the lockdown period. Sociodemographic data which included, gender, age, whether an individual was a student or member of the university staff, ethnicity, caring responsibilities, and highest educational level were collected. Other data included, the NHP Sleep Sub-scale, change in alcohol consumption during the lockdown period, routine behaviours during the lockdown period, self-efficacy and health and wellbeing. There was a significant deterioration in NHP Sleep scores (p < 0.001) and all areas of sleep that were assessed significantly deteriorated during the lockdown period. These included indicators of sleep quality, sleep latency, sleep duration, sleep disturbance and increased use of sleep medication. Following a multinomial logit regression with change of NHP sleep scores entered as the dependent variable there were several significant predictors. Women had greater sleep dysfunction than men. Increased alcohol consumption, lower educational status and a deterioration in health and well-being scores were associated with greater sleep dysfunction. Not having a designated area to work in and not putting on clothes and make-up were both associated with greater sleep dysfunction during the lockdown period. These findings confirm the importance of taking steps to maintain sleep hygiene during extended lockdown periods.

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.

Development of the motivation to use substance questionnaire

BACKGROUND

The use of a substance is always accompanied by a motivation that pushes the subject to use and abuse the substance. This work reports the validation data of the MUS (Motivation to Use Substance), which measures and evaluates the motivation to use substances based on the dimension of resistance, confidence, pleasure, and relaxation.

METHODS

The validation process involved 605 subjects belonging to a clinical sample of patients who used substances. The sample was divided into two groups: on the first, consisting of 342 subjects, an exploratory analysis was carried out, and on the second, consisting of 263 subjects, a confirmatory analysis was carried out. For concurrent and convergent validation, the SCL-90 test (Symptom Check List-90) was administered for the measurement of addiction-related psychiatric symptoms, and the ASI (Addiction Severity Index) test was administered for the measurement of the severity of the addiction.

RESULTS AND CONCLUSIONS

The MUS was found to be a robust test of construct validity, convergent, and concurrent. The results highlight gender and age differences for some of the MUS scales. Ultimately, MUS can be considered an excellent tool for structuring treatment programs for addiction services.

Ethnic-racial identity and hazardous drinking among black drinkers: A test of the minority stress model

Black Americans who consume alcohol experience negative alcohol-related outcomes, indicating a need to identify psycho-sociocultural factors that may play a role in drinking and related problems to inform prevention and treatment. Although lower levels of ethnic-racial identity (ERI) are related to negative drinking outcomes, this is the first known test of whether psychological distress and drinking to cope with distress play a role in these relations. Participants were 155 Black current drinking undergraduates at a racially/ethnically diverse university. ERI was significantly, negatively correlated with drinking frequency, drinking problems, coping motivated drinking, depression, and social anxiety. ERI was unrelated to drinking quantity. ERI was indirectly related to drinking and related problems via the sequential effects of depression and coping motivated drinking, but not via depression or coping motives alone. ERI was indirectly related to drinking via the sequential effects of social anxiety and coping motivated drinking, and indirectly related to drinking problems via social anxiety but not via coping motives alone. In line with minority stress-based models, ERI is related to less negative drinking outcomes (less frequent drinking, fewer problems) via less psychological distress (depression, social anxiety) and less coping motivated drinking. Also, social anxiety was robustly related to drinking frequency and problems among Black drinkers, a group that has been underrepresented in the social anxiety-drinking literature. This finding indicates that anxiety about social situations may play an especially important role in drinking behaviors in this group.

African Americans, Caribbean Blacks and Depression: Which Biopsychosocial Factors Should Social Workers Focus On? Results from the National Survey of American Life (NSAL)

Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.

Social anxiety and risky Marijuana use: The role of underutilization of protective behavioral strategies

Social anxiety is a common mental health problem that increases the risk of experiencing cannabis-related problems. In fact, social anxiety more than quadruples the risk of developing cannabis use disorder, yet it is inconsistently related to more cannabis use. Inconsistent findings may be due to lack of attention to protective behavioral strategies (PBS) among socially anxious cannabis users. PBS are cognitive-behavioral strategies to reduce cannabis use and related problems. Yet socially anxious persons may be less likely to use PBS for a variety of reasons (e.g., fear of negative evaluation for engaging in behaviors to reduce use), leading to heavier or more frequent use and related problems. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month cannabis use and related problems among current (past-month) cannabis users (N = 102). Social anxiety was significantly positively related to past-month cannabis problems, but not directly related to cannabis use. Social anxiety was significantly negatively related to PBS. Social anxiety was indirectly (via PBS) related to more frequent use, greater peak use, and more cannabis problems. Serial mediation analyses indicated that social anxiety was indirectly related to more cannabis problems via the serial effects of PBS and cannabis use variables. Findings suggest that socially anxious persons may be vulnerable to heavier cannabis use and more cannabis problems due to PBS underutilization. Treatment implications are discussed.

