The Interplay of Anxiety and Substance Use

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­­­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
Cloutier, R. M., Anderson, K. G., Kearns, N. T., Carey, C. N., & Blumenthal, H. (2021). ­ Psychology of Addictive Behaviors. Advance online publication.

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, non-alcoholic 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 no 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 poly-substance use in laboratory settings.

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Real-time social stress response and subsequent alcohol use initiation among female adolescents.

Cloutier, R. M., Blumenthal, H., Trim, R. S., Douglas, M. E., & Anderson, K. G. (2019). Psychology of Addictive Behaviors, 33(3), 254. 10.1037/adb0000454 . PMCID: PMC6483836

Adolescents who are particularly sensitive to social stress may be vulnerable to earlier alcohol consumption and related problems. While a small literature supports this contention, previous studies mostly rely on retrospective self-report. The current study used discrete-time survival analysis (DTSA) to test whether real-time social stress responding (via laboratory induction) and social anxiety symptoms predicted 12-month alcohol onset in an alcohol-naïve sample of young female adolescents. Anxiety elicited by the task was expected to predict greater and earlier rates of alcohol incidence, particularly among girls with higher levels of self-reported social anxiety symptoms. Participants were 104 community-recruited girls (12-15 years) who completed a modified Trier Social Stress Test and questionnaires; follow-up calls were conducted at 3-, 6-, 9-, and 12-months after the laboratory visit. Self-reported anxiety was assessed in response to the stressor following acclimation (baseline), instruction (anticipation), and speech (post-task). By 12-months, 30.8% of the sample had consumed a full alcoholic beverage. The DTSA revealed that girls with higher levels of social anxiety and greater elevations in anticipatory (but not post-task) anxiety compared to baseline, had earlier alcohol initiation. This is the first study to examine the role of both laboratory-induced anxious responding and retrospective reports of social anxiety as prospective predictors of alcohol incidence. These preliminary findings suggest that adolescent girls who are more sensitive to social stress may be at risk for experimenting with alcohol earlier than their peers.

Posttraumatic stress severity is associated with coping motives for alcohol use among in-patient and community recruited adolescents.

Cloutier, R. M., Schuler, K. L., Kearns, N. Ruggero, C. J., Lewis, S. F., & Blumenthal, H. (2018). Anxiety, Stress, & Coping, 31(5), 500-513. PMCID: PMC6289047

Background and Objectives: A growing body of work suggests individuals with more severe post-traumatic stress symptoms (PTSS) are at higher risk for developing problematic alcohol use outcomes. Extending work from the adult literature, the present study was the first to examine the extent to which PTSS is related to drinking motives for alcohol use in both clinical and non-clinical samples of adolescents. Design: Hierarchical regression analyses were used to predict coping motives for alcohol use from PTSS, above and beyond demographic variables, alcohol use frequency, and other alcohol use motives. Methods: Trauma-exposed adolescents before entering treatment (Sample 1 n = 41) and recruited from the local community (Sample 2 n = 55) self-reported on PTSS and alcohol use motives. Results: PTSS positively predicted coping motives for alcohol use after controlling for age, gender, and alcohol use frequency. Conclusions: The current study highlights the need to consider both PTSS severity, as well as underlying cognitive mechanisms (e.g., motives), to better understand the etiology of problematic alcohol use among trauma-exposed youth. Future work focused on clarifying the trajectory of alcohol use motives and problems as a function of PTSS is needed.

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An examination of social anxiety in marijuana and cigarette use motives among adolescents.

