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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptHHS Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Anxiety Stress Coping. Author manuscript; available in PMC 2016 July 1.
Published in final edited form as:
PMCID: PMC4751071
NIHMSID: NIHMS717846

Social anxiety, disengagement coping, and alcohol use behaviors among adolescents

Abstract

Background and Objectives

Although research indicates that social anxiety (SA) is associated with problematic drinking, few studies have examined these relations among adolescents, and all alcohol-related assessments have been retrospective. Socially anxious youth may be at risk to drink in an effort to manage negative affectivity, and a proclivity towards disengagement coping (e.g., avoidance of aversive stimuli) may enhance the desire to drink and learning of coping-related use.

Design

Adding to research addressing adolescent SA and alcohol use, the current study examined (1) proportional drinking motives (subscale scores divided by the sum of all subscales), (2) current desire to drink in a socially-relevant environment (introduction to research laboratory), and (3) the indirect effect of retrospectively-reported disengagement in social stress contexts on proportional coping motives and desire to drink.

Method

Participants were 70 community-recruited adolescents who reported recent alcohol use. Level of SA, disengagement coping, drinking motives, and desire to drink following laboratory introduction were assessed.

Results

Proclivity toward disengagement in prior socially-stressful contexts accounted for significant variance in the positive relations between SA and both proportional coping motives and current desire to drink.

Conclusions

These data complement existing work. Continued efforts in building developmentally-sensitive models of alcohol use are needed.

Keywords: alcohol use, coping, social anxiety, adolescence

Adolescent alcohol use is linked to an array of negative consequences, including neurological and somatic damage, sexual risk-taking, violence, and increased mortality rates (Hingson & Kenkel, 2004; Tapert et al., 2004). Moreover, risk-related use of alcohol during adolescence (e.g., early initiation; heavy consumption; coping-motivated drinking) is positively correlated with drinking behaviors in adulthood (Rohde et al., 2001; Wittchen et al., 2008), and adolescents transition from initial use to problematic drinking (i.e., experiencing negative consequences from drinking, including alcohol use disorders) more rapidly than adults (Deas et al., 2000). Of note, adolescence is characterized by an increase in certain risk-taking behaviors, including the use of alcohol (Arnett, 1999; Masten et al., 2009). Disentangling “normative” experimentation and “problem-prone” drinking, including work identifying subgroups of youth and malleable factors linked with problematic trajectories (e.g., heavy drinking, coping-related consumption; Jackson, 2008, Kuntsche, Stewart, & Cooper, 2008) is key to the development of effective intervention strategies (Labouvie & White, 2002; Masten et al., 2009; Weber et al., 1989).

Consistent with a large body of work conducted with adults (e.g., see Morris et al., 2005 for a review), a burgeoning literature indicates a positive association between adolescent social anxiety and problematic alcohol use (see Blumenthal, Leen-Feldner, Badour, & Babson, 2011). Indeed, despite documented “protection” from early initiation or regular use (Tomlinson & Brown, 2012), extant work consistently demonstrates elevated risk for an alcohol use disorder (AUD) among adolescents with social anxiety disorder (e.g., Clark et al., 1995) or elevated social fears (Essau et al., 1999). Further, social anxiety is identified as the antecedent disorder in the majority of cases across both large-scale retrospective (Nelson et al., 2000) and prospective (Zimmerman & Schmeelk-Cone, 2003; Zimmerman et al., 2003) designs. For example, in a sample of over 2,000 youth (14–24 years), Zimmerman and colleagues (2003) found that social anxiety disorder was associated with a two-fold increase in risk for concurrent alcohol dependence, as well as the onset of regular use, hazardous use (i.e., greater than 40g/day for men, 20g/day for women), and the persistence of alcohol dependence across a four-year follow-up period. Similarly, Buckner and colleagues (2008) found that adolescents diagnosed with social anxiety disorder were significantly more likely to develop alcohol dependence by age 30 years as compared to those without the diagnosis, even after controlling for gender and other relevant diagnoses (e.g., other anxiety, substance use, and mood disorders). Although compelling, the majority of work conducted with adolescents has solely addressed the frequency of social anxiety-AUD co-occurrence, and little work has examined theoretically-derived mechanisms (e.g., social stress responding; drinking motives) potentially undergirding this relation.