Effects of topiramate on the association between affect, cannabis craving, and cannabis use in the daily life of youth during a randomized clinical trial

RATIONALE

Topiramate is an anticonvulsant currently under study for treating substance use disorders. Topiramate is thought to reduce substance use by attenuating craving and the rewarding effects of acute substance use through its concurrent GABAergic agonism and glutamatergic antagonism. Importantly, topiramate also impacts mood states central to many models of substance use. Despite this, little previous research has examined whether topiramate attenuates the respective associations of affect and craving with substance use.

OBJECTIVES

We conducted a secondary analysis of 63 youths that exhibited heavy cannabis use, aged 15-24 years, who were randomized in a double-blinded 6-week clinical trial comparing the effects of topiramate (up to 200 mg/day) and placebo on cannabis use. Ecological momentary assessment data were leveraged to model the role positive affect, negative affect, and craving on use over the 6-week period and whether topiramate attenuated associations between these feeling states and cannabis use.

RESULTS

Findings showed that craving was positively associated with use at the within-person level, while positive affect was negatively associated with use at the between-person level. Topiramate appears to attenuate the negative association of between-person positive affect (i.e., average) and cannabis use. Specifically, those in the placebo condition exhibited this inverse association between average positive affect and use while those in topiramate condition did not. No other significant affect or affect × medication condition interactions were observed.

CONCLUSIONS

These findings implicate craving and low positive affect as important risk factors for cannabis use in youth in treatment. Topiramate may attenuate this association for positive affect.

Implications on hypnotherapy: Neuroplasticity, epigenetics and pain

We provide a brief review about the significance of hypnosis with respect to applications and physiological processes in hypnotherapy. Our review concludes that hypnosis is a promising method to manage acute and chronic pain. In addition, we discuss indications pointing toward the view that hypnosis can induce changes in neuroplasticity possibly involving epigenetic mechanisms.

Ayahuasca Improves Self-perception of Speech Performance in Subjects With Social Anxiety Disorder: A Pilot, Proof-of-Concept, Randomized, Placebo-Controlled Trial

BACKGROUND

Ayahuasca is a classic hallucinogen with anxiolytic and antidepressive properties. Anecdotal evidence also suggests that it improves performance (eg, singing, speech). This controlled trial assessed the effects of ayahuasca on speech performance and anxiety in individuals with social anxiety disorder.

METHODS

Seventeen volunteers with social anxiety disorder participated in a pilot, proof-of-concept, randomized, parallel-group trial. Self-perception of performance during a public-speaking test was assessed with the Self-statements During Public Speaking Scale primary outcome). Secondary outcomes included anxiety/subjective effects (Visual Analog Mood Scale; Bodily Symptoms Scale), recognition of emotions in facial expressions (REFE), tolerability measures (cardiovascular measures, self-reports), and brain-derived neurotrophic factor plasma levels. Effects on anxiety and REFE were assessed again 7, 14, and 21 days postdrug.

FINDINGS

Compared with placebo, ayahuasca significantly improved self-perception of speech performance (Self-statements During Public Speaking Scale) and increased somatic symptoms (Bodily Symptoms Scale). There was also a significant time × group interaction in the cognitive deterioration Visual Analog Mood Scale factor and a significant effect of time in the REFE task, especially in reaction time. Other measures were not significantly modified. Ayahuasca was well tolerated, producing mainly nausea, gastrointestinal discomfort, and vomiting.

CONCLUSIONS

Ayahuasca improved self-perception of speech performance in socially anxious individuals. These effects occurred independent of task-related anxiety and REFE, suggesting that ayahuasca could specifically improve the cognitive aspect of speech performance. Further studies should try to unveil the mechanisms involved in the effects of ayahuasca and to better understand its effects on anxiety.