Cloutier, R. M., Blumenthal, H., & Mischel, E. R. (2016). Substance Use & Misuse, 51(3), 408-418. PMCID: PMC4851246

Marijuana and nicotine are two of the most widely used substances among adolescents in the United States. Symptoms of social anxiety (SA) typically emerge during early adolescence, and elevated levels are associated with increased substance-related problems despite inconsistent links to frequency of use. Substance use motives, and in particular coping motives, have been found to play an important role in understanding the heightened risk for use problems among those with elevated SA. Importantly, work to date has been conducted almost exclusively with adult samples; thus the current study examined whether similar patterns would emerge among adolescents. The current project included 56 community-recruited adolescents (ages 12-17 years; 41% girls) with a positive history of lifetime marijuana and cigarette use. Consistent with the adult literature, SA was not positively associated with frequency of use across either substance. Further, SA was positively associated with conformity use motives and unrelated to social or enhancement motives for both substances. Unexpectedly, SA was unrelated to coping use motives for either marijuana or cigarettes. These preliminary data highlight the need for future research designed to forward developmentally sensitive models of substance use behaviors and etiology.


Social anxiety, disengagement coping, and alcohol use behaviors among adolescents.

Blumenthal, H., Ham, L. S., Cloutier, R. M., Bacon, A. K., & Douglas, M. E. (2016). Anxiety, Stress, & Coping, 29 (40), 432-446. PMCID: PMC4751071

Background and Objectives: Although research indicates that social anxiety (SA) is associated with problematic drinking, few studies have examined these relations among adolescents, and all alcohol-related assessments have been retrospective. Socially anxious youth may be at risk to drink in an effort to manage negative affectivity, and a proclivity toward disengagement coping (e.g. avoidance of aversive stimuli) may enhance the desire to drink and learning of coping-related use. Design: Adding to research addressing adolescent SA and alcohol use, the current study examined (1) proportional drinking motives (subscale scores divided by the sum of all subscales), (2) current desire to drink in a socially relevant environment (introduction to research laboratory), and (3) the indirect effect of retrospectively reported disengagement in social stress contexts on proportional coping motives and desire to drink. Method: Participants were 70 community-recruited adolescents who reported recent alcohol use. Level of SA, disengagement coping, drinking motives, and desire to drink following laboratory introduction were assessed. Results: Proclivity toward disengagement in prior socially stressful contexts accounted for significant variance in the positive relations between SA and both proportional coping motives and current desire to drink. Conclusions: These data complement existing work. Continued efforts in building developmentally sensitive models of alcohol use are needed.

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A laboratory-based test of the relation between adolescent alcohol use and panic-relevant responding.

Blumenthal, H., Cloutier, R. M., Zamboanga, B. L., Bunaciu, L., & Knapp, A. A. (2015). Experimental and Clinical Psychopharmacology, 23(5), 303-313. PMCID: PMC4578981

A burgeoning literature supports a link between alcohol use and panic-spectrum problems (e.g., panic attacks, disorder) among adolescents, but the direction of influence has yet to be properly examined. From a theoretical perspective, panic-spectrum problems may increase risk for problematic drinking via affect regulation efforts (e.g., self-medication), and problematic consumption also may increase or initiate panic-relevant responding (e.g., learning or kindling models). The objective of the current investigation was to examine the role of prior alcohol use in predicting panic-relevant responding, as well as panic symptom history in predicting the desire to consume alcohol, in the context of either a voluntary hyperventilation or a low-arousal task. Participants were community-recruited adolescents aged 12-17 years (n = 92, Mage = 15.42, SD = 1.51; 39.1% girls). Results indicated that prior alcohol use predicted panic-relevant responding among those undergoing the hyperventilation task (but not the low-arousal task), and that this finding was robust to the inclusion of theoretically-relevant covariates (i.e. age, sex, negative affectivity). However, panic symptom history did not predict the desire to consume alcohol as a function of either the hyperventilation or low-arousal condition. This work sheds further light on the nature of the relation between panic-spectrum problems and problematic alcohol use in adolescence. Specifically, the current findings suggest that frequent alcohol use may increase panic vulnerability among adolescents, whereas acute panic symptoms may not elicit the immediate (self-reported) desire to drink.

Experimental & Clincal Psychoparmacology