Understanding the relationship of social anxiety with alcohol use and alcohol‐related problems in young people: A meta‐analysis

Anton J Fichtenmaier; Amanda M George

doi:10.1111/add.70345

. 2026 Mar 8;121(6):1362–1380. doi: 10.1111/add.70345

Understanding the relationship of social anxiety with alcohol use and alcohol‐related problems in young people: A meta‐analysis

Anton J Fichtenmaier ^1,^✉, Amanda M George ¹

PMCID: PMC13155264 PMID: 41796042

Abstract

Background and aims

Social anxiety is associated with disparate alcohol‐related outcomes among young people. This meta‐analysis synthesised the literature to determine what factors (e.g. impulsivity) may account for variance in these outcomes.

Methods

Empirical studies reporting the correlation of social anxiety with alcohol use and/or alcohol‐related problems (ARPs) among young people (aged 13–29 years) were identified through a systematic literature search. Five random‐effects meta‐analyses were performed for ARPs, problematic alcohol use, frequency, quantity and quantity by frequency index measures of alcohol use. Seventy studies were included with 233 effect sizes extracted. The average age was 20 years (n = 38 517; 66.2% female).

Results

Social anxiety was negatively associated with index alcohol use [number of studies (k) = 28, r = −0.05, 95% confidence interval (CI) = −0.08 to −0.03, t = −4.04, P < 0.001] but statistically non‐significant with quantity (k = 21, r = 0.00, 95% CI = −0.04 to 0.05, t = 0.18, P = 0.86) or frequency (k = 18, r = −0.01, 95% CI = −0.06 to 0.05, t = −0.29, P = 0.78) of alcohol use. Social anxiety was statistically significantly positively associated with ARPs (k = 45, r = 0.13, 95% CI = 0.10–0.16, t = 9.93, P < 0.001) and problematic alcohol use (k = 23, r = 0.06, 95% CI = 0.01–0.11, t = 2.68, P = 0.01). Impulsivity was a statistically significant moderator, such that, as the correlation of impulsivity with social anxiety increased, the association of social anxiety with index alcohol use positively increased. Subgroup analyses for ARPs measure used were also statistically significant.

Conclusion

Young people with elevated social anxiety appear to drink less alcohol than their peers, but report more problematic alcohol use and alcohol‐related problems. Impulsivity may clarify unexpected patterns of lower alcohol consumption, although conclusions remain tentative due to methodological constraints.

Keywords: alcohol use, alcohol‐related problems, impulsivity, meta‐analysis, social anxiety, young people

INTRODUCTION

Social anxiety symptoms have been linked with a range of adverse alcohol‐related outcomes among young people [1]. The current consensus is that young people with higher social anxiety symptoms typically experience more alcohol‐related problems (ARPs), despite drinking less [2]. This pattern may seem contradictory to self‐medication theory, which posits individuals high in social anxiety drink to alleviate distress, leading to both greater alcohol use and ARPs [3, 4]. However, these disparate findings of lower use but more ARPs may reflect unique drinking behaviours across distinct subtypes of social anxiety. Specifically, the identification of an approach‐motivated high social anxiety and high impulsivity subtype may help explain the discrepant findings [5]. Ultimately, clarity on the complex relationship of social anxiety with alcohol use and ARPs, particularly among young people, is needed.

Social anxiety

Social anxiety is defined as an intense fear of evaluation by others in social situations [6]. Subclinical social anxiety symptoms are pervasive and symptoms can cause levels of functional impairment, known as social anxiety disorder (SAD) [6, 7]. SAD is one of the most common diagnoses among all anxiety disorders [8], with a lifetime and 12‐month prevalence rate of 12.1% and 7.1%, respectively [9]. SAD disproportionately affects young people, with 90% of cases occurring before the age of 23 years [10, 11]. In one large (n = 6825) worldwide survey, 36% of respondents aged 16–29 years scored above the threshold criteria for SAD [12].

Social anxiety and alcohol use/problems

Social anxiety and alcohol use disorders (AUDs) are highly comorbid [13, 14, 15, 16, 17]. This comorbidity has been linked with greater impairments than either condition alone [18], with evidence suggesting that SAD temporally precedes AUDs [18, 19]. Epidemiological data indicate that 48% of adults with lifetime SAD also met the criteria for AUD [16]. In one report, 43% of college students with SAD also met the criteria for AUD [20]. Moreover, individuals with subclinical social anxiety symptoms are nearly twice as likely to develop heavy drinking habits or meet criteria for alcohol abuse/dependence [21]. The high prevalence of both clinical and subclinical levels of social anxiety with alcohol‐related outcomes, especially among young people, warrants research attention.

Individuals with elevated social anxiety may be more prone to problematic alcohol use [1, 2]. Coping‐based theoretical models like the self‐medication theory [3], the stress‐response dampening model [22] and the tension reduction theory [23] suggest that individuals with social anxiety symptoms may seek the anxiolytic effects of alcohol to manage their anxiety [3, 24]. Specifically, it is predicted that those with greater social anxiety symptoms are more sensitive to the anxiolytic effects of alcohol [25, 26]. Consequently, through coping‐related drinking patterns, dependence may develop, resulting in both greater alcohol use and ARPs [1, 25, 26]. However, the extant literature comprises mixed findings [1, 2].

A critical review by Morris and colleagues [1] identified a strong relationship of social anxiety with AUDs, while also illustrating the ambiguity seen in associations with different alcohol‐related outcomes. Regarding alcohol consumption, there was no clear pattern, with studies showing positive, negative or no associations with social anxiety symptoms. Similar patterns were observed for the association of social anxiety with ARPs, albeit this association was more consistently positive. More recently, a meta‐analysis by Schry and White [2] identified a negative relationship of social anxiety with frequency (r = −0.10) and quantity (r = −0.07) of alcohol use, but a positive relationship with ARPs (r = 0.05), among college students. Notably, this same disparate pattern extends to non‐college‐attending young people (aged 13–29 years) with social anxiety [1, 27, 28], highlighting the need for a review on the broader population of young people. These disparate findings seemingly contradict assumptions from coping‐based models of substance use, which would suggest a positive association of social anxiety with both alcohol use and ARPs.

Perhaps individuals with greater social anxiety still seek the anxiolytic effects of alcohol without drinking more frequently or in large quantities [2]. This would align with traditional characterisations of social anxiety, marked by avoidance and risk aversion [5, 6]. For instance, an individual with elevated social anxiety may predominantly avoid distressing social drinking contexts or consume just enough alcohol to reduce anxious distress, but not in excess, to avoid potential consequences from intoxication [2]. This behaviour would correspond with lower scores on alcohol consumption metrics. However, these individuals may still be more susceptible to certain ARPs. Fearing negative evaluation may make one more sensitive to potential social consequences when drinking, such as being rude/obnoxious or getting into fights and arguments [18, 29]. This proposition would align with both findings from Schry and White [2] and expectations from coping‐based models, like the self‐medication theory. This argument highlights the need to consider the heterogeneity of social anxiety in differential drinking behaviours.

