Risk of heavy drinking and alcohol use disorders in social phobia: A prospective analysis

Objective: The risks of heavy drinking and alcohol abuse/dependence were prospectively assessed among individuals with DSM-III social phobia and individuals with subclinical social phobia (irrational fear of social situations without significant impairment or avoidance). Method: The baseline interview for the Baltimore site of the Epidemiologic Catchment Area program was completed in 1981. Between 1993 and 1996 the original cohort was traced. Among the 1,161 individuals who did not have episodes of heavy drinking or current or prior alcohol abuse/dependence at baseline, logistic regression was used to assess the association of social phobia and subclinical social phobia with incident alcohol abuse/dependence and incident episodic heavy drinking. Results: Among the 33 individuals with a DSM-III diagnosis of social phobia at baseline, only one developed heavy drinking by follow-up, and none developed alcohol abuse or dependence. Among the 84 individuals with a history of subclinical social phobia, the cumulative incidence rates of heavy drinking and alcohol abuse/dependence were 119 per 1,000 and 95 per 1,000, respectively. After adjustment for sex, age, race, education level, marital status, age at first alcohol intoxication, and history of other psychiatric or illicit drug use disorder, the estimated relative risk for heavy drinking among respondents with subclinical social phobia was 2.41, and the estimated relative risk for alcohol abuse/dependence was 2.30, relative to respondents without social phobia or subclinical social fears. Conclusions: The data may improve our understanding of the relationship of social phobia and risk for alcohol conditions, which may have important implications for preventive measures.