Protective behavioral strategies underutilization mediates effect of a brief motivational intervention among socially anxious undergraduate drinkers

Social anxiety (SA) is implicated in problematic undergraduate drinking. Brief motivational interventions (BMIs) reduce problematic undergraduate drinking. However, not all students benefit. Identification of vulnerable subgroups is an important next step. The current study examined the role of SA and protective behavioral strategies (PBS) on BMI outcomes. We reanalyzed a subset of data (53.3%; N = 120; 62.5% male) from a randomized trial in which heavy drinking undergraduates were randomized to a BMI or control. SA, past-month typical drinks, peak drinks, weekly quantity, alcohol problems, and PBS were assessed at baseline and 6 weeks. Main effects and interaction among the intervention condition (BMI vs. control) and SA group (low vs. high) were tested on alcohol outcomes and PBS. High SA undergraduates reported greater baseline drinking, more alcohol problems, and lower PBS. Post-BMI, high SA drinkers continued to report greater peak drinks, typical drinks, alcohol problems, and lower PBS use, controlling for baseline use. Among the BMI condition, parallel multiple mediation analyses revealed the PBS subscale Manner of Drinking uniquely mediated the relationship between SA and heavier post-BMI drinking. The PBS Manner of Drinking and Serious Harm Reduction subscales jointly mediated the relationship between SA and greater post-BMI alcohol problems. BMIs may need to be refined to improve outcomes for socially anxious drinkers. Increasing PBS utilization post-BMI may help improve BMI efficacy in this vulnerable group. Clinical implications are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hikikomori: psychopathology and differential diagnosis of a condition with epidemic diffusion

OBJECTIVE

Hikikomori, from the Japanese words 'hiku' (to pull) and 'komoru' (to withdraw), is a clinical condition in which a subject locks himself/herself into his/her own house for more than 6 months. This condition is becoming relevant in Japan and other Asian countries, with new cases emerging in Europe and a steep increase in its incidence.

METHODS

In this article, the various psychopathological and diagnostic hypothesis and the different criteria proposed by the various authors have been analysed and compared, paying attention also to the new studies conducted in Europe and to therapeutic perspectives that are opening up for its treatment.

RESULTS

Numerous hypothesis have been put forward for the genesis of hikikomori, in particular, the hypothesis of a behaviour seen as a dysfuncion of the family system or as a result of our current modern society. Furthermore, this behaviour has been compared to other conditions such as internet addiction and a specific form of depression called Modern Type Depression (MTD).

CONCLUSIONS

Hikikomori could represent the clinical answer to a social evolution, similarly to other phenomena such as binge behaviours and use of psychoactive substances. Further studies are needed to clarify diffusion, diagnosticassessment and differential diagnosis.Key pointsHikikomori is now considered a contemporary society-bound syndrome linked to modern society changes.Hikikomori might be a coping strategy to avoid relationships, social judgement and possible failures.Hikikomori might represent an extreme suffering that needs to be identified early: it is linked to severe form of modern type depression and it is a risk factor for suicidal behaviours.It is important to inform and sensitise communities about hikikomori to assure early interventions.More clinical studies are needed to define a unitary and specific model of hikikomori and to structure focussed interventions.

Can a pure motivational interviewing intervention be manualized and still efficacious? A test of feasibility and initial efficacy

The importance of attending to the therapeutic process despite the challenges in manualizing it is demonstrated in the empirical evolution of motivational interviewing (MI). Whereas manuals exist for adaptations of MI, no manual has been developed and tested for MI in its pure form (pure MI). This study evaluated the feasibility and initial efficacy of a pure MI intervention manual - MI for risky social drinking (MI-RSD) - designed to target risky social drinking behaviors in college students with social anxiety. A pilot sample of 42 college students completed measures of alcohol use and mental health symptoms and the MI-RSD intervention. We developed a manual for the 2-session MI-RSD intervention, trained 4 clinical doctoral students, and used observer-, therapist- and participant-completed measures to evaluate fidelity. Therapists met beginner proficiency in MI fidelity and participant gave high ratings of therapist adherence to MI and working alliance, demonstrating intervention feasibility. Also, participants reported significant reductions in hazardous drinking and evaluation fears, but not in social interaction anxiety. We offer preliminary evidence that pure MI can be manualized and effective. Specifically, MI-RSD represents an alternative to MI adaptations in mitigating alcohol-related harm for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An experimental investigation of peer rejection and social anxiety on alcohol and cannabis use willingness: Accounting for social contexts and use cues in the laboratory