Heterogeneity in social anxiety presentations has been explored through the examination of different subtypes of social anxiety [8, 18]. Evidence indicates individuals with different profiles of social anxiety report distinct drinking behaviours. For instance, in Morris and colleagues’ [1] review, individuals in the generalised subtype of social anxiety consumed more alcohol than those in the performance‐based subtype. Since Schry and White's [2] review, a subtype of approach‐motivated individuals characterised by higher social anxiety and elevated impulsivity has been identified [5]. This profile contrasts with the more prototypical avoidant presentation of social anxiety [5]. Perhaps individuals with prototypical avoidant traits may drink less while experiencing more ARPs, mirroring the findings of Schry and White [2]. Whereas those who score high in both social anxiety and impulsivity may consume more alcohol and experience even greater ARPs through their approach‐motivated strategies to regulate anxiety [30, 31]. This premise would align more with coping‐based theoretical models of substance use, which predicts social anxiety to be positively associated with both alcohol use and ARPs. Ultimately, this subtype highlights the necessity to consider impulsivity when examining these relationships.

Social anxiety and impulsivity

Social anxiety is typically characterised by inhibition, avoidance and risk aversion [30]. However, a subset presents with impulsive and risk‐prone tendencies [5, 31]. Individuals with this profile of high social anxiety and high impulsivity are characterised by being approach motivated, with elevated novelty seeking, disinhibition, reward sensitivity and rash impulsivity [32, 33]. When in an anxiety‐inducing situation they may not demonstrate prototypical avoidant behaviours. Rather, they may act on impulsive externalising behaviours [34]. Profile analyses link individuals high in social anxiety and impulsivity with greater problematic alcohol use [5, 31, 32, 33, 34]. Additional research has demonstrated that impulsivity impedes maturing out of ARPs for college students with social anxiety [35], and found that impulsivity moderated the relationship of social anxiety with ARPs, but not alcohol use [36]. In contrast, evidence suggests that those with high social anxiety and high impulsivity‐related fun‐seeking behaviours reported greater alcohol use than individuals with high social anxiety but lower fun‐seeking behaviours [37]. Taken together, evidence indicates that those with elevated social anxiety and impulsivity may be particularly susceptible to alcohol use/ARPs.

Impulsivity may account for the disparate outcomes observed in the relationship of social anxiety with alcohol use and ARPs. Specifically, approach‐motivated individuals high in social anxiety and impulsivity may be less avoidant of anxiety‐inducing situations. Consequently, they may situate themselves in drinking contexts more regularly and, thus, drink more frequently. Additionally, research demonstrates that individuals high in social anxiety and impulsivity experience more severe social anxiety symptoms [5, 30]. Therefore, they may be more sensitive to the anxiolytic effects of alcohol and may drink in greater quantities to alleviate distressing symptoms. Lastly, the combination of greater alcohol use, elevated social anxiety symptoms (i.e. fear of evaluation) and rash behaviour traits may further increase susceptibility to more ARPs [31, 35].

Alternate sources of variance

In examining associations of social anxiety with alcohol variables, factors beyond impulsivity need consideration. Men and women vary on reported alcohol use and endorsed ARPs, such that men drink more while women experience more ARPs [38, 39, 40, 41]. Among young people aged 18–29 years, women were also 1.5 times more likely to meet the criteria for SAD than men [42]. Thus, gender identity must be considered. Schry and White [2] also demonstrated the significance of participant recruitment (i.e. selection based on social anxiety or alcohol use status). Most research utilises college students [43]. Whether results differ by college student status is important to consider.

Features of research design must also be examined. Social anxiety research often relies on cross‐sectional surveys, which yield different participant types compared with lab studies and may produce different outcomes [44]. Additionally, distinct measures of social anxiety may capture different social anxiety traits/symptoms. Measuring avoidance compared with evaluative fears may impact drinking behaviours [2]. Similar concerns arise from the operationalisation of different alcohol measures. For example, the Alcohol Use Disorder Identification Test (AUDIT) [63], a brief measure of problematic alcohol use with items that assess use and ARPs, has been used as a sole measure of use or ARPs within the literature. However, to provide clarity on the relationship of social anxiety with alcohol measures, it is essential to examine alcohol use and ARPs separately. Additionally, owing to recall bias, the reporting time frame for alcohol measures should be considered [45].

The present study

Given the complex relationships linking social anxiety, alcohol use and ARPs among young people, a synthesis of the literature is needed. This meta‐analysis expands on Schry and White's [2] work from 2013, by integrating research published since 2008 and broadening the population to include all young people. We also examine subgroups and moderators, including impulsivity, noting the recent identification of a profile of both high social anxiety and impulsivity [5].

Based on past literature, it was expected that social anxiety would be negatively correlated with alcohol use and positively correlated with ARPs and measures of combined alcohol use/problems. It was also hypothesised that impulsivity would moderate the relationship of social anxiety with alcohol use, problems and combined use/problems. Lastly, it was predicted that subgroup analyses comparing the type of alcohol measure used would show effect sizes for studies that utilise the AUDIT to be non‐significant for measuring alcohol use and ARPs.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were abided by throughout all stages of this review. This meta‐analysis was not pre‐registered. The lead author performed all screenings, extractions and analyses. The second author co‐completed full‐text screenings and a subset of extractions, coding, and quality assessments to ensure consistency and reliability; disagreements were resolved by consensus, as necessary.

Operational definitions

Alcohol use was defined as any measure examining the consumption of alcohol. Specifically: frequency of alcohol use, a measure of the number of times one consumed alcohol within a given time frame; quantity of alcohol use, the amount of alcohol consumed within a given time period; and index of alcohol use, a measure of quantity by frequency of alcohol use. ARPs were defined as a measure of the problems or negative consequences associated with the consumption of alcohol. When a measure captured a combination of alcohol use/problems as a screening tool (e.g. AUDIT), it was defined as a measure of problematic alcohol use. All alcohol‐related outcomes were considered in a general alcohol use context; specific contexts (i.e. drinking games) were excluded. Lastly, social anxiety was captured as either: (i) an official clinical diagnosis of social anxiety; or (ii) a valid and reliable measure of social anxiety symptomology, like the Social Interaction Anxiety Scale (SIAS) [46].

Study inclusion

Peer‐reviewed publications were eligible for inclusion if written in English, empirically based, had younger participants (mean age range of 13–29 years), included a measure of social anxiety and had at least one alcohol‐related measure of interest. Studies had to report the zero‐order correlation or provide sufficient information for the correlation to be calculated between social anxiety and the alcohol‐related measure. Considering the interest in individuals with a profile of high social anxiety and high impulsivity, only studies published from 2008 (the first recorded identification of this subtype) [5] were considered. Since a single study can span multiple publications using the same data set, only the original or earliest published study was included, to avoid dependency effects.