A general proclivity towards disengagement coping strategies (e.g., efforts to avoid or separate one’s self from an aversive stimulus; Connor-Smith et al., 2000) among socially anxious adolescents may set the stage for coping-related alcohol consumption (a pattern of use associated with the development of problematic drinking; Carpenter & Hasin, 1999; Kuntsche et al., 2005), particularly in the context of social stress. Drawing on contemporary self-medication (see Carrigan & Randall, 2003; Kushner, Abrams, & Borchardt, 2000) and the recently proposed biopsychosocial (Buckner et al., 2013) models of alcohol use, socially anxious youth may be at particular risk to use alcohol in an effort to manage or avoid negative affectivity. Implicit in models of avoidance-related drinking is that the anxiolytic effects of alcohol negatively reinforce consumption (Sayette, 1999; Torres & Ortega, 2004), thereby eliciting and maintaining its use as an avoidance or escape technique. The more distal tendency to employ voluntary disengagement strategies when faced with social stress (a characteristic consistent with the nature of social anxiety) may facilitate the learning, and maintenance of, avoidance-related drinking in socially stressful contexts (i.e., “telescoping”). Socially anxious adolescents may be at particular risk for the employment and eventual reliance upon disengagement coping strategies for at least two reasons. First, avoidance-related coping and dependence on identified ‘safety behaviors’ are common features of social anxiety (Ollendick, & Hirshfeld-Becker, 2002; Ottenbreit et al., 2014; Plasencia, Alden, & Taylor, 2011). Extant work further indicates that disengagement coping is positively correlated with anxiety (broadly defined) among both adolescents (Connor-Smith et al., 2000) and young adults (Connor-Smith & Compas, 2002). Second, as adolescents mature their coping repertoire also advances in complexity, and the ability to identify and employ voluntary responses is refined (e.g., Compas et al., 2001). As such, adolescence may be a key period during which socially anxious individuals learn to rely on disengagement coping strategies broadly and, subsequently, avoidance-related drinking behaviors specifically.

Cooper’s (1994) four-factor model suggests four proximal motivational categories for alcohol use: a) coping (reducing or avoiding negative affect/anxiety), b) conformity (avoiding peer rejection), c) enhancement (increasing positive affect), and d) social (enhancing social situations). Enhancement and social motives are the most widely endorsed among adolescents; however, elevated coping motives are most consistently and uniquely linked with the development of alcohol-related problems (e.g., Kuntsche et al., 2005; Kuntsche, Stewart, & Cooper, 2008). Although findings are mixed (cf. Buckner et al., 2006; Ham, Bonin, & Hope, 2007; O’Grady et al., 2011), much of the extant work conducted with adults supports the contention that social anxiety is linked with avoidance-motivated alcohol consumption (i.e., coping, conformity; Buckner & Heimberg, 2010; Ham, Zamboanga, Bacon, & Garcia, 2009; Thomas et al., 2008). Further, across both large-scale cross-sectional (Ham et al., 2009) and prospective (Windle & Windle, 2012) designs, social anxiety evidences a positive, and unique, relation with coping motives in young adult samples (cf. Buckner et al., 2006). In the one study to date directly investigating the association between social anxiety and motives for alcohol consumption among adolescents (50 community-recruited adolescents; age 12–17 years), Blumenthal and colleagues (2010) reported that level of social anxiety was positively related to coping motives for alcohol consumption, but not conformity, enhancement, or social motives. At present, the extant literature suggests that socially anxious adolescents may be at risk for avoidance-related alcohol consumption, and coping-related motivations in particular; however, it is important to replicate these findings across independent samples, as well as ascertain the role of responding to social stress specifically, as opposed to negative affect generally (Hussong & Chassin, 1994).

Recent work conducted with adults highlights the role of managing and/or avoiding social stress specifically in the relation between social anxiety and problematic drinking (e.g., Cludius et al., 2013). For example, Thomas and colleagues (2003) found that community-recruited adults high in social anxiety reported (a) drinking in an effort to reduce anticipatory and concurrent anxiety associated with social situations, (b) relief of (social) anxiety as a function of alcohol use, as well as (c) avoidance of social situations if alcohol is not available, all to a greater degree than a non-socially anxious comparison group. Similarly, in a sample of over 350 college students, Buckner and Heimberg (2010) found that drinking to cope in social situations (specifically), as well as intentional avoidance of social situations if alcohol was not available, accounted for a significant proportion of the relation between social anxiety and alcohol-related problems. This growing body of work more directly speaks to the supposition that socially anxious individuals, when faced with social stress, are at risk for using alcohol as a means of disengagement coping (please see O’Grady et al., 2011 for additional important considerations). Accordingly, the proclivity towards disengagement coping may represent a promising target for intervention, particularly in efforts aimed at disrupting the development of problematic substance use behaviors via avoidance-related patterns of use (e.g., also see Buckner, Heimberg, & Schmidt, 2011).