OBJECTIVE

Evidence suggests that social anxiety (SA) is a risk factor for problematic alcohol and cannabis use, particularly during states of social stress. Unfortunately, laboratory studies to date have overlooked decision-making mechanisms (e.g., use willingness) and contextual features of commonly used social stress tasks that may clarify what is driving these links. The current study begins to address this gap by testing the effects of SA and laboratory-induced peer rejection on acute alcohol and cannabis use willingness within a simulated party setting.

METHOD

80 emerging adults (18-25 years; 70% women) endorsing lifetime alcohol and cannabis use were randomly assigned to experience rejection or neutral social cues. They rated their willingness to use alcohol and cannabis before and after cue exposure within the simulated party. A hierarchical regression tested the main and interaction effects of SA symptoms and experimental condition (Rejection vs. Neutral) on alcohol and cannabis use willingness, controlling for past-year use frequency and willingness to accept any offers (e.g., food and nonalcoholic drinks).

RESULTS

There were statistically significant main (but not interaction) effects of SA and experimental condition on cannabis use willingness. Higher SA and Rejection exposure were each associated with greater cannabis use willingness. There were neither main nor interaction effects on alcohol willingness.

CONCLUSIONS

Results suggest that elevated SA increases cannabis use willingness across social contexts, regardless of Rejection exposure, while Rejection exposure increases use willingness similarly across levels of SA. Together, findings reinforce the need to consider social-contextual factors and polysubstance use in laboratory settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Biopsychosocial Model Social Anxiety and Substance Use Revised

PURPOSE OF REVIEW

To review data published in the past 5 years to evaluate the utility of our biopsychosocial model of social anxiety's relation to substance misuse to evaluate the model's utility and update it.

RECENT FINDINGS

Data support the utility of our revised model-e.g., socially anxious persons report using substances to manage subjective anxiety, despite evidence that some substances may not have a direct effect on physiological responding. Other factors with promise include social influence, cognitive processes (e.g., post-event processing), and avoidance. Data highlight the importance of context as socially anxious persons use some substances more in some high-risk situations, despite lack of relation between social anxiety and use generally. Sociocultural factors remain understudied. This updated model is a theory- and data-driven model of the relations between social anxiety and substance misuse that can inform future work to improve substance-related outcomes among this especially vulnerable group.

Self-Perception and Relative Increases in Substance Use Problems in Early Adulthood

This study assessed self-perception as a long-term predictor of relative changes in problems related to alcohol and marijuana use in early adulthood. Self-report questionnaires were completed by a community sample of 124 individuals in the Southeastern United States who were followed longitudinally from age 19 to age 27. More problems due to substance use at age 27 were predicted by participants' negative perceptions of their social acceptance, romantic appeal, and self-worth. Predictions remained after accounting for potential confounds including gender, income, and baseline substance use problems at age 19. Social avoidance and distress in new situations at age 19 mediated the relationship between self-perception and relative changes in substance use problems, such that increases in substance use problems from age 19 to 27 were potentially explainable by the linkage of negative self-perceptions to social avoidance and distress in new situations.

Desire to drink as a function of laboratory-induced social stress among adolescents

BACKGROUND AND OBJECTIVES

Research consistently demonstrates a link between social anxiety and alcohol-related problems; however, the majority of work has been retrospective, and conducted with adults. Despite an extensive literature highlighting coping-related motives as an underlying mechanism, real-time work presents mixed findings, and no published research has examined an adolescent sample using experimental psychopathology techniques.

METHODS

The current study tested whether (1) history of social anxiety symptoms positively correlated with alcohol-related cognitions following laboratory-induced social stress, (2) state anxiety was positively correlated with alcohol-related cognitions, and (3) whether the nature of the stressor (performance versus rejection) impacted the strength of identified relations, in a sample of community-recruited adolescents reporting recent alcohol use. Participants (n = 114; Mage = 16.01; 64% girls) were randomly assigned to either a performance- or rejection-oriented task.