Search strategy

Articles were retrieved from PsychInfo, Scopus, Web of Science and Medline, using the following search strategy: ((social* anxi* OR social* phob*) AND (alcoh* OR drink*)). Publications between 1 January 2008 and 11 June 2024 (last search date across all platforms) were included. An expert librarian was consulted for database selection and development of the search strategy (Appendix S1).

Study selection

Studies were screened using Covidence [47]. The lead author screened all titles and abstracts (after duplicates were removed). Both authors screened full texts for inclusion eligibility; discrepancies were resolved by discussion. If a full text could not be accessed and/or there was not enough information to calculate an effect size, the corresponding author was contacted. None of the nine authors contacted could share the requisite information, and thus, these articles were excluded.

Summary measure

Pearson zero‐order correlation coefficients (r) between social anxiety and alcohol‐related outcomes were extracted where possible. When an r value was not included, it was calculated from raw data or from other effect sizes, such as Cohen's d, t‐values, F‐values, β weights or χ ² values (Appendix S2) [48, 49, 50].

Data collection process

A data extraction template and variable coding rationale was developed in Microsoft Excel, influenced by Schry and White [2] and Pittelkow and colleagues [51]. The data extraction template and coding rationale was confirmed by both authors piloting five random studies; there were no disagreements. The following data were extracted from the included studies: author(s), publication year, study design, sample size, mean age, proportion female, sample type, recruitment selection criteria, country, social anxiety measure, impulsivity measure, alcohol measure, reported time frame for each alcohol measure, correlation of social anxiety with impulsivity and correlation of social anxiety with an alcohol‐related outcome (Appendix S3).

The internal validity of meta‐analytic results can be impacted by the inclusion of dependent effects [52]. Therefore, when multiple effect sizes for the same outcome were reported, an averaged composite effect size was created to avoid dependency effects [53]. For instance, when subscales of a measure were used (e.g. the Fear and Avoidance subscales of the Liebowitz Social Anxiety Scale, LSAS) [54] an average composite effect size was calculated across the subscales. If multiple measures captured the same construct (e.g. both the SIAS and LSAS were used) an average composite effect size was calculated across all scales. Additionally, if effect sizes were reported separately for males and females, even though these can be classified as independent groups [48], a composite effect size was calculated. Composite effect sizes were calculated by converting correlations into a Fisher's z‐score, calculating associated variance, applying a random‐effects model, pooling the effect size and converting back to a correlation coefficient (Appendix S4).

Study quality

The quality of the included studies was assessed using the 20‐item Quality of Survey Studies in Psychology (Q‐SSP) [55]. The Q‐SSP suits the prevalent cross‐sectional survey‐based methodologies in psychology and addresses key aspects of a good quality bias tool [56]. The Q‐SSP assesses quality in four domains: study rationale and justification (n = 3); participant recruitment (n = 4); data treatment and interpretation (n = 10); and ethical procedures (n = 3). Studies meeting each criterion received a score of one on that item, or zero if they did not reach the standard. Some items were not applicable to all studies. As such, the overall quality score is a percentage of the summed score for applicable items. Protogerou and Hagger [55] provided a flexible quality threshold recommendation score of 70%–75% (based on the number of applicable items) to categorise acceptable study quality, which was also adopted here. The lead author scored all studies (Appendix S5), while the second author independently scored 10 random studies. There were no identified disagreements.

Planned methods of analysis

All analyses were conducted in RStudio [57] using the metafor package [143]. The pooled relationships of social anxiety with alcohol use and ARPs were examined using the random‐effects model. Under this model, between‐study variance was calculated under restricted maximum likelihood and the Hartung–Knapp adjustment [58]. Publication bias was assessed through the visual inspection of funnel plots, Egger's test [59] and a trim‐and‐fill test [60]. Heterogeneity was assessed through the visual inspection of forest plots and interpretation of Q, I ² and a prediction interval based on T ² [61], to inform the need for moderator and subgroup analyses.

Planned subgroup and moderator analyses

Several planned subgroup analyses for this review required the collapsing of different codes. For sample type, extracted descriptors included college, middle school, high school, community, mixed community and college, and clinical samples. Subgroups were divided into college students (samples that were composed entirely of college students) or collapsed into a non‐college (other) sample group. Study design extracted codes were cross‐sectional, longitudinal, micro‐longitudinal and lab study (dichotomised into cross‐sectional studies and all other study designs). For recruitment criteria, the codes included: status as current drinker; meeting a threshold level indicative of a social anxiety classification; both current drinker and social anxiety classification (collapsed into the social anxiety classification code); and studies that had no recruitment criteria. There were 25 unique measures of social anxiety extracted. Owing to the distribution of these measures, subgroups were collapsed into studies that used the SIAS, any other single measure of social anxiety or multiple measures of social anxiety. Eighteen unique alcohol measures were extracted; grouping varied depending on the alcohol outcome. For ARPs, the subgroups included studies that utilised: the Rutgers Alcohol Problem Index (RAPI) [62]; AUDIT (only when the correlation of social anxiety with AUDIT items 4–10 was reported); Brief Young Adult Alcohol Consequences Questionnaire (B‐YAACQ) [64]; Young Adult Alcohol Consequences Questionnaire (YAACQ) [65]; and any other single or multiple measures used. Problematic alcohol use was divided into the AUDIT and other. Index, quantity and frequency of alcohol use were divided into: the AUDIT (only when the correlation for the relevant AUDIT frequency and/or quantity items with social anxiety were reported); Daily Drinking Questionnaire (DDQ) [66]; and other. Planned moderation analyses included examining the role of gender identity (% female), age (in years), reporting time frame (days) and impulsivity (correlation of impulsivity measure with social anxiety measure). All analyses required at least two studies representing the construct for the test to be conducted [48].

Sensitivity analysis

Sensitivity analyses assessed the robustness of the present research assumptions. Specifically, a subgroup analysis of studies that required composite effect sizes/transformations to be made compared with studies that did not, and a moderation test utilising the Q‐SSP quality score of each study.

RESULTS

Study selection

Pilot searching was performed between March and June to refine the search criteria. The final search was conducted on 11 June 2024 and resulted in 4228 identified studies. After removing duplicates, the titles and abstracts for 2363 articles were screened. Full texts of 134 studies were screened to ensure they fulfilled the pre‐specified inclusion criteria, and 70 studies were then included in the final review (for the PRISMA flow chart, see Figure 1). A total of 196 effect sizes were extracted, including gender‐split composite effect sizes, and an additional 37 composite effect sizes were calculated when multiple measures or subscales were used.

