ترکیب اضطراب اجتماعی با یک مدل از آشامیدنی مشکل ساز دانشجویان دانشکده

College problem drinking and social anxiety are significant public health concerns with highly negative consequences. College students are faced with a variety of novel social situations and situations encouraging alcohol consumption. The current study involved developing a path model of college problem drinking, including social anxiety, in 316 college students referred to an alcohol intervention due to a campus alcohol violation. Contrary to hypotheses, social anxiety generally had an inverse relationship with problem drinking. As expected, perceived drinking norms had important positive, direct effects on drinking variables. However, the results generally did not support the hypotheses regarding the mediating or moderating function of the valuations of expected effects and provided little support for the mediating function of alcohol expectancies in the relations among social anxiety and alcohol variables. Therefore, it seems that the influence of peers may be more important for college students than alcohol expectancies and valuations of alcohol's effects are. College students appear to be a unique population in respect to social anxiety and problem drinking. The implications of these results for college prevention and intervention programs were discussed.

Problem drinking among college students represents a major public health concern. Although problematic alcohol use occurs across many age groups, young adults aged 18–24 show the highest rates of alcohol use and have the greatest percentage of problem drinkers Kandel & Logan, 1984, U.S. Department of Health and Human Services, 1984 and U.S. Department of Health and Human Services, 1997. The majority of college students have consumed alcohol in the past year (over 80% throughout the 1990s; Johnston, O'Malley, & Bachman, 2000), with at least 40% reporting a recent heavy or binge drinking episode (5+ standard drinks for men, 4+ for women in one sitting) in national studies O'Malley & Johnston, 2002, Wechsler et al., 1994, Wechsler et al., 1998 and Wechsler et al., 2000. The pattern of college drinking is unique because it seems to be relatively variable and has a transitory course with only a subset of students exhibiting heavy drinking patterns into adulthood (Weingardt et al., 1998). Although many students “mature out” of heavy drinking (Zucker, 1987), some do not (e.g., Marlatt et al., 1993 and Weingardt et al., 1998). Moreover, heavy drinking puts these students at risk for experiencing significant, negative alcohol-related consequences during their college years. Since the mid-1990s, there has been greater media attention given to alcohol-related deaths among college students, including deaths by acute alcohol poisoning, falls, drownings, automobile collisions, fires, and hypothermia resulting from exposure (Wechsler et al., 2000). However, there is a multitude of other less severe negative consequences more commonly experienced by heavy drinkers that may be neglected by the media (e.g., unplanned sexual activity, hangovers, academic problems, legal problems, and lowered immunity; Engs & Aldo-Benson, 1995 and Wechsler et al., 1994). Unfortunately, problem drinkers are not the only individuals who are affected by their drinking behavior. Heavy drinking also endangers other drinking or nondrinking college students and the community in general. In addition to the experience of “secondhand effects” of binge drinking on others (e.g., being insulted or humiliated, experiencing unwanted sexual advances, and having interrupted sleep; Wechsler, 1996), there is an increase in physical or sexual assault or damaging property committed by students when intoxicated Hingston et al., 2002 and Wechsler et al., 1994. Approximately 32% of college drinkers report driving under the influence of alcohol (Wechsler et al., 1994), putting themselves and others at risk for injury and death. 1.1. Defining problem drinking in college students Previous research has often utilized self-report measures assessing the quantity and/or frequency of drinking behavior. Many have asserted that using quantity and frequency measures of alcohol use is not sufficient to determine the problem status of college student drinkers. For instance, some heavy drinkers may report low levels of alcohol-related problems, while some light or moderate drinkers may experience high levels of alcohol-related problems (White & Labouvie, 1989). As much of the concern with college student drinking deals with the negative alcohol-related consequences, this seems to be a relevant definition. Thus, the current study examined both weekly alcohol consumption and alcohol-related problems. 