RESULTS

Findings indicated that history of social anxiety symptoms was positively correlated with state anxiety elicited by both tasks. Further, history of social anxiety symptoms was not related to change in desire to drink, but was positively related to the belief that alcohol 'would make me feel better.' State anxiety was positively related to both desire to drink and relief outcome expectancies across both tasks. Finally, the nature of the task did not moderate responding.

LIMITATIONS

Single site, community sampling confines interpretations, and the tasks did not fully perform as expected.

CONCLUSIONS

Further study is needed; however, the current findings support the contention that socially-oriented distress may be a developmentally-relevant, malleable target for prevention efforts aimed at problematic alcohol use among adolescents.

Protective Behavioral Strategies and Alcohol Use While Pregaming: The Moderating Role of Depression and Anxiety Symptoms

The study evaluated the moderating role of anxiety and depression symptoms on the association between subscales on the Protective Behavioral Strategies for Pregaming (PBSP) scale (safety and familiarity, setting drink limits, pacing drinking, and minimizing intoxication) and alcohol consumption during pregaming. Methods: Participants were 359 traditional age undergraduate college students (M = 20, SD = 1.37; 61.7% female; 61.2% White) who reported pregaming in the past year. All participants completed measures through an online survey which evaluated PBSP, depression and anxiety symptoms, and alcohol use during pregame events in the past month. Results: Among students with high depression symptoms, the more frequent use of PBSP to minimize intoxication was not associated with alcohol consumption levels, whereas among those with low depression symptoms, higher use of PBSP to minimize intoxication was associated with higher alcohol consumption. Among those with high anxiety symptoms, the more frequent use of PBSP to minimize intoxication was associated with lower alcohol consumption at pregaming events, whereas among those with low anxiety symptoms, the use of this PBSP was associated with higher alcohol consumption. The more frequent use of PBSP related to safety and familiarity among those with high anxiety symptoms was unrelated to alcohol consumption during pregaming, whereas among those low in anxiety symptoms, the more frequent use of this PBSP was associated with lower alcohol consumption. Conclusion: The findings begin to inform clinical care and intervention techniques aimed at reducing harm associated with risky drinking practices among a vulnerable subset of college students.

Psychological Symptoms and Outcomes in Adults Receiving Community-based Treatment for Substance Use Disorders

BACKGROUND

Mental health issues in individuals with substance use disorders are common and can affect treatment outcomes.

OBJECTIVES

Secondary analysis of a multi-center trial of an internet-delivered psychosocial SUD treatment intervention (Therapeutic Education System; TES) to: 1) describe psychological symptoms over time, 2) explore whether treatment assignment was associated with psychological symptoms 3) explore whether psychological symptoms at baseline moderated the effect of TES on abstinence or retention at the end of treatment.

METHODS

Psychological symptoms were measured using the Global Severity Index (GSI) from the Brief Symptom Inventory (BSI-18), PHQ-9, and MINI SPIN (social anxiety). Zero-inflated-negative-binomial models given high numbers of "0" GSI scores and multivariate logistic regression models were run to estimate the effect of the interaction between treatment and baseline psychological symptoms.

RESULTS

The mean age was 35, 37.9% were female, 56.0% were white. Fifty-four percent had a negative urine drug or breath alcohol screen at baseline. Mean GSI score at baseline was 13.5 (SD = 12.6). GSI scores significantly improved (p<.0001) over time. Treatment was not significantly associated with GSI scores (aIRR = 0.97, 95%CI = 0.85-1.11). Those with social anxiety at baseline had a higher likelihood of achieving abstinence when receiving TES compared to TAU (b = 1.2071, SE = 0.6109, p = 0.0482).

CONCLUSIONS

Psychological symptoms may improve over time in individuals seeking treatment for SUD, and for those with social anxiety, technology-based treatments may result in a better response. Examining the effect of SUD treatment on broader psychological outcomes in addition to abstinence may help clinicians provide more individualized care for those with co-occurring conditions.