It is important to note that no work has yet examined how social anxiety, disengagement coping, and alcohol use indices may relate to one another among adolescents. The dearth of literature in this area is unfortunate, given adolescence is a period in which (a) a more sophisticated understanding and application of coping responses, including forms and functions of disengagement emerges (Compas et al., 2001), (b) normative increases in social anxiety and experimentation with alcohol are seen (Essau et al., 1999; Wittchen et al., 2008), (c) the onset of dysfunctional social anxiety and problematic alcohol use behaviors typically occur (Labouvie & White, 2002; Velting & Albano, 2001), and (d) beliefs about the effects of alcohol continue to form (Christiansen, Goldman, & Inn, 1982; Schell et al., 2005). This suite of characteristics highlights adolescence as an important developmental epoch during which to study the onset of, and linkages among, problematic social anxiety and alcohol use. The current study was designed to address several key limitations of the extant literature.

First, no work has specifically examined the role of disengagement responding to social stress in the association between adolescent social anxiety and (coping-related) alcohol use behaviors. Given that this construct reflects the putative mechanism underlying the link between social anxiety and problematic alcohol use, the current study tested the indirect effect of retrospectively-reported disengagement coping in the relation between social anxiety and two relevant drinking indices: (1) coping motives broadly, and (2) current desire to drink in the unfamiliar laboratory environment. Second, only one study to date has directly examined social anxiety and coping-related drinking motives among adolescents (Blumenthal et al., 2010), and thus replication in an independent sample is needed to support the stability of this finding. Finally, retrospective data may be subject to several reporting biases, (e.g., misattribution, memory distortion; Nisbett & Ross, 1980), which can be reduced by assessing the desire to consume alcohol during a potentially anxiety producing activity (e.g., in anticipation of or during a social interaction; Thomas & Bacon, 2013). For that reason, in addition to self-reported coping motives for drinking, the present study examined participants’ current desire to drink shortly after their introduction to the laboratory (e.g., Gunnar et al., 2009; Walker et al., 2001), a novel social situation with unfamiliar individuals and unclear expectations for behavior. Further, participants were aware that completion of questionnaires would be followed by an interview with the researcher, thus enhancing the social relevance of the environment.

Consistent with prior work conducted with adults (e.g., Ham et al., 2009) and preliminary data among adolescents (Blumenthal et al., 2010), it was hypothesized that social anxiety would positively relate to self-reported coping-related drinking motives as well as the current desire to drink in a novel, socially-relevant context (i.e., research laboratory; Gunnar et al., 2009) beyond variance attributable to typical alcohol use frequency (cf. Blumenthal et al., 2010; Christiansen et al., 1982; Windle & Windle, 2012). It was further expected that the indirect effect of disengagement coping in response to prior social stress would account for a significant proportion of these relations. This series of analyses was then tested in regard to current desire to drink (i.e., replacing coping motives).

Method

Participants

Participants were 70 community-recruited adolescents ages 12 to 17 years (M = 15.78, SD = 1.26; 42.9% girls) who reported a positive history of recent alcohol use (i.e., within the past 6 months; Cooper et al., 1995; Huselid & Cooper, 1992) and took part in a larger investigation focused on adolescent emotional vulnerability and health-related behaviors (N = 96). As a part of the larger protocol, which included possible assignment to a voluntary hyperventilation procedure, exclusionary criteria were as follows: (a) chronic respiratory (e.g., bronchitis) or cardiovascular (e.g., hypertension) problems related to physiological arousal, (b) current pregnancy, (c) lifetime history of DSM-IV-defined panic disorder or AUD, (d) current suicidality, (e) limited mental capacity or inability to provide informed, written assent to participate, or (f) absence of a parent or legal guardian to provide written informed consent. Approximately 600 parents and youth contacted the laboratory about the larger study. Seventeen interested participants did not fall within the required age range (12–17 years); 372 reported never having consumed a full, standard alcoholic beverage, and 63 had done so but not in the past six months. Additional exclusionary criteria reported at screening included: relevant respiratory problems (primarily asthma; n = 68), cardiovascular problems (n = 6), potential lifetime panic disorder (n = 5) and/or AUD (n = 14). Finally, 49 individuals were not interested in participation following study description and/or were unable to provide assent/consent for participation.1 Ninety-six adolescents met all screening criteria and participated in the larger study; participants included in the current analyses were those with complete predictor (e.g., social anxiety) and criterion (e.g., desire to drink) data (72.9% total study sample). It is important to note that participants selected for analysis did not differ significantly from those in the larger study across any of the primary predictor, criterion, or demographic variables.

