آزمون ویژگی بین اختلال اضطراب اجتماعی و انگیزه های الکل نوشیدن

Abstract This study tested the specificity of the relationship between social anxiety disorder (SAD) and coping drinking motives (versus enhancement drinking motives and social drinking motives) within the context of a range of potentially confounding variables measured during adolescence (e.g., quantity and frequency of alcohol use, coping drinking motives) and substantively important variables assessed during young adulthood (e.g., other anxiety disorders and major depressive disorder). A sample of high school sophomores and juniors (n = 717) completed measures of substance use and risk factors during adolescence and were then prospectively followed-up in early- and middle-young adulthood, and psychiatric diagnoses and drinking motives (i.e., coping, enhancement, and social) were assessed each time. Findings indicated that SAD was specifically related to coping motives (measured during early-to-middle young adulthood) after controlling for the effects of a range of alcohol and mental health variables. In addition, adolescent variables predicted young adult drinking motives as did major depressive disorder and other anxiety disorders. These findings are discussed within a conceptual framework of the functional role (e.g., self-medication) that drinking motives, and especially coping drinking motives, may play in the etiology of alcohol problems and disorders. Implications for prevention and treatment interventions are discussed.

Introduction Considerable research has been conducted on the proximal and differential role of motives for drinking on alcohol use, alcohol problems, and alcohol disorders (Kuntsche et al., 2005, Kuntsche et al., 2006 and Sher et al., 2005). However, studies of precursors of motives for drinking have been limited despite some recent studies supporting the potential role of motives for drinking as a mediator or moderator between social anxiety symptoms and disorders (SAD), a typically early onset disorder (in childhood/early adolescence), and alcohol use and alcohol problems in adolescence and young adulthood ( Blumenthal et al., 2010, Buckner et al., 2006, Ham et al., 2007, Ham et al., 2009 and Lewis et al., 2008). Moreover, issues have been raised about the strength and specificity of the associations between SAD and drinking motives, particularly in coping motives for drinking. For example, Blumenthal et al. (2010) reported a significant, positive relationship between social anxiety and coping drinking motives but not between social anxiety and enhancement, social, or conformity motives. In contrast, Buckner et al. (2006) found that social anxiety was related to enhancement motives but not to social or coping motives. Drinking motives are guided by the notion that individuals imbibe alcohol to achieve valued outcomes and that these motives involve cognitive-motivational aspects of decision-making (Cooper et al., 1992 and Cox and Klinger, 1988). Cooper et al. identified three distinct drinking motives they referred to as coping, social, and enhancement motives. Social and enhancement motives were conceptualized as positively reinforcing motivations for drinking (e.g., social drinking to facilitate camaraderie; enhancement drinking to facilitate confidence in social situations or to enhance the impact of another drug), and coping motives were conceptualized as negatively reinforcing motivations for drinking (e.g., to cope with or escape from stress). These motivations for drinking have been linked to theoretical models of the etiology of alcohol disorders through positive and negative affect regulatory processes (Cooper et al., 1995 and Sher et al., 2005). The objective of the current study was to provide an evaluation of the potentially unique association between SAD and coping motives for drinking, relative to the association (or lack thereof) between SAD and social motives and SAD and enhancement motives. A hypothesized unique relationship between SAD and coping motives for drinking is an interesting research question given that it has been postulated that SAD may represent an especially potent risk factor (relative to other anxiety disorders) for the development of problematic alcohol use and alcohol disorders (Buckner et al., 2008), and that a self-medication or tension reduction process may at least partially explain this relationship (Carpenter and Hasin, 1999, Carrigan and Randall, 2003 and Kushner et al., 2000). That is, some individuals with high levels of social anxiety may consume alcohol in feared social situations in an attempt to reduce the adverse physiological and psychological symptoms they experience. In many Western societies, the consumption of alcohol within the context of numerous