Coping Motivated Alcohol Use: The Role of Social Anxiety and Dissociation

Background: Social anxiety has been associated with higher rates of negative alcohol use consequences, and this relationship appears to be accounted for by coping drinking motives. Dissociation is commonly present in anxiety disorders, including social anxiety disorder, and may serve to unconsciously reduce negative emotions when more effortful coping strategies are not effective. Objectives: The present study examined whether the relationship between social anxiety, coping motives, and alcohol consequences was moderated by dissociative symptoms. It was hypothesized that coping motives would mediate the relationship between social anxiety and alcohol consequences, and that dissociation would moderate the relationship between social anxiety and coping motives. Undergraduate students who endorsed alcohol use within the past 30 days (n = 320) were recruited from a large public university. Participants completed measures of social anxiety, dissociation, alcohol motives, and alcohol consequences as part of a larger online questionnaire. Results: Coping motives were found to mediate the relationship between social anxiety and alcohol consequences. Dissociation did not moderate the relationship between social anxiety and coping motives. Dissociation was significantly associated with alcohol consequences via coping motives. Conclusions: Future research should include longitudinal research designs or ecological momentary assessment designs and should examine these relationships in clinical and community samples.

Descended Social Anxiety Disorder and Craving in Women Heroin Dependence Through Exercise Alerts Plasma Oxytocin Levels

Purpose: This study explored the association between peripheral blood oxytocin (OT) and social anxiety disorder (SAD) and cue-induced cravings in female heroin addicts. The effect of exercise on alleviation of SAD and OT levels was also explored. Methods: A total of 72 females with heroin dependence were assigned to three groups based on SAD severity. The three groups were Non-SAD control, SAD control, and SAD exercise groups. Subjects in the SAD exercise group underwent aerobic exercise and resistance training for 8 weeks (60 min/day, 5 days/week). Enzyme-linked immunosorbent assay analysis and Liebowitz Social Anxiety Scale (LSAS) scores were used to determine plasma OT concentration and SAD, respectively. Cue-induced craving was assessed using Visual Analog Scale (VAS) and Desires for Drug Questionnaire (DDQ). Mixed-effect analysis of variance and Pearson correlation analysis were used to explore the effect and correlation between different parameters. Results: OT levels in the SAD exercise group were significantly high after exercise (p < 0.01). LSAS, VAS, and DDQ ("Desire and Intention" and "Negative reinforcement") scores in the SAD exercise group were significantly lower after exercise (p < 0.01). Plasma OT level was negatively correlated with LSAS score (r = -0.534, p < 0.001), VAS score (r = -0.609, p < 0.001), "Desire and Intention" score (r = -0.555, p < 0.001), and "Negative reinforcement" score (r = -0.332, p < 0.01) and positively correlated with the "control" score (r = 0.258, p < 0.05). LSAS was positively correlated with VAS score (r = 0.588, p < 0.001) and "Desire and Intention" score (r = 0.282, p < 0.05). Conclusions: The findings of the present study indicate that plasma OT is a potential peripheral biomarker for prediction of the severity of social anxiety in female heroin withdrawal patients. Aerobic exercise combined with resistance training plus incremental load for 8 weeks can increase plasma OT levels and significantly reduce severity of SAD and cue-induced cravings in female heroin addicts.

Multifaceted impulsivity as a moderator of social anxiety and cannabis use during pregaming

Individuals may drink or use cannabis to cope with social anxiety, and drinking or using cannabis prior to social situations (e.g., pregaming) may be a way to limit the experience of anxiety when entering social settings. However, theoretical and empirical work has reported mixed associations between social anxiety and substance use, specifically alcohol and cannabis. Little work has looked at how other variables, such as impulsivity (a central component to high risk drinking such as pregaming), may shed light onto these mixed findings. College students who reported past year pregaming (n = 363) completed self-report surveys. Supporting prior work, we found that social anxiety was associated with fewer pregaming days, even among those high in sensation seeking. However, those reporting higher social anxiety also reported higher cannabis use during pregaming, specifically among those who reported high sensation seeking and high positive urgency. Results suggest specific facets of impulsivity may affect the association between social anxiety and cannabis use during high risk drinking events.

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.