Included studies overview

The average age for all 70 included studies (n = 38 517) ranged from 13 to 28 years (mean age, M = 20 years). Age was not weighted across studies. The average gender identity proportion across all included studies was 66.2% female. Included studies varied by the country of origin for the sample, with 51 US samples, seven Canadian samples, four Australian samples, two Nigerian samples, and one sample each from Cyprus, Germany, South Korea and Switzerland, and a hybrid US–Cypriot sample. There were 58 cross‐sectional, eight longitudinal and four laboratory study designs. Fifty‐eight studies included college samples, four community populations, three high school students, three hybrid college and community or clinical populations, one sample comprising middle school students and one sample comprising hospital patients.

Data synthesis

Mean effects

Table 1 summarises the mean effects and heterogeneity tests for each analysis. Social anxiety was significantly positively correlated with problematic alcohol use and ARPs, and was significantly negatively correlated with index measures of alcohol use. The association with drinking frequency and quantity were both non‐significant (for forest plots, see Figures 2, 3, 4, 5, 6). Significant heterogeneity was observed for each outcome, indicating the potential presence of moderators or subgroups. The visual inspection of funnel plots (Appendix S6), outcomes of Egger's regression and stable estimates post random‐effects trim‐and‐fill tests (Appendix S7) [59, 60] suggest that publication or small study bias should not be an issue.

TABLE 1.

Mean effect analyses of social anxiety with different alcohol‐related outcomes.

	Sample size		Effect size			Heterogeneity
	k	n	r	95% CI	t	Q	I ²	PI	H ²	95% CI
ProbAU	23	12 424	0.06^**	0.01, 0.11	2.68	103.41^***	78.72	−0.14, 0.26	5.91	3.33, 13.11
IndexAU	28	17 533	−0.05^***	−0.08, −0.03	−4.04	59.52^***	54.64	−0.14, 0.04	2.22	1.26, 4.80
FreqAU	18	6116	−0.01	−0.06, 0.05	−0.29	55.57^***	69.41	−0.19, 0.17	3.51	1.90, 10.10
QuantAU	21	8868	0.00	−0.04, 0.05	0.18	57.11^***	64.98	−0.14, 0.15	3.04	1.77, 8.86
ARPs	45	26 938	0.13^***	0.10, 0.16	9.93	147.31^***	70.13	−0.01, 0.26	4.31	2.38, 7.74

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Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; Q = heterogeneity significance test; I ² = variation across studies; PI = prediction interval; H ² = sampling variability; ProbAU = problematic alcohol use; IndexAU = index of alcohol use; FreqAU = frequency of alcohol use; QuantAU = quantity of alcohol use; ARPs = alcohol‐related problems.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

Forest plot of the analysis of the association between social anxiety with problematic alcohol use. Weighted effect size and 95% CI are presented on the right. Studies are sorted alphabetically.

Forest plot of the analysis of the association between social anxiety with index of alcohol use. Weighted effect size and 95% CI are presented on the right. Studies are sorted alphabetically.

Forest plot of the analysis of the association between social anxiety with frequency of alcohol use. Weighted effect size and 95% CI are presented on the right. Studies are sorted alphabetically.

Forest plot of the analysis of the association between social anxiety with quantity of alcohol use. Weighted effect size and 95% CI are presented on the right. Studies are sorted alphabetically.

Forest plot of the analysis of the association between social anxiety with alcohol‐related problems (ARPs). Weighted effect size and 95% CI are presented on the right. Studies are sorted alphabetically.

Moderation analyses

Five potential moderators were considered: impulsivity, age, gender identity, reported time frame for alcohol measure and study quality. Meta regressions under restricted maximum effects with each moderator for the associations of social anxiety with each alcohol‐related outcome were performed. Table 2 depicts the effect sizes and heterogeneity tests of each meta‐regression for all alcohol‐related outcomes. Two of these analyses were significant. First, the effect of gender identity on the association of social anxiety with problematic alcohol use (Q _M [1] = 4.64, P = 0.04, R ² = 21.43), meaning that as the proportion of females in the studies increased, the strength of the association of social anxiety with problematic alcohol use increased slightly. The test of residual heterogeneity remained significant and decreased slightly. Second, there was a significant effect of impulsivity on the relationship of social anxiety with index measures of alcohol use (Q _M [1] = 2.25, P = 0.04, R ² = 100). Specifically, as the association of social anxiety with impulsivity increased, there was a stronger positive association of social anxiety with alcohol use. The test of residual heterogeneity was insignificant, meaning that the remaining variability in effect sizes can be attributed to random variation. Notably, the small k may impact this result, and so findings should be interpreted cautiously [48, 67].

TABLE 2.

Moderation analyses of social anxiety with different alcohol‐related outcomes.

	Sample size		Effect size			Heterogeneity
	k	n	r	95% CI	P	H ²	I ²
ProbAU
Gender	22	11 746	0.01	0.00, 0.01	0.04^*	4.44^***	77.50
Age	23	12 424	0.01	−0.02, 0.03	0.55	5.24^***	80.93
Reported time frame	3	3969	−0.00	−0.00, 0.00	0.87	1.00	0.00
Quality	23	12 424	−0.00	−0.01, 0.00	0.42	5.66^***	82.34
IndexAU
Impulsivity	3	1212	0.26	0.07, 0.46	0.04^*	1.00	0.00
Gender	28	17 533	−0.00	−0.00, 0.00	0.38	1.83^**	45.43
Age	27	16 365	0.01	−0.00, 0.02	0.12	1.71^*	41.47
Reported time frame	20	14 633	0.00	−0.00, 0.00	0.36	1.97^*	49.34
Quality	28	17 533	0.00	−0.00, 0.01	0.31	2.25^***	44.57
FreqAU
Gender	17	5769	0.00	−0.00, 0.01	0.61	3.75^***	73.36
Age	18	6116	0.04	−0.00, 0.08	0.10	2.95^***	66.15
Reported time frame	14	4901	0.00	−0.00, 0.00	0.98	3.75^***	73.33
Quality	18	6116	0.00	−0.01, 0.01	0.59	3.54^***	71.73
QuantAU
Gender	20	8521	0.00	−0.00, 0.01	0.25	2.97^***	66.36
Age	21	8668	0.01	−0.01, 0.03	0.50	3.13^***	68.03
Reported time frame	20	8049	0.00	−0.00, 0.00	0.92	3.35^***	70.13
Quality	21	8868	0.00	−0.00, 0.01	0.33	3.00^***	66.66
ARPs
Impulsivity	4	3870	0.07	−0.28, 0.42	0.46	1.00	0.00
Gender	43	25 913	0.00	−0.00, 0.00	0.09	3.23^***	69.07
Age	44	25 770	−0.00	−0.02, 0.01	0.53	3.33^***	69.96
Reported time frame	33	20 712	0.00	−0.00, 0.00	0.69	3.26^***	69.37
Quality	45	26 938	−0.00	−0.00, 0.00	0.75	3.78^***	73.55

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Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; H ² = sampling variability, with significance based on Q; I ² = variation across studies; ProbAU = problematic alcohol use; IndexAU = index of alcohol use; FreqAU = frequency of alcohol use; QuantAU = quantity of alcohol use; ARPs = alcohol‐related problems; Quality = Q‐SSP score. Gender identity was coded as proportion of sample female.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

Subgroup analyses

For problematic alcohol use (Table 3), only the study design yielded significant differences for subgroup effect size comparisons. The mean effect for studies with a cross‐sectional design was significant, small, positive and significantly reduced heterogeneity. The effect size for all other study designs was non‐significant and did not significantly reduce the heterogeneity.