types of social events (e.g., parties, weddings) is normative behavior; thus, socially anxious people who are motivated to use alcohol as a coping mechanism in social situations are able to do so without fear of negative evaluation by others. Across time, the continued use of alcohol for coping purposes may eventually result in the development of heavy drinking, alcohol-related problems, and/or alcohol disorders (Kushner, Sher, & Beitman, 1990). A finding that SAD is specifically related to coping drinking motives has implications for prevention and treatment interventions. By focusing on this objective of investigating the association between SAD and coping motives for drinking, we aimed to advance the research literature in two ways. First, several methodological limitations of recent studies investigating the relationship between social anxiety and drinking motives include cross-sectional research designs, small sample sizes, and/or restricted samples, such as college students or a preponderance of female participants (Blumenthal et al., 2010, Buckner et al., 2006, Ham et al., 2009, Lewis et al., 2008 and Stewart et al., 2006). In order to address these limitations, we used data from a long-term longitudinal project that spanned adolescence to young adulthood and included a relatively large community sample with a high representation of each gender (Windle, Mun, & Windle, 2005). Second, most studies have used social anxiety as the sole predictor variable in regression or structural equation modeling analyses, with a range of drinking motives and/or alcohol use variables as outcomes ( Blumenthal et al., 2010, Ham et al., 2007 and Lewis et al., 2008). Given that other variables not included in these analyses might account for the relationship between social anxiety and drinking motives or alcohol use indicators, the objective of the current study was to provide a more rigorous test of the relationship between SAD and drinking motives by controlling some potential third variable influences. To accomplish this, we utilized linear regression models that included a range of potentially confounding and substantive variables in the equations. That is, with young adult coping, enhancement, and social drinking motives as outcomes, we included sex, adolescent alcohol consumption, and adolescent depressive symptoms as potentially confounding variables that may partially account for the relationship between SAD and young adult motives for drinking. Further, we included Time 1 (adolescent) coping drinking motives as a control for T2 (young adult) coping motives. Because of the high co-morbidity of SAD with major depressive disorder (MDD) and other anxiety disorders ( Grant et al., 2005), we included lifetime diagnoses of MDD, SAD, and other anxiety disorders as substantive predictor variables. This allowed us to test the ability of SAD to predict coping (and possibly other) drinking motives after accounting for the effects of prior adolescent predictors and other potentially influential variables (e.g., other anxiety and major depressive disorders). Within this context, we put forth three study hypotheses. First, based on the findings of previous research (Blumenthal et al., 2010 and Ham et al., 2007), we hypothesized that SAD would be a significant predictor of coping motives for drinking. Second, we hypothesized that SAD would not be a significant predictor of social drinking motives given that such motives (e.g., drinking to be sociable, drinking to celebrate special occasions with family and friends) have generally been found to be more commonly endorsed and to be associated with non-problematic alcohol consumption in social situations (Cooper, 1994 and Kuntsche et al., 2005). That is, drinking alcohol in social situations for celebratory purposes is viewed as normative social behavior, and is generally not associated with internalizing psychopathology, such as anxiety and depression. With regard to our third hypothesis, Cooper (1994) conceptualized enhancement motives such that they would, in general, be characterized by heavier levels of alcohol consumption within social situations in which the goal was to get high and have fun, rather than to cope with internalized feelings of insecurity and fear. Some researchers have found no relationship between social anxiety and enhancement motives (Blumenthal et al., 2010 and Cooper et al., 1995), others have found only a weak relationship (Ham et al., 2007), whereas others found that enhancement motives are related to social anxiety (Buckner et al., 2006 and Ham et al., 2009). Within the context of these mixed results and based on Cooper's conceptualization, we hypothesized that SAD would not be a significant predictor of enhancement drinking motives.