Psychological factors associated with substance use initiation during the COVID-19 pandemic

The 2019 outbreak of the novel coronavirus (COVID-19) has had a devastating impact. Given the on-going nature of the outbreak, the deleterious toll on mental health, including substance use, is unknown. Negative reinforcement models of substance use posit that elevations in stress from the COVID-19 pandemic will elicit a corresponding motivation to downregulate COVID-19-related stress reactivity via substance use for a subset of the population. The current study sought to evaluate: (1) if COVID-19-related worry and fear were associated with substance use coping motives; and (2) how levels of COVID-19-related worry and fear differ between pre-COVID-19 substance users, COVID-19 substance initiators, and abstainers. Participants were 160 adults recruited nationally between April-May 2020 for an online study. Results indicated that COVID-19-related worry was associated with substance use coping motives. Additionally, compared to abstainers, pre-COVID-19 substance users and COVID-19 substance initiators demonstrated the highest levels of worry and fear. Examination of differences suggested that the COVID-19 substance initiators had the highest COVID-19-related worry and fear for all substances except for opioids, with effect size estimates ranging from small to medium. The results of this study suggest that COVID-19-specific psychological factors appear to be involved in substance use behavior.

Prevalence and Predictors of Depression, Anxiety, and Stress among Youth at the Time of COVID-19: An Online Cross-Sectional Multicountry Study

Depression and anxiety are prevalent mental illnesses among young people. Crisis like the Coronavirus Disease 2019 (COVID-19) pandemic may increase the current prevalence of these illnesses. A cross-sectional, descriptive design was used to (1) explore the prevalence of depression, anxiety, and stress among youth and (2) identify to what extent certain variables related to COVID-19 could predict depression, anxiety, and stress (DAS) among young people in six different countries. Participants were requested to complete an online survey including demographics and the DAS scale. A total of 1,057 participants from Oman (n = 155), Saudi Arabia (n = 121), Jordan (n = 332), Iraq (n = 117), United Arab Emirates (n = 147), and Egypt (n = 182) completed the study. The total prevalence of depression, anxiety, and stress was 57%, 40.5%, and 38.1%, respectively, with no significant differences between countries. Significant predictors of stress, anxiety, and depression were being female, being in contact with a friend and/or a family member with mental illness, being quarantined for 14 days, and using the internet. In conclusion, COVID-19 is an epidemiological crisis that is casting a shadow on youths' DAS. The restrictions and prolonged lockdowns imposed by COVID-19 are negatively impacting their level of DAS. Healthcare organisations, in collaboration with various sectors, are recommended to apply psychological first aid and design appropriate educational programmes to improve the mental health of youth.

Characteristics associated with marijuana use in Latinx college students

While marijuana use rates are significantly high within college students, less is known about use patterns and correlates in Latinx groups. This study assessed the relationships between ever use and frequency of use of marijuana, polysubstance use, expectancies, motives, and mental illness symptoms among Latinx college students (n = 345). Results indicated more frequent marijuana use was positively associated with: enjoyment, celebration, social anxiety, low risk, sleep and availability and was negatively associated with: experimentation, boredom, altered perception, and anxiety. Other dual use with tobacco expectancies were also observed. These constructs should be explored prospectively and inform prevention and intervention efforts.

A latent profile analysis of social anxiety and alcohol use among college students

BACKGROUND

The social, normative nature of alcohol use may make college students with social anxiety vulnerable to problematic alcohol use. Yet, social anxiety is typically unrelated to drinking quantity or frequency. One potential explanation is that researchers primarily use a variable-centered approach to examine alcohol use among students with social anxiety, which assumes population homogeneity.

METHODS

The current study utilized a person-centered approach to identify distinct classes among 674 college students (69.6% female) based on social anxiety characteristics and alcohol use behaviors, and tested how these classes differed in their experience of adverse outcomes.

RESULTS

Latent profile analysis resulted in six distinct classes of students - two classes with low levels of social anxiety and non-problematic drinking behaviors that differed based on frequency of alcohol use, three classes with moderate levels of social anxiety that differed based on quantity, frequency, and extent of problematic drinking behaviors, and one class with high levels of social anxiety and low, frequent problematic drinking behaviors. Two classes - moderate levels of social anxiety and heavy, problematic drinking behaviors or high levels of social anxiety and light, problematic drinking behaviors - appeared to have riskier profiles due to endorsing more social anxiety-specific beliefs about social impressions while drinking and more emotional distress.

CONCLUSIONS

Current findings offer clarity surrounding the role of alcohol use in the association between social anxiety and problematic alcohol use. Although preliminary, findings demonstrate that comorbid social anxiety and alcohol use disorder symptoms appear to place students at greater risk for adverse outcomes.