TABLE 3.

Subgroup analyses of social anxiety with problematic alcohol use.

		Sample size		Effect size			Heterogeneity
		k	n	r	95% CI	P	Q	I ²	PI
Study design						0.02^*
	Other	3	3818	0.00	−0.05, 0.05	0.88	1.09	0.00	−0.03, 0.03
	Cross‐sectional	20	8606	0.07	0.01, 0.13	0.02^*	93.90^***	79.77	−0.14, 0.28
Sample type						0.80
	True college	20	8277	0.07	0.01, 0.12	0.03^*	93.75^***	79.73	−0.15, 0.28
	Other	3	4147	0.05	−0.11, 0.21	0.29	6.59^*	69.67	0.04, 0.14
Recruitment criteria						0.05
	Current drinker	11	4684	0.11	0.01, 0.20	0.04^*	62.92^***	84.11	−0.17, 0.36
	None	12	7740	0.01	−0.02, 0.05	0.47	15.67	29.81	−0.05, 0.08
SA measure						0.94
	SIAS	8	4236	0.06	0.00, 0.12	0.04^*	17.80^*	60.68	−0.01, 0.18
	Other single measure	8	4727	0.08	−0.07, 0.23	0.24	45.40^***	84.58	−0.26, 0.41
	Multiple measures used	7	3461	0.06	−0.04, 0.15	0.20	36.28^***	83.46	−0.15, 0.25
ProbAU measure						0.44
	AUDIT	19	8272	0.06	−0.00, 0.11	0.05	83.41^***	78.42	−0.14, 0.25
	Other(s)	4	4152	0.11	−0.10, 0.30	0.19	18.24^***	83.55	−0.15, 0.35
Transformed						0.91
	Yes	8	3703	0.07	−0.00, 0.14	0.06	26.60^***	73.69	−0.09, 0.23
	No	15	8721	0.06	−0.01, 0.14	0.09	73.75^***	81.02	−0.17, 0.29

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P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

For index measures of alcohol use (Table 4) there were no significant subgroup differences. However, for both frequency (Table 5) and quantity (Table 6) of alcohol use, the mean effect for recruitment criteria used yielded significant differences between subgroups. For frequency, the mean effect for studies that recruited individuals based on a social anxiety classification was the only subgroup with a positive effect size, albeit non‐significant. The effect sizes for studies that recruited current drinkers or had no recruitment criteria were both negative and non‐significant. For drinking quantity, the mean effect for the current drinker subgroup was small, negative and non‐significant. The effect size for studies with no recruitment criteria was significant, small and negative. The mean effect for studies that recruited based on a social anxiety classification was small, positive and significant. For both quantity and frequency of alcohol use, only the current drinker subgroup saw reduced heterogeneity.

TABLE 4.

Subgroup analyses of social anxiety with index of alcohol use.

		Sample size		Effect size			Heterogeneity
		k	n	r	95% CI	P	Q	I ²	PI
Study design						0.12
	Other	6	5777	−0.02	−0.08, 0.05	0.55	5.82	14.07	−0.09, 0.06
	Cross‐sectional	22	11 756	−0.06	−0.09, −0.03	< 0.001^***	40.61^**	48.29	−0.15, 0.03
Sample type						0.23
	True college	25	11 563	−0.06	−0.09, −03	< 0.001^***	39.81^*	39.72	−0.14, 0.02
	Other	3	5970	−0.01	−0.17, 0.14	0.72	6.59	57.49	−0.12, 0.09
Recruitment criteria						0.43
	Current drinker	15	12 428	−0.05	−0.09, −0.01	0.03^*	38.15^***	63.30	−0.15, 0.06
	Social anxiety classification	4	1127	−0.03	−0.12, 0.06	0.39	2.57	0.00	−0.10, 0.05
	None	9	3978	−0.07	−0.13, −0.02	0.13	13.50	40.75	−0.16, 0.02
SA measure						0.67
	SIAS	10	4222	−0.07	−0.12, −0.01	0.02^*	18.15^*	50.41	−0.18, 0.05
	Other single measure	9	8742	−0.04	−0.10, 0.02	0.14	23.41^*	65.83	−0.15, 0.07
	Multiple measures used	9	4569	−0.05	−0.10, −0.01	0.03^*	10.71	25.32	−0.11, 0.01
IndexAU measure						0.75
	AUDIT	5	2137	−0.08	−0.17, 0.02	0.09	7.11	43.71	−0.18, 0.03
	DDQ	12	6051	−0.05	−0.10, −0.00	0.04^*	22.49^*	51.09	−0.16, 0.06
	Other(s)	11	9345	−0.05	−0.09, −0.00	0.03^*	24.82^**	59.71	−0.14, 0.05
Transformed						0.10
	Yes	14	7388	−0.07	−0.10, −0.04	< 0.001^***	17.29	24.80	−0.12, −0.02
	No	14	10 145	−0.03	−0.08, 0.01	0.13	29.06^**	55.26	−0.13, 0.07

Open in a new tab

Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; I ² = variation across studies; PI = prediction interval; SA = social anxiety; IndexAU = quantity by frequency index measure of alcohol use; AUDIT = Alcohol Use Disorder Identification Test; DDQ = Daily Drinking Questionnaire; SIAS = Social Interaction Anxiety Scale.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

TABLE 5.

Subgroup analyses of social anxiety with frequency of alcohol use.