The ethnic and racial composition of the sample was as follows: 11.8% Hispanic/Latino, 82.6% Caucasian, 7.2% African American, 1.4% Asian, 1.4% Native American, 4.3% multiracial, and 2.8% “other.” Parents who accompanied youth to the laboratory (62.2% biological mothers) reported a median household income of $70,000. Parental education was as follows: 2.2% did not graduate high school, 15.6% received a high school diploma or equivalent degree, 26.7% completed some college, 35.6% held an Associate’s or Bachelor’s degree, 8.9% reported some graduate or professional schooling, and 11.1% completed graduate or professional school. Finally, 64.4% of parents reported being married or living with someone, 22.2% were divorced, 4.4% separated, and 8.9% never married.

Measures

Screening materials

Relevant items from the well-established Youth Risk Behavior Survey (e.g., “[Other than for religious purposes], have you ever had an alcoholic drink;” CDC, 2006) in conjunction with a timeline follow-back procedure (Chung, Maisto, Cornelius, & Martin, 2004; Sobell & Sobell, 1996; Winters, 2003) were used to screen for recent alcohol use. Only youth endorsing a positive history of alcohol consumption (i.e., at least one standard drink; National Institute on Alcohol and Alcoholism, 2000) in the past six months were eligible to participate in the current study (e.g., Cooper et al., 1995). Relevant medical conditions were assessed via a structured medical health interview (e.g., Leen-Feldner, Reardon, & Zvolensky, 2007). The interview consisted of a series of two-part open-ended questions, asking (1) whether a doctor has ever diagnosed the participant with a specific condition (e.g., asthma), and (2) whether the participant has any reason to believe that they might have the condition. The full interview was administered separately to the parent (regarding child medical history) and adolescent. Finally, the well-established ADIS-C for DSM-IV (Silverman & Albano, 1996; Silverman et al., 2001) was administered by trained interviewers to establish the presence/absence of psychological exclusionary criteria (i.e., panic disorder, AUD, current suicidality).

Social anxiety

The Revised Child Anxiety and Depression Scale – Social phobia subscale (RCADS-SP; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000) was used to index level of social anxiety. Participants rated nine items (e.g., “I am afraid of looking foolish in front of other people;” “I worry about what others think of me”) on a four-point scale (0 = Never to 3 = Always), indicating how often each statement reflects how they typically feel. Item ratings were summed to yield a total score. Designed to reflect the dimensions of several DSM-IV-defined anxiety disorders among adolescents, the RCADS evidences good reliability, validity, and internal consistency (e.g., SP subscale α = .85 in the present sample; Chorpita et al., 2000).

Disengagement coping

The Voluntary Disengagement subscale of the Responses to Stress Questionnaire – Social stress version (RSQ-VD; Connor-Smith et al., 2000) was used to assess volitional disengagement responses to social stressors. Participants first are presented with a description and list of specific social stress examples (e.g., being teased, feeling pressured, being left out or rejected), and are instructed to respond to the following questions regarding how they feel, or things they do, when they have experienced these specific types of problems. The RSQ-VD subscale includes nine items addressing avoidance (e.g., “I try not to feel anything”), denial (e.g., “I try to believe it never happened”), and wishful thinking (e.g., “I wish that I were stronger, smarter, or more popular so that things would be different”), to which participants respond on a four-point scale (1 = Not at all to 4 = A lot) the frequency they use each strategy in the context of social stress (e.g., being teased). Responses were summed to yield a total score. The RSQ-VD was designed for work with adolescents, and evidences adequate reliability, validity, and internal consistency (e.g., current study α = .76; Connor-Smith et al., 2000).

