Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2012 Jan 1.
Published in final edited form as: Addict Behav. 2010 Aug 25;36(1-2):129–132. doi: 10.1016/j.addbeh.2010.08.015

Social Anxiety and Marijuana-Related Problems: The Role of Social Avoidance

Julia D Buckner a,*, Richard G Heimberg b, Norman B Schmidt c
PMCID: PMC2981690  NIHMSID: NIHMS245408  PMID: 20832947

Abstract

Background

People with elevated social anxiety seem vulnerable to marijuana-related impairment. Yet little work has examined core facets of social anxiety that may be especially related to marijuana-related problems.

Method

The present study examined the relationships between current (past three months) marijuana-related problems and two aspects of social anxiety (fear in social situations and social avoidance) among current (N=102) marijuana users.

Results

Although both social fear and social avoidance were significantly correlated with marijuana-related problems, only social avoidance was uniquely related to marijuana problems (after controlling for social fear, sex, negative affect, alcohol problems, and marijuana use frequency). Sex moderated the relationship between social avoidance and marijuana-related problems such that men with greater social avoidance exhibited the greatest severity of marijuana-related problems.

Conclusions

Avoidance of social situations appears robustly related to marijuana-related problems. This finding has important implications for theoretical models that can inform treatment of co-occurring social anxiety and marijuana problems.

Keywords: Marijuana, Cannabis, Drug Abuse, Social Anxiety, Social Phobia, Social Avoidance

Approximately 6% of the U.S. population used marijuana in the past month and nearly 30% of marijuana users suffer from a marijuana use disorder (MUD; Substance Abuse and Mental Health Services Administration [SAMHSA], 2009). Individuals with elevated social anxiety appear particularly vulnerable to marijuana-related problems. The lifetime prevalence rate of marijuana dependence among people with social anxiety disorder (SAD) is nearly seven times that of the general population (Agosti, Nunes, & Levin, 2002; Anthony, Warner, & Kessler, 1994). Undergraduates with higher social anxiety also appear to be particularly vulnerable to marijuana problems (Buckner, Bonn-Miller, Zvolensky, & Schmidt, 2007; Buckner, Mallott, Schmidt, & Taylor, 2006; Buckner & Schmidt, 2008, 2009; Buckner, Schmidt, Bobadilla, & Taylor, 2006). Social anxiety was related to the transition from first use to the development of marijuana-related problems among adolescent boys (Marmorstein, White, Loeber, & Stouthamer-Loeber, 2010). Moreover, adolescents with SAD, compared to those without SAD, were nearly five times more likely to develop marijuana dependence as adults (Buckner et al., 2008).

People with elevated social anxiety may use marijuana to reduce anxiety in social situations, a hypothesis consistent with tension reduction models (Conger, 1956). Supporting this idea, those with higher social anxiety were more likely to use marijuana to manage negative affect (NA; Buckner, Bonn-Miller et al., 2007). Yet, social anxiety and SAD were unrelated to the expectation that marijuana reduces NA (Buckner & Schmidt, 2008, 2009), suggesting the relationship between social anxiety and marijuana-related problems may be motivated by more than simple tension reduction. Another limitation of this hypothesis is that it does not address why people with elevated social anxiety, as opposed to other types of NA, experience such high rates of marijuana-related problems.

Anecdotal evidence from our clinic suggests socially anxious individuals may use marijuana as a social avoidance strategy. To illustrate, one client reported that he used marijuana at home instead of going to social events. He reported that, since his friends also used marijuana, they would understand that sometimes using marijuana makes it difficult to leave the house. However, research is necessary to test whether social avoidance is related to marijuana use behaviors more broadly.

This study examined whether affective (fear in social situations) or behavioral (social avoidance) facets of social anxiety were uniquely related to marijuana-related problems and whether relations between social fear/avoidance and marijuana-related problems remained robust after controlling for sex, NA, alcohol problems, and marijuana use frequency. Also because social anxiety may be differentially related to marijuana-related problems based on sex (Buckner, Mallott et al., 2006), we tested whether sex moderated these relationships. We examined these relationships among undergraduates because college students appear vulnerable to marijuana-related problems (Buckner, Ecker, & Cohen, 2010; Caldeira, Arria, O’Grady, Vincent, & Wish, 2008) and the transition from high school to college appears associated with increased social anxiety (Spokas & Heimberg, 2009).