1.2. Social anxiety and college student problem drinking Social anxiety may be an important motivator for drinking in college students (e.g., Burke & Stephens, 1999). Recent work has found social anxiety disorder to be the third most common psychiatric disorder, with a lifetime prevalence of 13.3% (Kessler et al., 1994). Alcohol problems and social anxiety appear to be related, as many studies have found higher prevalence rates of alcoholism within samples of socially anxious individuals compared with the prevalence for the general population Davidson et al., 1993, Kushner et al., 2000, Kushner et al., 1990 and Merikangas & Angst, 1995 and higher rates of socially anxious individuals in alcoholic samples compared with normal control and community samples Chambless et al., 1987, Merikangas & Angst, 1995 and Schneider et al., 2001. Furthermore, the onset of social anxiety disorder typically precedes the onset of alcohol problems Davidson et al., 1993 and Kushner et al., 1990, indicating that social anxiety disorder may be a risk factor for alcohol problems. This may be particularly relevant to college students, as there are high social demands and frequent promotion of drinking on college campuses Johnson et al., 1982 and Nathan, 1994. In fact, Lewis and O'Neill (2000) found that college students identified as problem drinkers reported higher social anxiety than non-problem-drinkers did, providing evidence of a high co-occurrence of social anxiety and alcohol-related problems in a college population. Despite this connection, there has been little attempt made to develop a model of social anxiety and alcohol use in the college student population (Burke & Stephens, 1999). Martin and Hoffman (1993) recommend that future research should focus on developing comprehensive models of drinking behaviors that predict relationships among person and socioenvironmental variables using approaches such as path analysis. The creation of such a model, including social anxiety and other correlates of drinking behavior, is essential to improve both the efficacy of prevention as well as treatment efforts. 1.3. Expectancies, social anxiety, and drinking The expectancy theory Goldman et al., 1987 and Goldman et al., 1999 may help explain how social anxiety could be a risk factor for alcohol problems. “Alcohol expectancies” refer to the beliefs that people hold about the effects of consuming alcohol that are believed to influence drinking behavior. Several studies have supported the relationship between expectancies and increased problematic drinking behavior (e.g., Reis & Riley, 2000 and Smith et al., 1995). Previous literature has generally demonstrated positive correlations among social anxiety and social and tension reduction alcohol expectancies Burke & Stephens, 1999, Ham et al., 2002 and O'Hare, 1990. Bruch et al. (1992) and Bruch, Rivet, Heimberg, and Levin (1997) contended that shy individuals may fear and avoid drinking if they hold the expectancy that alcohol will increase social assertiveness because they fear that social assertiveness would result in negative evaluation for disinhibited behavior. The study of Bruch et al. revealed that social assertiveness alcohol expectancies acted as a “suppressor variable” between shyness and alcohol use. Although shyness and social anxiety are not synonymous, it is possible that the results of the studies of Bruch et al. could partially be explained by a failure to assess the valuations of the expectancies, a criticism of many widely used measures of alcohol expectancies Fromme et al., 1993 and Leigh, 1989. According to classic expectancy-value theory (Bandura, 1977), an outcome expectancy will only increase behavior if the person desires or values the expected outcome. For example, there is evidence that heavier drinkers may view negative effects of alcohol as more benign than lighter drinkers do (Williams & Ricciardelli, 1996). Furthermore, Leigh (1989) reported that the desirability of alcohol effects, independent of expectancies, added significantly to the prediction of drinking frequency and quantity. Thus, socially anxious individuals that positively value a particular expectancy (e.g., social assertiveness) would be more likely to engage in problem drinking than one who negatively values the expected outcome. It would be expected that this effect would be greater for those with greater levels of social anxiety, as those with more severe levels of social anxiety would have greater motivation to use alcohol to reduce the social discomfort (e.g., Tran, Haaga, & Chambless, 1997). 1.4. Other factors relevant to college student drinking Gender, living environment, peer influence, and involvement in religion are variables relevant to college student drinking that were important to consider in the model. Although there have been a number of other factors associated with problem drinking, such as genetic influences, often examined in alcohol-related research, the current model focuses on psychosocial, nongenetic variables that are important specifically for college drinking. 