Coping motives for alcohol use

The Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994) was used to index motives for alcohol consumption. This measure includes four, five-item subscales indexing coping (e.g., “because it helps you when you feel depressed or nervous”), conformity (e.g., “to fit in with a group you like”), enhancement (e.g., “because it gives you a pleasant feeling”), and social (e.g., “to celebrate a special occasion with friends”) motives for drinking. Participants indicated on a five-point scale (1 = Almost never/never to 5 = Almost always/always) the frequency with which they drink for the purpose listed in each item; ratings across each of the five items were averaged to yield a subscale score. This measure has been successfully used in prior work with adolescents (Blumenthal et al., 2010; Kuntsche et al., 2008), and evidences good internal consistency (e.g., α = .85, .79, .92, .88 for coping, conformity, enhancement, and social, respectively in the present sample), and validity (Cooper, 1994). Finally, in an effort to account for shared variance and capture relations unique to coping motives, a proportional score was derived from the subscale and total scores (Vitaliano, Maiuro, Russo, & Becker, 1987). Specifically, the coping motives subscale score was divided by the sum of all of the subscales (including coping), to create a proportional value reflecting the relative degree to which one endorsed coping motives for drinking. This proportion score was used in the primary analyses; however, raw scores also are presented in Table 1 for descriptive purposes.

Table 1
Means (standard deviation) and Zero-order Relations among all Continuous Variables

Current desire to drink

In an effort to capture the desire to consume alcohol in a novel, socially-relevant context, participants completed the Desires for Alcohol Questionnaire (DAQ; Love, James, & Willner, 1998) shortly after introduction to the laboratory (e.g., Gunnar et al., 2009; Walker et al., 2001). Importantly, participants also were aware that completion of the questionnaires would be followed by an interview with the researcher, thus enhancing the social relevance of the environment. The well-established DAQ includes 28 items to which participants indicated their agreement with how much each statement reflects how they currently feel on a scale of 1 (Strongly disagree) to 7 (Strongly agree). Items reflect moderate (e.g., “I might like a drink now”), as well as strong (e.g., “I need a drink now”) desires for alcohol; responses were summed to compute an overall desire for alcohol score. The DAQ evidences excellent psychometric properties (e.g., α = .96 in the current sample; Love et al., 1998), and has been successfully employed in studies examining social drinkers (Duka, Jackson, Smith, & Stephens, 1999; Schulze & Jones, 2000), as well as adolescent populations (Tapert et al., 2003).

Alcohol use frequency

The Adolescent Alcohol and Drug Involvement Scale (AADIS; Moberg, 2000), was used to assess frequency of alcohol use. This face-valid measure asks participants to select a single answer on a scale of 0 (never used) to 7 (several times a day) that best reflects how often they typically drink alcohol (i.e., “…. the response that best matches your experience.”). Each response point is accompanied by a written descriptor and higher numbers reflect increased alcohol consumption (e.g., 2 = several times a year; 3 = several times a month). This scale has been successfully used in prior work examining similar community-based samples of adolescents (e.g., Blumenthal et al., 2010).

Procedure

Study procedures were approved by the University Institutional Review Board prior to participant contact. Adolescents and guardians responding to recruitment efforts (e.g., flyers, radio advertisements) were given a detailed description of study procedures. Importantly, all participant data was kept confidential (including drinking status); parents and adolescents were made aware of this prior to screening and again at the laboratory. Following verbal parental consent, interested youth completed a preliminary (confidential) telephone screening. Adolescents eligible at this stage were invited to the laboratory (accompanied by a parent or legal guardian), at which time written parental consent and adolescent assent were obtained, and screening criteria (e.g., prior alcohol consumption) were again privately assessed and recorded. Interested parents completed a small battery of questionnaires (e.g., demographics), and adolescent participants completed a larger series of questionnaires, including the DAQ (placed near the top of the packet to ensure proximity to laboratory introduction), RCADS, RSQ, DMQ-R, and AADIS (randomly ordered). Participants then completed the ADIS-C and a series of tasks not related to the current project (e.g., breath holding). Finally, both parties were thanked, debriefed, and compensated for participation (adolescents: $40; participating parents: $5).

Results

Please see Table 1 for descriptive data concerning all continuous measures. Importantly, voluntary disengagement responding (RSQ-VD) evidenced statistically significant, but modest correlations with social anxiety (RCADS-SP; r = .47), raw (r = .48) and proportional coping motives scores (DMQ-R; r = .47), as well as the desire to drink (DAQ; r = .34), suggesting this measure taps a distinct construct and supporting theoretical distinctions among these variables.