Results Wave 6 sample characteristics for the 717 young adults in this study are provided in Table 1; both sociodemographic variables and the prevalence of lifetime psychiatric disorders are provided. The prevalence of lifetime psychiatric disorders for this sample is similar to that reported for this demographic group in other national surveys (Kessler et al., 2005). Bivariate correlations among the variables used in the linear regression analyses are provided in Table 2 and include adolescent variables, lifetime anxiety and major depressive disorders, and motives for drinking at Wave 6. In addition, means and standard deviations are provided at the bottom of Table 2. Table 1. Wave 6 sample characteristics. Variables Sex Males 306 (42.7%) Females 411 (57.3%) Ethnicity Non-Hispanic White 98.7% Other 1.3% Age 28.87 years. (SD = 1.16) Marital status Currently married 449 (62.6%) Cohabitation 87 (12.1%) Divorced 37 (5.2%) Never married 144 (20.1%) Number of children 0 (58.8%) 1 (21.2%) ≥ 2 (20.1%) Average # years of education 15.83 (SD = 2.33) Employment status Employed full-time 551 (76.7%) Employed part-time 77 (10.7%) Full-time homemaker 37 (5.2%) Unemployed 52 (7.2%) Median family income $40,000–$54,999 Lifetime DSM-IV disorders n (%) Social anxiety disorder (SAD) 91 (12.7%) General anxiety disorder (GAD) 56 (7.8%) Panic disorder (PD) 46 (6.4%) Simple phobia (SP) 151 (21.1%) Major depressive disorder (MDD) 206 (28.7%) Table options Table 2. Correlation matrix of variables used in regression analyses (N = 717). Variables 1 2 3 4 5 6 7 8 9 10 11 12 1. Sex (1 = M; 2 = F) – 2. Adol—Coping .05 – 3. Adol—QFI −.173 .323 – 4. Adol—CESD .122 .423 .03 – 5. Lifetime MDDa .112 .112 −.02 .153 – 6. Lifetime SAD .091 .163 .01 .213 .203 – 7. Lifetime GAD .102 .06 .03 .143 .193 .122 – 8. Lifetime panic disorder .04 .112 −.05 .102 .213 .173 .163 – 9. Lifetime simple phobia .173 .091 −.112 .132 .233 .293 .133 .173 – 10. Young adult—Coping motives −.03 .323 .283 .132 .243 .223 .163 .173 .112 – 11. Young adult—Social motives −.132 .163 .253 −.04 .07 .04 .01 .04 .05 .503 – 12. Young adult—Enhancement motives −.143 .223 .283 .01 .153 .122 .07 .173 .05 .703 .653 – Mean 1.57 11.12 2.86 14.94 0.29 0.13 0.08 0.06 0.21 8.52 13.32 10.61 SD 0.50 4.03 0.66 10.01 0.45 0.33 0.27 0.24 0.41 2.74 2.82 3.31 a Psychiatric diagnoses were assessed at Wave 5 and Wave 6. 1 p < .05. 2 p < .01. 3 p < .001. Table options Table 3 provides a summary of the three regression equations predicting each of the three drinking motives in young adulthood. For coping drinking motives, support was provided for the statistically significant association of SAD with coping drinking motives while controlling for prior relevant adolescent variables, including adolescent coping motives, alcohol use, and depressed affect, and other lifetime anxiety disorders and major depressive disorder. The specificity of the SAD-to-coping drinking motives association was unique in that for the other two regression equations, SAD was not a significant predictor of social or enhancement drinking motives in young adulthood. Hence, support was provided for the salience of the SAD–coping motives relationship and this relationship did not generalize to other motives for drinking. Table 3. Standardized coefficients for linear regression models predicting motives for drinking in young adulthood. Variables Coping motivesa (n = 717) Social motives (n = 717) Enhancement motives (n = 717) Sex (1 = M; 2 = F) −.05 −.112 −.133 Adolescent variables Coping motives for drinking .213 .132 .163 Alcohol consumption (QFI) .213 .203 .223 Depressive symptoms (CESD) −.04 −.112 −.102 Lifetime disorders Major depressive disorder .163 .06 .122 Social anxiety disorder .123 .01 .07 Generalized anxiety disorder .081 −.01 .02 Panic disorder .091 .02 .133 Simple phobia .03 .07 .02 F-Statistic (df = 9707) 22.113 8.433 15.633 Adjusted R2 value .21 .08 .15 a Drinking motives were assessed at Wave 6. 1 p < .05. 2 p < .01. 3 p < .001. Table options While highlighting the importance of the statistically significant SAD-to-coping motives relationship, secondarily it is also of importance that other variables in the regression analyses significantly predicted coping motives as well as social and enhancement motives. The adolescent variables of coping motives for drinking and alcohol use significantly predicted all three young adult motives for drinking approximately 11 years later. Likewise, lower depressive symptoms in adolescence significantly predicted higher levels of social and enhancement motives in young adulthood. Lifetime major depressive disorder and panic disorder were also significantly associated both with young adult coping and enhancement drinking motives, and generalized anxiety disorder was significantly associated with young adult coping drinking motives. Therefore, our findings supported the specific hypothesized association of SAD with coping drinking motives in young adulthood, but also indicated potentially important roles for other anxiety disorders and major depressive disorder, as well as adolescent behaviors, in understanding variation in motives for drinking in young adulthood.