		Sample size		Effect size			Heterogeneity
		k	n	r	95% CI	P	Q	I ²	PI
Study design						0.21
	Other	2	202	0.14	−0.89, 0.93	0.46	2.69	62.79	−0.22, 0.46
	Cross‐sectional	16	5914	−0.02	−0.08, 0.04	0.47	48.45^***	69.04	−0.19, 0.15
Sample type						0.56
	True college	14	5262	−0.02	−0.08, 0.04	0.55	43.73^***	70.27	−0.19, 0.16
	Other	4	854	0.04	−0.26, 0.33	0.70	8.33^*	64.00	−0.30, 0.37
Recruitment criteria						0.002^**
	Current drinker	11	3692	−0.01	−0.07, 0.06	0.80	25.87^**	61.34	−0.16, 0.14
	Social anxiety classification	4	496	0.11	−0.04, 0.25	0.10	3.10	3.14	0.02, 0.19
	None	3	1928	−0.11	−0.27, 0.07	0.12	5.82	65.62	−0.24, 0.03
SA measure						0.14
	SIAS	6	2718	−0.06	−0.16, 0.04	0.20	17.82^**	71.94	−0.23, 0.11
	Other single measure	6	968	0.08	−0.07, 0.22	0.22	9.94	49.71	−0.11, 0.26
	Multiple measures used	6	2430	−0.02	−0.11, 0.07	0.58	11.89^*	57.96	−0.15, 0.11
FreqAU measure						0.57
	AUDIT	3	1321	0.01	−0.32, 0.35	0.87	13.62^**	85.32	−0.28, 0.30
	DDQ	6	2078	0.03	−0.10, 0.15	0.63	14.08^*	64.48	−0.16, 0.21
	Other(s)	9	2717	−0.04	−0.12, 0.05	0.35	25.21^**	68.27	−0.21, 0.15
Transformed						0.16
	Yes	9	2471	0.03	−0.05, 0.11	0.43	21.86^**	63.41	−0.14, 0.20
	No	9	3645	−0.04	−0.13, 0.04	0.28	28.68^***	72.10	−0.23, 0.14

Open in a new tab

Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; I ² = variation across studies; PI = prediction interval; SA = social anxiety; FreqAU = frequency of alcohol use; AUDIT = Alcohol Use Disorder Identification Test; DDQ = Daily Drinking Questionnaire; SIAS = Social Interaction Anxiety Scale.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

TABLE 6.

Subgroup analyses of social anxiety with quantity of alcohol use.

		Sample size		Effect size			Heterogeneity
		k	n	r	95% CI	P	Q	I ²	PI
Study design						0.50
	Other	2	202	0.11	−0.96, 0.97	0.62	4.74^*	78.88	−0.38, 0.56
	Cross‐sectional	18	8129	0.00	−0.05, 0.05	0.94	50.57^***	66.38	−0.14, 0.15
Sample type						0.64
	True college	18	6601	0.00	−0.05, 0.05	0.97	50.43^***	66.29	−0.16, 0.16
	Other	3	2267	0.04	−0.32, 0.40	0.67	6.50^*	69.23	−0.23, 0.31
Recruitment criteria						< 0.001^***
	Current drinker	10	3875	−0.02	−0.08, 0.04	0.52	20.82^*	56.78	−0.15, 0.11
	Social anxiety classification	6	1285	0.13	0.07, 0.19	0.003^**	3.82	0.00	0.07, 0.18
	None	5	3708	−0.05	−0.09, −0.00	0.04^*	3.56	0.00	−0.08, −0.01
SA measure						0.46
	SIAS	5	2220	0.03	−0.08, 0.14	0.47	12.16^**	67.10	−0.13, 0.19
	Other single measure	7	3113	−0.03	−0.09, 0.04	0.36	13.97^*	57.04	−0.06, 0.00
	Multiple measures used	9	3535	0.00	−0.08, 0.08	0.98	29.00^***	72.42	−0.18, 0.18
QuantAU measure						0.22
	AUDIT	3	1321	−0.01	−0.25, 0.23	0.88	5.19	61.45	−0.18, 0.17
	DDQ	10	3391	0.04	−0.04, 0.12	0.26	28.14^***	68.02	−0.13, 0.22
	Other(s)	8	4156	−0.03	−0.10, 0.03	0.24	13.70	48.89	−0.22, 0.15
Transformed						0.38
	Yes	13	5370	0.02	−0.05, 0.09	0.53	40.39^***	70.29	−0.16, 0.20
	No	8	3498	−0.02	−0.08, 0.05	0.58	15.74^*	55.54	−0.14, 0.10

Open in a new tab

Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; I ² = variation across studies; PI = prediction interval; SA = social anxiety; QuantAU = quantity of alcohol use; AUDIT = Alcohol Use Disorder Identification Test; DDQ = Daily Drinking Questionnaire; SIAS = Social Interaction Anxiety Scale.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

Two subgroup analyses were significant for ARPs (Table 7). The first was the recruitment criteria used. Mean effects were significant and positive for all subgroups: current drinker samples, studies using a social anxiety classification (which had the largest effect size) and studies with no recruitment criteria. However, only the current drinker subgroup effect size reduced heterogeneity. Additionally, there were significant differences for the type of ARP measure used. Studies that used the RAPI yielded the largest significant positive effect. The mean effects for the B‐YAACQ, YAACQ and studies that used other measure(s) were all significant, positive and relatively similar in magnitude. The effect size for the AUDIT was positive, but was also the only non‐significant subgroup. Only the RAPI and other(s) subgroups significantly reduced heterogeneity (for further details of subgroup/moderator analyses, see Appendix S8).

TABLE 7.

Subgroup analyses of social anxiety with alcohol‐related problems (ARPs).

		Sample size		Effect size			Heterogeneity
		k	n	r	95% CI	P	Q	I ²	PI
Study design						0.13
	Other	9	6331	0.10	0.05, 0.14	0.002^**	9.41	14.98	0.01, 0.17
	Cross‐sectional	36	20 607	0.13	0.10, 0.16	< 0.001^***	126.13^***	72.25	−0.01, 0.28
Sample type						0.05
	True college	39	17 415	0.13	0.06, 0.12	< 0.001^***	141.84^***	70.19	−0.04, 0.29
	Other	6	9523	0.09	0.05, 0.12	0.001^***	5.91	15.33	0.04, 0.14
Recruitment criteria						0.02^**
	Current drinker	25	16 303	0.13	0.09, 0.17	< 0.001^***	103.15^***	76.73	−0.03, 0.28
	Social anxiety classification	10	3233	0.17	0.12, 0.22	< 0.001^***	12.44	27.67	0.08, 0.26
	None	10	7402	0.09	0.05, 0.12	< 0.001^***	13.81	34.81	05, 0.13
SA measure used						0.50
	SIAS	11	5093	0.12	0.04, 0.19	0.005^**	50.02^***	80.01	−0.08, 0.30
	Other single measure	14	12 267	0.12	0.06, 0.18	< 0.001^***	44.36^***	70.70	−0.05, 0.28
	Multiple measures used	20	9578	0.15	0.12, 0.18	< 0.001^***	34.56^*	45.02	0.06, 0.23
ARP measure						< 0.001^***
	RAPI	23	11 807	0.16	0.13, 0.19	< 0.001^***	66.29^***	66.81	0.04, 0.28
	AUDIT	7	3062	0.09	−0.04, 0.22	0.15	32.98^***	81.81	−0.18, 0.35
	B‐YAACQ	4	4285	0.11	0.08, 0.15	0.002^**	1.86	0.00	0.09, 0.14
	YAACQ	4	1141	0.06	0.03, 0.09	0.009^**	0.31	0.00	0.00, 0.12
	Other(s)	7	6643	0.10	0.04, 0.17	0.01^**	12.67^*	52.65	−0.00, 0.21
Transformations						0.97
	Yes	25	11 574	0.13	0.10, 0.16	< 0.001^***	69.85^***	65.64	−0.00, 0.26
	No	20	15 364	0.13	0.08, 0.17	< 0.001^***	75.25^***	74.75	−0.03, 0.28

Open in a new tab

Note: k = number of studies; n = number of participants; r = correlation coefficient; CI = confidence interval; I ² = variation across studies; PI = prediction interval; SA = social anxiety; ARPs = alcohol‐related problems; AUDIT = Alcohol Use Disorder Identification Test; B‐YAACQ = Brief Young Adult Alcohol Consequences Questionnaire; DDQ = Daily Drinking Questionnaire; SIAS = Social Interaction Anxiety Scale; YAACQ = Young Adult Alcohol Consequences Questionnaire.