Primary analyses were conducted using the PROCESS custom dialog for SPSS 19 (Hayes, 2008). Specifically, the first model tested the hypotheses that (1) social anxiety would positively relate to proportional coping motives (pathway c), (2) social anxiety positively related to voluntary disengagement responding (pathway a), (3) disengagement responding positively related to proportional coping motives (pathway b), and (4) a significant proportion of the total effect of social anxiety on the coping motives would be accounted for by the indirect effect via voluntary disengagement responding (pathway ab). The second model tested the same series of hypotheses in regard to desire to drink rather than coping motives. A bias-corrected 95% confidence interval (CI) was used to examine the indirect effect in each model. As recommended, this approach included 5000 bootstrapping samples, and the interpretation of the indirect effect was based upon a CI that does not include zero (Preacher & Hayes, 2008).

Coping Motives

As expected, the first model accounted for a significant amount of the variance in proportional coping motives for alcohol use (F [3, 66] = 6.51, p < .001, adjusted R2 = .22). Specifically, social anxiety significantly related to proportional coping motives (path c; p = .046) as well as voluntary disengagement (path a; p < .001), and voluntary disengagement significantly related to proportional coping motives (path b; p < .001). Analyses also indicated an indirect effect of social anxiety on proportional coping motives through voluntary disengagement (path ab: corrected β = .003, SE = .001, 95% CI [.001, .006]). Finally, the direct effect of social anxiety on proportional coping motives no longer met traditional levels of significance with the indirect effect via voluntary disengagement included in the model (path c’; p = .983).2 Please see Figure 1 for further detail.

Figure 1
Diagram of the final model predicting proportional coping-related drinking motives (adjusted for alcohol use frequency).

Desire to Drink

The second model accounted for a significant amount of the variance in current desire to drink (F [3, 66] = 12.27, p < .001, adjusted R2 = .35). Similar to the pattern found for coping motives as the outcome variable, social anxiety significantly related to current desire to drink (path c; p = .046), as well as voluntary disengagement (path a; p < .001), and voluntary disengagement significantly related to current desire to drink (path b; p = .029). Analyses also indicated an indirect effect of social anxiety on current desire to drink through the linkage with voluntary disengagement (path ab: corrected β = .93, SE = .61, 95% CI [.073, 2.46]). Finally, the direct effect of social anxiety on current desire to drink no longer met traditional levels of significance with the indirect effect via voluntary disengagement included in the model (path c’; p = .500). Please see Figure 2 for further detail.

Figure 2
Diagram of the final model predicting desire to drink upon laboratory introduction (adjusted for alcohol use frequency).

Discussion

Adolescent alcohol use represents a considerable public health and safety concern (U.S. Department of Health & Human Services, 2011), and a growing body of work indicates that socially anxious individuals are at risk for problematic use behaviors (Morris et al., 2005). The present study was designed to address several key limitations of the literature examining this linkage among adolescents. First, analyses indicated that a proclivity toward disengagement coping in the context of prior social stressors accounted for a significant proportion of the relation between social anxiety and the precursors to drinking behavior assessed here. The current study replicated prior work, indicating a positive relation between level of social anxiety and coping motives for alcohol use after accounting for variance attributed to frequency of use. Finally, social anxiety also was similarly related to adolescents’ current desire to drink upon introduction to the novel, socially-relevant laboratory environment.

The current study uniquely adds to the extant literature via retrospective assessment of disengagement coping in the context of social stress. These data are consistent with contemporary theoretical accounts (e.g., Buckner et al., 2013), as well as a growing body of work conducted with adults (e.g., Buckner & Heimberg, 2010; Cludius et al., 2013). Specifically, disengagement-related affective and behavioral responding to prior social stressors, above and beyond social anxiety per se, accounted for a significant proportion of the variance in the relation between social anxiety and the drinking indices assessed here. Continued efforts in specifying the nature and boundaries of this relation are needed. Of primary importance is the current cross-sectional, correlational design; although such work is a necessary first step in establishing linkages among related processes, prospective and experimental designs will be required to ascertain the temporal patterning and causal mechanisms that are at the heart of this work (e.g., Kraemer, Yesavage, Taylor, & Kupfer, 2000). It is also important to note that only the voluntary disengagement subscale of the RSQ was available for analysis in the current study. Future work would benefit from use of the full measure, allowing for examination of the relative role of proclivity towards disengagement and/or engagement coping (e.g., “I think about the things that I am learning from the situation…,” “I try to think of different ways to change the problem or fix the situation.”), as well as involuntary stress responding (e.g., rumination, inaction; Connor-Smith et al., 2000) in the strength and direction of these relations. Further, a next step will be adaptation of current assessments (i.e., validated with adults) designed to directly tap in to drinking in an effort to reduce social anxiety and negative affectivity experienced in social situations (e.g., Drinking to Cope with Social Anxiety questionnaire; Buckner & Heimberg, 2010).