1.4.1. Gender Overall, male students tend to drink alcohol more frequently and in larger quantities than female students do (e.g., Clements, 1999 and Read et al., 2002). Additionally, male students are more likely to engage in binge drinking Wechsler et al., 1994 and Wechsler et al., 1995, meet criteria for an alcohol use disorder (Clements, 1999), and experience more alcohol-related consequences (Read et al., 2002) than women do. 1.4.2. Living environment Students living in on-campus residences, such as fraternities, sororities, or residence halls, tend to drink more, more often engage in binge drinking, and report more alcohol-related negative consequences than do those living with their parents (e.g., Harford et al., 2002 and Martin & Hoffman, 1993), possibly due to peers who encourage drinking as normative behavior. This may be particularly applicable for socially anxious college students, being faced with many new social situations and having the desire to be accepted socially by their peers. Social desirability, combined with more potential social situations (e.g., interactions with roommates and other students in dormitories) and greater availability of alcohol than those living off campus, may lead to even more alcohol consumption for those with higher social anxiety. 1.4.3. Peer influence The influence of peers' attitudes and behaviors about alcohol seems to be related to alcohol consumption Oetting & Beauvais, 1987 and Reis & Riley, 2000. An atmosphere in which heavy drinking is encouraged and perceived as normative and positive tends to have more heavy drinkers than peer groups in which heavy drinking is not encouraged (e.g., Agnostinelli et al., 1995 and Baer & Carey, 1993). The influence of perceived peer drinking norms would appear to be particularly important in the case of socially anxious individuals, as these individuals may have an increased desire to be socially accepted. 1.4.4. Religious involvement as a protective factor Religiosity has generally been found to be negatively related to alcohol use and alcohol problems (e.g., Forthun et al., 1999 and Wechsler et al., 1995), independent of the negative relationship between religiosity and sensation seeking (Forthun et al., 1999). In conclusion, the development of a comprehensive model of the role of social anxiety in college student problematic drinking is essential to understanding the interrelatedness among social and environmental variables associated with problematic drinking behavior in this population. This model would also aid in examining the inconsistencies in the literature regarding the alcohol–social anxiety relationship by including expectancies and valuations of drinking outcomes. Additionally, the model will study an important area, namely, that of social anxiety and problematic college drinking, which has been neglected. Social anxiety and drinking is particularly important in college populations, as college students are faced with a variety of novel social situations as well as situations that involve alcohol consumption. Such a model would serve as the basis for future research, further our understanding of the relationship between alcohol and social anxiety, and inform interventions for problematic drinking among college students. 1.5. Hypotheses The following hypotheses involve the path analytic model depicted in Fig. 1. 1. It was hypothesized that expectancies, valuations, and perceived drinking norms would have positive, direct effects on alcohol use and alcohol-related problems. Gender, living environment, and religious involvement were expected to have negative, direct effects on alcohol use and alcohol-related problems, in that being male, living on campus, and lower religious involvement would be related to greater alcohol consumption and problems. 2. It was expected that valuations would moderate the effect of social anxiety on alcohol use and alcohol-related problems, such that those having high social anxiety and high valuations would have even greater levels of the drinking variables than those with lower social anxiety do. Furthermore, it was hypothesized that living environment and perceived drinking norms would moderate the effect of social anxiety on alcohol use and drinking-related problems, such that those with high social anxiety and living on campus or with high perceived drinking norms would have even greater levels of the drinking variables than those with lower social anxiety would. 3. As demonstrated in Fig. 1, it was hypothesized that social anxiety would have positive, indirect effect on alcohol use and alcohol-related problems through the mediating variables of expectancies, valuations, and perceived drinking norms.