P < 0.05;

^**

P < 0.01;

^***

P < 0.001.

Sensitivity analyses

There were a wide range of quality scores on the Q‐SSP (53–90%), with median and average quality scores of 74% and 71%, respectively (Appendix S5), which is in the borderline range for acceptable quality (70%–75%) [55]. Of all 70 studies included, 61.4% were of an acceptable quality (>70%). Most studies did not meet the criteria for sample size justification (item 7), availability of full measures (item 11), information about who collected the data (item 13) and time frame of data collection (item 15). Moderation analyses for study quality were all non‐significant (Table 2), suggesting that study quality does not impact the relationship of social anxiety with any alcohol‐related outcomes. The mean effects for subgroups comparing studies that required an effect size to be transformed or not were also non‐significant for all alcohol‐related outcomes.

DISCUSSION

The present meta‐analysis addressed the need to consider the relationship of social anxiety with alcohol‐related outcomes among a broad population of young people. The mean effects for social anxiety with drinking quantity and frequency were non‐significant. However, the mean effect for index alcohol use was significant and negative, showing partial support for the hypothesis. The mean effects for problematic alcohol use and ARPs were significant and positive, supporting the hypothesis. These findings are consistent with Schry and White's study on college students [2]. For all mean‐effect analyses, there was significant heterogeneity, suggesting variance may be attributed to moderators or subgroup differences, such as other co‐occurring personality constructs (i.e. impulsivity).

Impulsivity

It was hypothesised that impulsivity would moderate the relationship of social anxiety with all alcohol‐related outcomes. However, only six studies included an impulsivity measure. Therefore, the moderating effect of impulsivity with social anxiety could only be examined for ARPs and index measures of alcohol use. Nonetheless, impulsivity moderated the association of social anxiety with alcohol use, but not ARPs, partially supporting the hypothesis. Specifically, when there was a stronger correlation of impulsivity with social anxiety, the association of social anxiety with alcohol use also became stronger in the positive direction. This finding contradicts those of Keough and colleagues [36], who reported a moderating role of impulsivity for social anxiety with ARPs, but not use. Additionally, research indicates greater alcohol use among individuals scoring high in social anxiety and impulsivity [31, 33, 37]. The result for ARPs was unexpected, considering the robust association of greater alcohol use with more ARPs [68, 69], and that for each study included in the analysis, the interactions of social anxiety, impulsivity and ARPs were significant. However, these analyses were underpowered, so the findings should be interpreted cautiously [48].

Alternatively, perhaps inconsistent characterisation for those with a high social anxiety and impulsivity profile may help explain non‐significant findings. Impulsivity is a multifaceted construct, with specific traits differentially driving associations with different alcohol‐related outcomes [70]. Impulsivity measures included in this meta‐analysis were the impulsivity subscale of the Substance Use Risk Profile Scale [71], the impulsivity subscale of the Difficulty in Emotion Regulation Scale [72], the Behavioural Inhibition System/Behavioural Activation System (BIS/BAS) [73] and the negative urgency subscale of the Urgency, Premeditation, Perseverance, Sensation Seeking and Positive Urgency (UPPS‐P) scale [74]. Results may differ with alternate measures, such as examining each UPPS‐P subscale. Coskunpinar and colleagues [70], for example, found that negative/positive urgency were the UPPS‐P facets most highly related to ARPs. However, none of the studies in the meta‐analysis included each facet of the UPPS‐P. Additionally, several studies that examined impulsivity were excluded for not meeting age eligibility or not reporting an effect size. Clearly, the effects of impulsivity on social anxiety with different alcohol outcomes warrants further investigation, and a theoretically driven conceptualisation of this high social anxiety and impulsivity profile would be beneficial.

Types of alcohol measure used

There were significant differences with the ARP measures used in the studies. The RAPI was the most frequently used measure and had the largest effect size (also larger than the mean effect for ARPs). The RAPI subgroup also demonstrated marginally less variability in effect sizes across studies in comparison with the mean effect for ARPs. The B‐YAACQ, YAACQ and other measure(s) all also had significant effect sizes for capturing ARPs. The AUDIT mean effect was non‐significant when measuring both ARPs and alcohol use, consistent with the hypothesis. The AUDIT is a brief measure of hazardous alcohol use and a diagnostic tool for AUDs [63, 75]. Results indicate that using the relevant AUDIT item(s) for frequency, quantity or ARPs is not effective as an independent measure of these metrics when assessing differential relationships with social anxiety.

We propose two explanations for the differences in effect sizes between ARP measures. First, there are differences in the response scales: the RAPI uses a Likert scale for responses, whereas the B‐YAACQ and the YAACQ use dichotomous responses. A greater response range allows for more flexibility and sensitivity for endorsing ARPs, potentially driving the greater effect size for the RAPI [76]. These measures also differ in the specific ARPs they measure. Perhaps certain ARPs drive the observed effect size [2, 77] or are not evaluated by the respondent as aversive [77, 78]. Future research should examine the differential endorsement of certain ARPs by people with different profiles of social anxiety and consider subjective appraisals of these ARPs, as there is research suggesting that young adults may not view certain ARPs as problematic [78].

Other notable findings

Subgroup analyses for the sample used (college samples vs others) were non‐significant across all alcohol outcomes. These findings correspond with research by Wiecko [79] who suggested that college students’ behaviour varies slightly but insignificantly with that of the general population, at least in criminology and criminal justice research. However, it is important to note the small k for the other(s) sample type subgroup, which also illustrates an over‐representation of college student samples in the literature.

The recruitment criteria used yielded significant subgroup contrasts for frequency and quantity of alcohol use, and ARPs. Studies that recruited participants based on a pre‐determined threshold of social anxiety symptoms generated the largest effect size. These results could arise from the formation of more extreme groups, which create extreme results [2]. Future research should consider these design factors when developing new studies.