The current findings complement existing work conducted with adults (e.g., Windle & Windle, 2012), replicating the finding that coping motives for alcohol use are elevated among socially anxious adolescent drinkers. Importantly, both large-scale cross-sectional and prospective work identifies coping-related drinking as an important predictor of the development and maintenance of problematic alcohol use (Carpenter & Hasin, 1998; Cooper et al., 1995; Windle, 1996). Work conducted with college-age samples also has identified coping-related drinking as a partial mediator of the relation between social anxiety and alcohol use problems (Ham et al., 2009; Lewis, Hove, & Whiteside, 2008). Learning to use alcohol in an effort to reduce socially-oriented anxiety may be especially problematic among adolescents given the social nature of typical drinking environments (e.g., at parties; group settings) and saliency of social evaluation (e.g., imaginary audience, Elkind, 1967; Schwartz, Maynard, & Uzelac, 2008) characteristic of this period. Taken together, this growing literature suggests that the use of alcohol in an effort to directly avoid or escape negative affect among socially anxious individuals may emerge in adolescence, laying the foundation for observed associations between adolescent social anxiety and subsequent drinking-related problems.

It is important to note that participants in the current study were screened and excluded for certain psychological and physical health indices, including lifetime history of a DSM-IV-defined AUD. Although this approach limits certain conclusions (e.g., generalizability to clinical populations), it allows for the consideration of theorized etiologic processes while limiting the potentially confounding effects of concurrent clinical conditions (e.g., Zvolensky et al., 2001). Indeed, as beliefs about the effects of alcohol and motives for consumption continue to be shaped across adolescence (Cooper, 1994; Schell et al., 2005), targeted intervention programs focused on such precipitants of alcohol use behaviors may help prevent the development of problematic use and related difficulties later in life (Conrod et al., 2011; Gottfredson & Wilson, 2003).

Although the current study extended prior work via the assessment of recent drinkers (cf., lifetime exposure; Blumenthal et al., 2010), alcohol-related problems were not examined. Given the burgeoning literature underscoring the relation between social anxiety and alcohol-related problems (as opposed to use behaviors broadly; Buckner & Heimberg, 2010; Buckner et al., 2008; Tomlinson & Brown, 2012), an important next step will be cross-sectional and prospective work directly addressing the linkages among social anxiety, motives for drinking, and alcohol- related problems among adolescents. Further, extension of this work to clinical populations, particularly those with social anxiety disorder and/or an AUD, is needed. If the present findings hold across such samples, then socially anxious adolescents may benefit from interventions targeting specific maladaptive coping strategies. For example, evidence supports using cognitive-behavioral interventions that target maladaptive coping strategies matching the adolescent’s “personality risk factors” in reducing alcohol-related and internalizing problems (Castellanos & Conrod, 2006; Conrod et al., 2011; Conrod et al., 2006). Such interventions could be applied to socially anxious adolescents who use disengagement strategies in the context of social stress to reduce the likelihood of coping-motivated drinking and subsequent alcohol-related problems.

Finally, the present study advanced prior work, which included only retrospective measures of drinking behaviors, via assessment of participants’ current desire to drink upon introduction to the socially-relevant laboratory context. The fact that these findings mirrored those found in terms of standard coping motives is noteworthy, given it suggests that more nuanced environments that adolescents regularly experience (e.g., new classes) may elicit the desire to consume alcohol among those with elevated social anxiety. Of note, the current study did not directly assess indices of current anxiety or physiological arousal (e.g., via self-report, skin conductance, cortisol level), or desire to drink prior to laboratory introduction. The correlational design also warrants significant caution in inferences drawn from these preliminary data, particularly in light of the fact that the laboratory context is not one in which alcohol promotion would be expected, thus limiting the ecological validity of the assessment. Further, both drinking motives and current desire to drink were indexed via self-report. Although this is a common technique in work conducted with adolescents (e.g., Tapert et al., 2003), and participants completed assessments in a private space following assurance of confidentiality, laboratory tasks such as assessing psychophysiological responding to alcohol-relevant cues (e.g., words, pictures; Lowman, Hunt, Litten, & Drummond, 2000; Sayette et al., 2000; Tapert et al., 2003) may provide more precise assessments as compared to self-report alone, particularly among socially anxious adolescents. In addition to efforts addressing the aforementioned limitations, this literature also would benefit from a task comparison study, in which the effects of a more subtle social context (such as in the current project) is compared with that elicited by more typical and universally stressful performance (e.g., the Trier Social Stress Test; Buske-Kirschbaum et al., 1997) and rejection-oriented (e.g., Yale Interpersonal Stressor; Stroud et al., 2000) social stress tasks (please see Battista, Stewart, & Ham, 2010 for a review of work conducted with adults). Incorporating these sophisticated assessment techniques into a larger study amenable to more advanced statistical approaches would allow for a comprehensive assessment of the pathways linking social anxiety, voluntary disengagement, coping-related drinking motives, and alcohol-relevant responding (e.g., selective attention to alcohol cues) in the context of acute social stress.

