Social anxiety disorder (also known as social phobia) is an Axis I anxiety disorder characterized by intense fear and avoidance of social or performance situations in which one might be scrutinized. Its onset is typically in the early teen years. It is the third most common mental disorder in the United States, exceeded in prevalence only by depression and alcoholism. Approximately 20 percent of the individuals with social anxiety disorder have alcohol problems. Anecdotal and empirical evidence suggests that alcohol is used by some socially anxious individuals to self-medicate anxiety symptoms, a practice that could lead to alcohol abuse and/or dependence. The proposed project further explores the self-medication hypothesis through the use of a double-blind, randomized, placebo-controlled clinical trial. Paroxetine (a selective serotonin reuptake inhibitor) is the drug to be used in the study; it is the only medication with FDA-approval for the treatment of social anxiety disorder. Seventy individuals (n=35/group) who drink alcohol to cope with social anxiety symptoms and who meet DSM-IV criteria for the dual-diagnoses of social anxiety disorder and alcohol use disorders will be enrolled in the trial. All individuals will be seeking treatment for social anxiety disorder. The treatment phase will last 16 weeks. Dosing will start at 20 mg/day (paroxetine or placebo) and will increase gradually to a maximum dose of 60 mg/day. Each week during treatment and at the end of the trial, assessments will be made with standard instruments to determine the effect of paroxetine (versus placebo) on social anxiety severity, alcohol use, and more specifically, the intentional use of alcohol to cope with social anxiety symptoms. The overarching hypothesis is that because paroxetine will improve social anxiety severity, alcohol use and/or alcohol use for coping will also be reduced in the paroxetine-treated group.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA013379-02
Application #
6620276
Study Section
Health Services Research Review Subcommittee (AA)
Program Officer
Lefauve, Charlene
Project Start
2002-03-01
Project End
2006-02-28
Budget Start
2003-03-01
Budget End
2004-02-29
Support Year
2
Fiscal Year
2003
Total Cost
$368,808
Indirect Cost
Name
Medical University of South Carolina
Department
Psychiatry
Type
Schools of Medicine
DUNS #
183710748
City
Charleston
State
SC
Country
United States
Zip Code
29425
Miller, Peter M; Book, Sarah W; Thomas, Suzanne et al. (2014) The potential utility of drinking motive questions to screen at-risk drinking in socially anxious patients. J Subst Use 19:225-228
Book, Sarah W; Thomas, Suzanne E; Smith, Joshua P et al. (2013) Treating individuals with social anxiety disorder and at-risk drinking: phasing in a brief alcohol intervention following paroxetine. J Anxiety Disord 27:252-8
Book, Sarah W; Thomas, Suzanne E; Smith, Joshua P et al. (2012) Severity of anxiety in mental health versus addiction treatment settings when social anxiety and substance abuse are comorbid. Addict Behav 37:1158-61
Book, Sarah W; Thomas, Suzanne E; Randall, Patrick K et al. (2008) Paroxetine reduces social anxiety in individuals with a co-occurring alcohol use disorder. J Anxiety Disord 22:310-8
Thomas, Suzanne E; Randall, Patrick K; Book, Sarah W et al. (2008) A complex relationship between co-occurring social anxiety and alcohol use disorders: what effect does treating social anxiety have on drinking? Alcohol Clin Exp Res 32:77-84