2. Method

2.1 Participants

The sample consisted of 102 (43.1% female) current marijuana users who received psychology research credit for participating. Ages ranged from 18–22 (M=19.13, SD=1.04). The racial/ethnic composition was: 2.0% African American or Black, 1.0% American Indian, 2.0% Asian or Asian American, 85.3% Caucasian, 2.9% Hispanic/Latino, 5.9% mixed, and 1.0% “other.” Participants completed computerized versions of study measures. This study was approved by the university’s Institutional Review Board and informed consent was obtained prior to data collection.

2.2 Measures

2.2.1 Liebowitz Social Anxiety Scale (LSAS)

Participants completed the self-report version of the LSAS which assesses fear and avoidance of 24 social situations and is comprised of two subscales: (1) fear in social situations and (2) avoidance of social situations (Liebowitz, 1987). The LSAS and these subscales demonstrate adequate psychometric properties (Fresco et al., 2001; Heimberg et al., 1999).

2.2.2 Marijuana Use Form (MUF)

The MUF is a self-report instrument assessing current (past three months) frequency using a 0–9 rating scale (Buckner, Bonn-Miller et al., 2007). Similar questionnaires have been successfully used to assess marijuana use (e.g., Buckner, Bonn-Miller et al., 2007; Buckner & Schmidt, 2008).

2.2.3 Marijuana Problems Scale (MPS)

The MPS is a 19-item list of negative consequences associated with past 90-day marijuana use on a 0–2 scale (Stephens, Roffman, & Curtin, 2000) with good reliability (Buckner, Keough, & Schmidt, 2007; Buckner & Schmidt, 2008; Stephens et al., 2000).

2.2.4 Positive and Negative Affect Schedule (PANAS)

The Negative Affectivity scale of the PANAS (Watson, Clark, & Tellegen, 1988) was used to control for general levels of NA. The PANAS is a widely used and well-validated measure (for review see Watson, 2000).

2.2.5 Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT is a 10-item self-report screen of alcohol-related problems (Saunders, Aasland, Babor, & de la Fuente, 1993) with good psychometric properties (O’Connell et al., 2004). The AUDIT was included to control for alcohol-related problems.

3. Results

Bivariate correlations between study variables (and means and standard deviations) are presented in Table 1. Social avoidance and social fear were both positively correlated with marijuana-related problems. Next, social avoidance and social fear were simultaneously entered as predictor variables into a linear regression to examine the unique relations of these variables with marijuana-related problems. Only social avoidance remained significantly related to marijuana problems, β = .48, p=.017, sr2=.054 (social fear: β = −.13, p=.513, sr2=.003).

Table 1.

Means, Standard Deviations, and Bivariate Correlations between Social Avoidance, Social Anxiety, Negative Affect, and Marijuana and Alcohol Use Behaviors

1 2 3 4 5
1. Social avoidance
2. Social fear .87**
3. Negative affect .43** .47**
4. Marijuana problems .37** .29** .44**
5. Alcohol problems .16 .06 .16 .26**
 M (SD) 17.3 (12.2) 18.5 (12.9) 17.5 (6.6) 4.7 (4.8) 11.64 (5.2)
 Range 0.0–52.0 0.0–59.0 10.0–38.0 0.0–28.0 0.0–28.0
Open in a new tab

Note. Social avoidance = the Avoidance Subscale of the Liebowitz Social Anxiety Scale. Social Fear = the Fear Subscale of the Liebowitz Social Anxiety Scale.

*

p < .05,

**

p < .01

A hierarchical linear regression analysis was conducted to examine whether this unique relationship remained after controlling for relevant variables. Predictor variables were: Step 1: sex, marijuana use frequency, alcohol-related problems, and NA; and Step 2: social avoidance and social fear. This strategy ensured that effects at Step 2 cannot be attributed to variance shared with variables in Step 1 (Cohen & Cohen, 1983). Social avoidance continued to be significantly related to marijuana-related problems after controlling for the Step 1 variables, β = .44, p=.021, sr2=.042. Overall, this model accounted for 30.1% of the variance in marijuana-related problems, with covariates accounting for 23.5%, social avoidance uniquely accounting for an additional 4.2%, and social fear only uniquely accounted for 0.7%.