Additional limitations of the current study warrant consideration. First, the sample was relatively homogenous (e.g., largely Caucasian), and comprised of adolescents willing and able to come to the laboratory for a monetary reward. More diverse sampling and collection strategies (e.g., via schools) will be important in determining the generalizability of the current findings (e.g., across racial/ethnic groups; Cooper et al., 2008). Finally, the current sample was too small to adequately address the role of gender (i.e., via moderated mediation analyses or separately within each gender). For example, following Buckner and Turner’s (2009) finding that social anxiety disorder was prospectively related to AUD status among women, but not men, future work designed and powered to examine these relations among male and female adolescents (as well as in terms of other relevant moderators, such as peer or family use behaviors) is needed.

Together, the current study provides a springboard for continued efforts in building developmentally-sensitive models of problematic alcohol use. These data complement extant theoretical and empirical work, suggesting that socially anxious adolescents are at risk for problematic use behaviors (e.g., coping related drinking), and specify the overarching influence of disengagement coping in this relation. Future research is needed, as understanding context-specific drinking, particularly among youth at risk for problematic use, will be key to the design of effective risk-reduction and prevention efforts (Neighbors et al., 2007).

Acknowledgments

This project was partially supported by a National Institute on Alcohol Abuse and Alcoholism National Research Service Award (F31 AA018589) awarded to the first author.

Footnotes

1Inclusionary and exclusionary category data are not mutually exclusive.

2Analyses including proportional conformity, enhancement, and social motives also were conducted. Findings replicated prior work suggesting specificity in the relation between social anxiety and coping motives among adolescents (total effect on conformity: β = .001, SE = .001, p = .328; enhancement: β = −.002, SE = .001, p = .190; social: β = −.002, SE = .001, p = .074).

Contributor Information

Heidemarie Blumenthal, Department of Psychology, University of North Texas, Denton, USA, 1155 Union Circle #311280, Denton TX 76201.

Lindsay S. Ham, Department of Psychological Science, University of Arkansas, Fayetteville, USA, 216 Memorial Hall, Fayetteville AR 72701.

Renee M. Cloutier, Department of Psychology, University of North Texas, Denton, USA, 1155 Union Circle #311280, Denton TX 76201.

Amy K. Bacon, Department of Psychology, Bradley University, Peoria, USA, 1501 W. Bradley Ave, Peoria IL 61625.

Megan E. Douglas, Department of Psychology, University of North Texas, Denton, USA, 1155 Union Circle #311280, Denton TX 76201.

References

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4. Washington, DC: Author; 2000. Text Revision.
  • Arnett JJ. Adolescent storm and stress. American Psychologist. 1999;54:317–326. [PubMed]
  • Battista SR, Stewart SH, Ham LS. A critical review of laboratory-based studies examining the relationships of social anxiety and alcohol intake. Current Drug Abuse Reviews. 2010;3:3–22. [PubMed]
  • Blumenthal H, Leen-Feldner EW, Frala JL, Badour C, Ham LS. Social anxiety and motives for alcohol use among adolescents. Psychology of Addictive Behaviors. 2010;24:529–534. doi: 10.1037/a0019794. [PMC free article] [PubMed] [Cross Ref]
  • Blumenthal H, Leen-Feldner EW, Badour CL, Babson KA. Anxiety psychopathology and alcohol use among adolescents: A critical review of the empirical literature and recommendations for future research. Journal of Experimental Psychopathology. 2011;2:318–353. doi: 10.5127/jep.012810. [PMC free article] [PubMed] [Cross Ref]
  • Buckner JD, Eggleston AM, