In a Finnish adolescent cohort, general anxiety predicted subsequent alcohol and cannabis use (mediated by depression), while social phobia symptoms appeared to reduce persistent alcohol use.
Read this if you are interested in how different types of anxiety relate to substance use in teenagers.
Social phobia decreased persistence of frequent alcohol use in teens
What the researchers found
Researchers followed Finnish adolescents aged 15-16 at baseline over two years to examine how anxiety related to substance use.
Anxiety preceded substance use, but no reciprocal effect was found (substance use did not predict anxiety). Depression mediated the relationship between anxiety and substance use.
General anxiety increased the incidence of frequent alcohol use and cannabis use. However, social phobia had a different pattern: it did not elevate substance use incidence and actually decreased the persistence of frequent alcohol use. The authors suggested social phobia may "protect" from substance use because socially anxious teens avoid the social situations where substance use typically occurs.
Frequent drunkenness was less strongly associated with anxiety than regular alcohol use or cannabis use.
Why it matters
The contrasting effects of general anxiety versus social phobia on substance use had direct implications for prevention, suggesting that different types of anxiety require different intervention approaches.
The numbers in context
Baseline age 15-16 with 2-year follow-up. Anxiety preceded substance use (no reciprocal effect). Depression mediated the anxiety-substance use link. Social phobia decreased persistence of frequent alcohol use.
How the study worked
Longitudinal cohort study using the Adolescent Mental Health Cohort Study, a school-based Finnish survey. Baseline assessment at ages 15-16 with 2-year follow-up. Associations between social phobia, general anxiety, and substance use (alcohol, drunkenness, cannabis) analyzed for prevalence, incidence, and continuity.
What this study cannot tell us
Finnish adolescent sample may not generalize to all cultures. Self-reported substance use and anxiety symptoms. Cannabis use was described as smoked hashish of unknown composition. Two-year follow-up may miss longer-term patterns.
How to read the evidence
Longitudinal school-based cohort study with 2-year follow-up distinguishing between types of anxiety, but self-reported measures.
When this study was published
Published in 2011. Understanding of anxiety subtypes and substance use trajectories has continued to develop.
The bigger picture
The finding that social phobia may actually protect against substance use challenged the common assumption that all anxiety disorders increase substance use risk through self-medication.
Questions still open
- Does social phobia continue to protect against substance use into adulthood? Would treating general anxiety in teens reduce subsequent substance use initiation?
Common questions
Does anxiety cause teens to use drugs?
Do anxious teens self-medicate with cannabis?
Read the original research
Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents.
Alcohol and alcoholism (Oxford, Oxfordshire), 46(2), 192-9
Citation
Fröjd, Sari; Ranta, Klaus; Kaltiala-Heino, Riittakerttu; Marttunen, Mauri. (2011). Associations of social phobia and general anxiety with alcohol and drug use in a community sample of adolescents.. Alcohol and alcoholism (Oxford, Oxfordshire), 46(2), 192-9. https://doi.org/10.1093/alcalc/agq096
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