We next examined whether sex moderated this relationship. Predictor variables were: Step 1: social avoidance, sex, marijuana use frequency, alcohol-related problems, and NA; and Step 2: the interaction between social avoidance and sex. The sex X social avoidance interaction was significant, β = −.32, p = .034, f2 = .051. The form of the interaction (Figure 1) was examined by inserting ratings of social avoidance (one standard deviation above and below the mean) for men and women (Cohen & Cohen, 1983). Although higher social avoidance was related to more severe marijuana-related problems for both men and women, this effect was particularly pronounced for men. Tests of simple slopes were also conducted (Aiken & West, 1991). Only the simple slope of the moderator variable for men was significant (t = 4.04, p < .001; women: t = 1.48, p = .136). This pattern suggests that greater social avoidance makes it particularly likely that men will experience marijuana-related problems.

Figure 1.

Figure 1

Open in a new tab

The interaction between social avoidance and sex in the prediction of marijuana-related problems.

***p < .001

4. Discussion

This study supports previous findings that people with elevated social fear and social avoidance experience more marijuana-related problems (Agosti et al., 2002; Buckner, Bonn-Miller et al., 2007; Buckner, Mallott et al., 2006; Buckner & Schmidt, 2008, 2009; Buckner, Schmidt, Bobadilla et al., 2006; Buckner et al., 2008). We extended this work by delineating that greater social avoidance (but not social fear) was uniquely related to marijuana-related problems, even after controlling for sex, marijuana use frequency, alcohol problems, and NA.

These data suggest that those who avoid situations may be engaging in more high-risk use. Using marijuana to manage affect is associated with more marijuana-related problems than using marijuana for more socially-oriented motives (Buckner, Bonn-Miller et al., 2007; Simons, Correia, Carey, & Borsari, 1998). Thus, it may be that those who avoid social situations use marijuana for more high-risk motives rather than for more benign reasons. Alternatively, it may be that social avoiders have fewer opportunities to use given that marijuana use tends to occur in social situations (Reilly, Didcott, Swift, & Hall, 1998). If this is the case, it may be that when they do use marijuana they are less able to successfully manage their use.

It is noteworthy that sex moderated the relationship between social avoidance and marijuana-related problems such that the relationship between social avoidance and marijuana-related problems was particularly pronounced among male marijuana users. Future work is necessary to directly test whether these men use marijuana as a means to avoid social situations and if so, what about this type of use is related to marijuana-related impairment.

It is also noteworthy that social fear and avoidance were unrelated to alcohol-related problems in this sample. This finding seems counter to mounting evidence that elevated social anxiety is related to alcohol-related problems (Buckner & Heimberg, in press; Buckner, Schmidt, & Eggleston, 2006; Buckner et al., 2008; Buckner & Turner, 2009; Lewis & O’Neill, 2000). Yet our sample was comprised entirely of current marijuana users. In another marijuana use sample, social anxiety was also unrelated to alcohol problems (Buckner, Bonn-Miller et al., 2007), suggesting that socially anxious marijuana users may use marijuana as their substance of choice to manage their social anxiety. Although their use seems related to marijuana problems, they may not be particularly vulnerable to also experiencing alcohol-related problems.

The present findings have important implications for the treatment of co-occurring social anxiety and marijuana-related problems. Using marijuana for social avoidance can be conceptualized as a “safety behavior,” or behavior that decreases anxiety in the short-term but tends to exacerbate anxiety in the long run (Clark, 2001). If individuals with elevated social anxiety use marijuana to avoid social situations, it may help them feel less anxious in the short-term but may increase anxiety in the long-term as they ruminate about potential social repercussions for not attending the social event, fail to habituate to anxiety by attending social situations, fail to obtain information that disconfirms negative thoughts that maintain social anxiety, etc. As with any safety behavior, therapists can use cognitive-behavioral strategies (see Hope, Heimberg, & Turk, 2010) to help clients reduce their reliance on marijuana for social avoidance.

Present findings should be considered in light of limitations. First, the cross-sectional nature of the design precludes delineation of causal relationships. Second, the sample was comprised of undergraduates. Third, we did not explicitly test whether individuals with elevated social anxiety (elevated social fear and/or avoidance) use marijuana to avoid social situations or to manage social fear and future work could benefit from more fine-grained examination of these marijuana use motives.

Research Highlights.