Implications

There are several key implications of this research for health practitioners and researchers. First, the efficacy of the AUDIT in assessing alcohol use or ARPs for individuals with elevated social anxiety symptoms should be considered. Despite its popularity, the mean effect for studies that used AUDIT was non‐significant for both ARPs and alcohol use. Assessing potential differential alcohol outcomes among those with elevated social anxiety symptoms with the AUDIT may be limited. Rather, a tool specifically designed for the relevant alcohol‐related outcome could be utilised (i.e. DDQ to measure use or RAPI to measure ARPs). Second, the significance of impulsivity as a moderator in the relationship of social anxiety with index measures of alcohol use is pertinent. This indicates that those scoring high in social anxiety and impulsivity likely consume the most alcohol. Findings here do not support the suggestion that these individuals would experience more ARPs, despite contrary evidence in the literature. More research on individuals scoring high in social anxiety and impulsivity is required to understand the drinking behaviours of these atypical individuals to best inform clinical treatment. For example, it may be that traditional behavioural activation exposure tasks are less effective for treating these approach‐motivated individuals [5]. Perhaps treatment tools like values clarification, cognitive restructuring and developing coping skills for impulse control should be considered [5], but further research is needed to substantiate this suggestion.

Additional implications include the expanded generalisability of findings on the association of social anxiety with different alcohol‐related outcomes to the broader population of young people. With no difference in effect sizes between college samples and non‐college samples, the findings between these two subgroups may be generalisable. This study also found a moderating effect of gender identity on the association of social anxiety with problematic alcohol use. Those who identified as female with elevated social anxiety symptoms may be more likely, albeit slightly, to engage in problematic drinking than males scoring high in social anxiety. Nevertheless, health practitioners should be conscious of a potential increased risk of problematic alcohol use among women with elevated social anxiety.

Limitations

The findings of the current meta‐analysis should be considered with certain limitations. Some moderator and subgroup analyses were underpowered, which may have impacted the ability to detect true effects in these conditions. The strategies for collapsing certain codes for subgroup analyses may also not best capture true effects. There were many studies that did not reach a suitable quality level on the Q‐SSP included in this meta‐analysis. Although sensitivity analysis suggested that this did not impact the results, the number of poorer‐quality studies included should be acknowledged. Moreover, studies were only included if published in English and requested data from several authors for other potentially eligible studies was not acquired, thus potentially affecting the representativeness. The failure to identify all eligible studies may also prevent the dismissal of publication bias. Although, Morrison and colleagues [80] have suggested that English language restrictions do not bias meta‐analyses. Lastly, specific drinking contexts (i.e. drinking games) were excluded. Context may play an important role in the complex association of social anxiety with alcohol‐related outcomes and merits future research attention.

CONCLUSION

The present findings illustrate that there is still considerable variability between studies that look at the relationship of social anxiety with different alcohol‐related outcomes. This meta‐analysis supports current consensus that social anxiety is associated with lower alcohol use, but more ARPs. However, the current synthesis also illustrates that social anxiety is associated with greater levels of problematic alcohol use, indicative of a potential AUD. This meta‐analysis suggests that impulsivity could be a relevant construct in understanding the complex co‐occurrence of social anxiety with alcohol use. The variation seen in ARP measures may suggest that certain problems or consequences could be particularly influential in the relationship of social anxiety with ARPs. Future researchers and health practitioners should be considerate of which ARP measures they adopt. Nonetheless, this synthesis offers clinicians and academics valuable insights on the nuanced relationship of social anxiety with alcohol use/problems that can inform future research and clinical practices.

AUTHOR CONTRIBUTIONS

Anton J. Fichtenmaier: Conceptualization (equal); data curation (lead); formal analysis (lead); investigation (lead); methodology (equal); project administration (lead); visualization (lead); writing—original draft (lead); writing—review and editing (lead). Amanda M. George: Conceptualization (equal); data curation (supporting); formal analysis (supporting); investigation (supporting); methodology (equal); project administration (supporting); supervision (lead); writing—original draft (supporting); writing—review and editing (supporting).

DECLARATION OF INTERESTS

None to declare.

Supporting information

Appendix S1. Search strategy and pilot searches.

Appendix S2. Formulae used.

Appendix S3. Data extraction table.

Appendix S4. Transformations.

Appendix S5. Quality scores.

Appendix S6. Funnel plots of social anxiety with different alcohol‐related outcomes.

Appendix S7. Publication bias checks for each alcohol‐related outcome.

Appendix S8. Additional subgroup/moderator analyses outcomes.

ADD-121-1362-s001.docx^{(133.7KB, docx)}

ACKNOWLEDGEMENTS

The authors wish to thank Tricia Brown and Phil Kavanagh for their insights throughout the current project. Open access publishing facilitated by University of Canberra, as part of the Wiley ‐ University of Canberra agreement via the Council of Australasian University Librarians

Fichtenmaier AJ, George AM. Understanding the relationship of social anxiety with alcohol use and alcohol‐related problems in young people: A meta‐analysis. Addiction. 2026;121(6):1362–1380. 10.1111/add.70345

Funding information This research was supported by an Australian Government Research Training Program (RTP) Scholarship.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix S1. Search strategy and pilot searches.

Appendix S2. Formulae used.

Appendix S3. Data extraction table.

Appendix S4. Transformations.

Appendix S5. Quality scores.

Appendix S6. Funnel plots of social anxiety with different alcohol‐related outcomes.

Appendix S7. Publication bias checks for each alcohol‐related outcome.

Appendix S8. Additional subgroup/moderator analyses outcomes.

ADD-121-1362-s001.docx^{(133.7KB, docx)}

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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PERMALINK

Understanding the relationship of social anxiety with alcohol use and alcohol‐related problems in young people: A meta‐analysis

Anton J Fichtenmaier

Amanda M George

Abstract

Background and aims

Methods

Results

Conclusion

INTRODUCTION

Social anxiety

Social anxiety and alcohol use/problems

Social anxiety and impulsivity

Alternate sources of variance

The present study

METHODS

Operational definitions

Study inclusion

Search strategy

Study selection

Summary measure

Data collection process

Study quality

Planned methods of analysis

Planned subgroup and moderator analyses

Sensitivity analysis

RESULTS

Study selection

FIGURE 1.

Included studies overview

Data synthesis

Mean effects

TABLE 1.

FIGURE 2.

FIGURE 3.

FIGURE 4.

FIGURE 5.

FIGURE 6.

Moderation analyses

TABLE 2.

Subgroup analyses

TABLE 3.

TABLE 4.

TABLE 5.

TABLE 6.

TABLE 7.

Sensitivity analyses

DISCUSSION

Impulsivity

Types of alcohol measure used

Other notable findings

Implications

Limitations

CONCLUSION

AUTHOR CONTRIBUTIONS

DECLARATION OF INTERESTS

Supporting information

ACKNOWLEDGEMENTS

DATA AVAILABILITY STATEMENT

REFERENCES

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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