Victims of social anxiety disorder (SAD) are exceptionally vulnerable to substance abuse problems. Studies have revealed that up to 20%nof all SAD sufferers have struggled with alcohol abuse issues, and drug abuse rates among the socially anxious are also disturbingly common. What Is Social Anxiety Disorder? Social anxiety disorder, which affects up to 7% of adult Americans, leaves its victims unable to function effectively or comfortably in a wide variety of social situations. Many descriptions of SAD focus on the physical symptoms suffers experience \u2014 sweating, blushing, rapid pulse rate, chest pains, stomach pains, breathing problems, vertigo and a \u201cbrain fog\u201d that makes it difficult to focus or think. But these physical manifestations of extreme anxiety are rooted in long-term self-esteem problems and a chronic lack of self-confidence. Victims of SAD worry about their ability to perform in social environments. They struggle to form interpersonal relationships or even initiate casual conversations, worrying they\u2019ll embarrass themselves and be judged inferior. Their fear of failure and inability to relax and be themselves around other people puts them under intense emotional strain, and when they do have social encounters they will tie themselves up in knots afterward second-guessing everything they said or did. When the Cure Is Worse Than the Disease: Self-Medicating for Anxiety For those beset by endless self-doubt and disabling anxiety symptoms, drugs and alcohol can seem like a gift from heaven \u2014 at least at first. Alcohol, for example, lowers inhibitions and smothers anxiety and nervousness, temporarily removing the shackles from SAD sufferers who are normally overwhelmed by fear of rejection. Marijuana doesn\u2019t possess the same capacity to remove inhibitions that prevent effective social performance. But it can help relieve stress and reduce the self-consciousness that usually makes relaxation impossible for socially anxious men and women. Meanwhile stimulants like ecstasy, methamphetamine and cocaine can give users with SAD an immediate boost of energy and self-confidence. The euphoria they experience under the influence of these drugs steamrollers their self-esteem issues and leaves them feeling like they can conquer the world \u2014 for a while. But drugs and alcohol only mask the symptoms of social anxiety. Actually overcoming it takes hard work and there are no easy fixes. Drugs and alcohol can help socially anxious users escape from their problems \u2014 and themselves \u2014 for a few brief moments. But when the effects wear off, too many SAD sufferers will go back again and again, looking to recapture those initial feelings of empowerment. Over time tolerance gradually develops, meaning they\u2019ll have to consume more drugs or alcohol to gain the same effect. This, of course, makes addiction virtually inevitable, unless SAD sufferers can somehow break this cycle before it leads to disaster. Some are conscious and aware enough to do so, but far too many are unable to elude the greedy, grasping clutches of chemical dependency. Getting Treatment for a Dual Diagnosis of Substance Abuse and Social Anxiety Because they are isolated and secretive by force of habit, SAD sufferers with substance use problems usually have no difficulty hiding their addictions. Plagued by shame and unable to speak up in their own defense, they won\u2019t volunteer information about their struggles and are unlikely to seek help for their substance use issues on their own. This puts extra pressure on close friends and family members, who must be perceptive enough to detect the problem and engaged enough to take action on their loved one\u2019s behalf. Interventions involving people with SAD must be handled with extreme care. Only those they care about and trust the most should be included in the process, and the approach of all participants should be solution-oriented and backed by constant positive reinforcement. SAD sufferers do not respond well to criticism or confrontation, since this only confirms their worst fears about their own weakness and inadequacy. Once they move to rehab, those with co-occurring substance abuse and social anxiety disorders will require an integrated treatment regimen that addresses both their chemical dependency and the feelings of fear and the low self-esteem that lie behind it. Substance abuse therapies for people with SAD should focus on helping them develop a healthier self-image, giving them the strength and courage to face their challenges head on. They also need to learn practical methods for coping with the symptoms of their mental health condition, to make sure they aren\u2019t tempted to return to drugs and alcohol in the future when they\u2019re feeling judged, pressured or rejected. Comprehensive aftercare is vital for SAD sufferers attempting to stay clean and sober after a stint in rehab. Support groups (for both substance abuse and social anxiety) can help, but SAD victims in recovery should also continue individual therapy sessions with counselors who know about their social anxiety and are working with them to overcome its disabling effects. Listening to the Cries of the Voice in the Wilderness Men and women dealing with social anxiety disorder desperately need compassion and understanding. But both are too often denied them, even by their family members, since others don\u2019t understand their condition, can\u2019t relate to their suffering and don\u2019t know how to interpret their puzzling behavior. Their silence and withdrawal is misconstrued as disinterest or a desire to be left alone, when in fact people with social anxiety disorder need human connections and relationships just as much as anyone else. When SAD sufferers turn to drugs and alcohol, it is mainly because they think those substances can help them make friends and find the social support they so fervently crave. Substance abuse in the socially anxious is a cry for help and a sign they\u2019ve been missing something crucial and life-sustaining. Others can help by doing their best to provide love, companionship, encouragement and unconditional acceptance, both during rehab and in the months and years following its conclusion. SAD sufferers have a hard time asking for social and moral support regardless of the circumstances. But that doesn\u2019t mean they need it any less. In fact not having it helped push them toward drugs and alcohol in the first place.