  • Social fear and social avoidance were positively correlated with marijuana problems

  • Only social avoidance (not social fear) was uniquely related to marijuana problems

  • Sex moderated the relationship between social avoidance and marijuana problems

  • Men with higher social avoidance were particularly vulnerable to marijuana problems

Acknowledgments

Role of Funding Sources

Funding for this study was provided by NIDA grant F31-DA021457 awarded to Julia D. Buckner. NIDA had no further role in study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Footnotes

Contributors

Author Buckner and Schmidt designed the study and wrote the protocol. Authors Buckner, Heimberg and Schmidt conducted literature searches and wrote reviews of prior research. Author Buckner conducted the statistical analysis. All authors contributed to and have approved the final manuscript.

Conflict of Interest

All authors declare that they have no conflicts of interest.

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Contributor Information

Richard G. Heimberg, Email: heimberg@temple.edu.

Norman B. Schmidt, Email: schmidt@psy.fsu.edu.

References

  1. Agosti V, Nunes E, Levin F. Rates of psychiatric comorbidity among U.S. residents with lifetime cannabis dependence. American Journal of Drug and Alcohol Abuse. 2002;28(4):643–652. doi: 10.1081/ADA-120015873. [DOI] [PubMed] [Google Scholar]
  2. Aiken LS, West SG. Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage; 1991. [Google Scholar]
  3. Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology. 1994;2(3):244–268. doi: 10.1037/1064-1297.2.3.244. [DOI] [Google Scholar]
  4. Buckner JD, Bonn-Miller MO, Zvolensky MJ, Schmidt NB. Marijuana use motives and social anxiety among marijuana-using young adults. Addictive Behaviors. 2007;32(10):2238–2252. doi: 10.1016/j.addbeh.2007.04.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Buckner JD, Ecker AH, Cohen AS. Mental health problems and interest in marijuana treatment among marijuana-using college students. Addictive Behaviors. 2010;35(9):826–833. doi: 10.1016/j.addbeh.2010.04.001. [DOI] [PubMed] [Google Scholar]
  6. Buckner JD, Heimberg RG. Drinking behaviors in social situations account for alcohol-related problems among socially anxious individuals. Psychology of Addictive Behaviors. doi: 10.1037/a0020968. in press. [DOI] [PubMed] [Google Scholar]
  7. Buckner JD, Keough ME, Schmidt NB. Problematic alcohol and cannabis use among young adults: The roles of depression and discomfort and distress tolerance. Addictive Behaviors. 2007;32(9):1957–1963. doi: 10.1016/j.addbeh.2006.12.019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Buckner JD, Mallott MA, Schmidt NB, Taylor J. Peer influence and gender differences in problematic cannabis use among individuals with social anxiety. Journal of Anxiety Disorders. 2006;20(8):1087–1102. doi: 10.1016/j.janxdis.2006.03.002. [DOI] [PubMed] [Google Scholar]
  9. Buckner JD, Schmidt NB. Marijuana effect expectancies: Relations to social anxiety and marijuana use problems. Addictive Behaviors. 2008;33(11):1477–1483. doi: 10.1016/j.addbeh.2008.06.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Buckner JD, Schmidt NB. Social anxiety disorder and marijuana use problems: The mediating role of marijuana effect expectancies. Depression and Anxiety. 2009;26(9):864–870. doi: 10.1002/da.20567. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Buckner JD, Schmidt NB, Bobadilla L, Taylor J. Social anxiety and problematic cannabis use: Evaluating the moderating role of stress reactivity and perceived coping. Behaviour Research and Therapy. 2006;44(7):1007–1015. doi: 10.1016/j.brat.2005.08.002. [DOI] [PubMed] [Google Scholar]
  12. Buckner JD, Schmidt NB, Eggleston AM. Social anxiety and problematic alcohol consumption: The mediating role of drinking motives and situations. Behavior Therapy. 2006;37(4):381–391. doi: 10.1016/j.beth.2006.02.007. [DOI] [PubMed] [Google Scholar]