Mindfulness training for clinically elevated social anxiety: The impact on peak drinking

Social anxiety is related to more drinking in high-risk drinking situations and to more drinking-related problems. Given the rise in mindfulness-based interventions for social anxiety, it is important to test whether drinking impacts outcomes among individuals with clinically elevated social anxiety. Undergraduates with clinically elevated social anxiety were randomly assigned to mindfulness training (n = 29) or thinking-as-usual control (n = 29). They were encouraged to practice mindfulness or thinking-as-usual in response to social events daily for two-weeks following baseline. Follow-up measures were completed one month post-baseline. The interaction of baseline peak estimated blood alcohol content (eBAC) X condition predicted one-month follow-up peak eBAC such that among those with greater (but not lower) baseline eBAC, mindfulness was related to lower follow-up eBAC compared to control. Similarly, mindfulness training resulted in less post-training anxiety among those with greater (but not lower) baseline eBAC. However, this effect was not evident during a two-week practice period nor at one-month follow-up. Rather, at one-month follow-up, the interaction of baseline eBAC X condition predicted follow-up mindfulness (non-reactivity); among those with higher (but not lower) baseline eBAC, mindfulness training was associated with less follow-up mindfulness than the control condition. Results indicate that among those with greater baseline peak eBAC, mindfulness practice resulted in lower follow-up eBAC compared to control among those with clinically elevated social anxiety. However, although mindfulness training may result in less anxiety in the short-term among heavy drinkers with social anxiety, this effect did not last longer-term. Rather, heavier drinkers evinced poorer longer-term mindfulness-related outcomes.

Context-specific drinking and social anxiety: The roles of anticipatory anxiety and post-event processing

Individuals with clinically elevated social anxiety are especially vulnerable to alcohol-related problems, despite not drinking more than those with less anxiety. It is therefore important to identify contexts in which socially anxious persons drink more to inform intervention efforts. This study tested whether social anxiety was related to greater drinking before, during, or after a social event and whether such drinking was related to the psychosocial factors anticipatory anxiety or post-event processing (PEP; review of the social event). Among past-month drinkers, those with clinically elevated or higher social anxiety (HSA; n = 212) reported more anticipatory anxiety, more pre-event drinking to manage anxiety, and PEP than those with normative or lower social anxiety (LSA; n = 365). There was a significant indirect effect of social anxiety on pre-drinking via anticipatory anxiety. Social anxiety was related to more drinking during the event indirectly via the serial effects of anticipatory anxiety and pre-drinking. Unexpectedly, PEP did not mediate or moderate the relation between social anxiety and post-event drinking. In sum, anticipatory anxiety was related to more drinking before, during, and after a social event and HSA drinkers were especially vulnerable to drinking more to manage this anxiety, which increased drinking before and during the event. This effect was specific to anticipatory anxiety and not evident for another social anxiety-specific risk factor, PEP. Thus, anticipatory anxiety may be an important therapeutic target for drinkers generally and may be especially important among HSA drinkers.

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

BACKGROUND

Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known.

METHODS

The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted).

RESULTS

The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding.

CONCLUSIONS

There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.

The role of underutilization of protective behavioral strategies in the relation of social anxiety with risky drinking

Social anxiety is prominent among undergraduates and increases the risk of experiencing alcohol problems. In fact, social anxiety more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently related to heavier drinking. Inconsistent findings may be due to lack of attention on protective behavioral strategies (PBS) among socially anxious drinkers. PBS are cognitive-behavioral strategies to reduce drinking and alcohol-related harm. Due to the nature of social anxiety, affected individuals may be especially vulnerable to PBS underutilization, leading to heavier and more problematic drinking. The current study examined the mediating role of PBS in the relationships of social anxiety with past-month drinking and alcohol problems using cross-sectional data among current (past-month) heavy undergraduate drinkers (N = 431). Social anxiety was significantly positively related to past-month alcohol problems and peak drinking. Social anxiety was significantly negatively related to typical drinking, drinking frequency, and PBSS Manner of Drinking. Social anxiety was indirectly (via PBSS Manner of Drinking) related to greater past-month peak drinks and more drinking problems. Findings suggest that socially anxious persons may be vulnerable to heavier and more problematic drinking due to PBS underutilization. Treatment implications are discussed.