  13. Buckner JD, Schmidt NB, Lang AR, Small JW, Schlauch RC, Lewinsohn PM. Specificity of social anxiety disorder as a risk factor for alcohol and cannabis dependence. Journal of Psychiatric Research. 2008;42(3):230–239. doi: 10.1016/j.jpsychires.2007.01.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Buckner JD, Turner RJ. Social anxiety disorder as a risk factor for alcohol use disorders: A prospective examination of parental and peer influences. Drug and Alcohol Dependence. 2009;100(1–2):128–137. doi: 10.1016/j.drugalcdep.2008.09.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Caldeira KM, Arria AM, O’Grady KE, Vincent KB, Wish ED. The occurrence of cannabis use disorders and other cannabis-related problems among first-year college students. Addictive Behaviors. 2008;33(3):397–411. doi: 10.1016/j.addbeh.2007.10.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Clark DM. A cognitive perspective on social phobia. In: Crozier WR, Alden LE, editors. International handbook of social anxiety: Concepts, research and interventions relating to the self and shyness. New York, NY US: John Wiley & Sons Ltd; 2001. pp. 405–430. [Google Scholar]
  17. Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1983. [Google Scholar]
  18. Conger JJ. Alcoholism: Theory, problem and challenge. II. Reinforcement theory and the dynamics of alcoholism. Quarterly Journal of Studies on Alcohol. 1956;17(2):296–305. [PubMed] [Google Scholar]
  19. Fresco DM, Coles ME, Heimberg RG, Liebowitz MR, Hami S, Stein MB, et al. The Liebowitz Social Anxiety Scale: A comparison of the psychometric properties of self-report and clinician-administered formats. Psychological Medicine. 2001;31(6):1025–1035. doi: 10.1017/S0033291701004056. [DOI] [PubMed] [Google Scholar]
  20. Heimberg RG, Horner KJ, Juster HR, Safren SA, Brown EJ, Schneier FR, et al. Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine. 1999;29(1):199–212. doi: 10.1017/S0033291798007879. [DOI] [PubMed] [Google Scholar]
  21. Hope DA, Heimberg RG, Turk CL. Managing social anxiety: A cognitive-behavioral therapy approach (Therapist Guide) 2. New York: Oxford University Press; 2010. [Google Scholar]
  22. Lewis BA, O’Neill HK. Alcohol expectancies and social deficits relating to problem drinking among college students. Addictive Behaviors. 2000;25(2):295–299. doi: 10.1016/s0306-4603(99)00063-5. [DOI] [PubMed] [Google Scholar]
  23. Liebowitz MR. Social phobia. Modern Problems of Psychopharmacology. 1987;22:141–173. doi: 10.1159/000414022. [DOI] [PubMed] [Google Scholar]
  24. Marmorstein NR, White HR, Loeber R, Stouthamer-Loeber M. Anxiety as a predictor of age at first use of substances and progression to substance use problems among boys. Journal of Abnormal Child Psychology. 2010;38(2):211–224. doi: 10.1007/s10802-009-9360-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. O’Connell H, Chin A-V, Hamilton F, Cunningham C, Walsh JB, Coakley D, et al. A systematic review of the utility of self-report alcohol screening instruments in the elderly. International Journal of Geriatric Psychiatry. 2004;19:1074–1086. doi: 10.1002/gps.1214. [DOI] [PubMed] [Google Scholar]
  26. Reilly D, Didcott P, Swift W, Hall W. Long-term cannabis use: Characteristics of users in an Australian rural area. Addiction. 1998;93(6):837–846. doi: 10.1080/09652149835350. [DOI] [PubMed] [Google Scholar]
  27. Saunders JB, Aasland OG, Babor TF, de la Fuente JR. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption: II. Addiction. 1993;88(6):791–804. doi: 10.1111/j.1360-0443.1993.tb02093.x. [DOI] [PubMed] [Google Scholar]
  28. Simons JS, Correia CJ, Carey KB, Borsari BE. Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology. 1998;45(3):265–273. doi: 10.1037/0022-0167.45.3.265. [DOI] [Google Scholar]
  29. Spokas M, Heimberg RG. Overprotective parenting, social anxiety, and external locus of control: Cross-sectional and longitudinal relationships. Cognitive Therapy and Research. 2009;33(6):543–551. doi: 10.1007/s10608-008-9227-5. [DOI] [Google Scholar]
  30. Stephens RS, Roffman RA, Curtin L. Comparison of extended versus brief treatments for marijuana use. Journal of Consulting and Clinical Psychology. 2000;68(5):898–908. doi: 10.1037/0022-006X.68.5.898. [DOI] [PubMed] [Google Scholar]
  31. Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: National Findings (HHS Publication No. SMA 09-4434, NSDUH Series H-36) Rockville, MD: 2009. [Google Scholar]
  32. Watson D. Mood and temperament. New York, NY US: Guilford Press; 2000. [Google Scholar]
  33. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology. 1988;54(6):1063–1070. doi: 10.1037/0022-3514.54.6.1063. [DOI] [PubMed] [Google Scholar]

RESOURCES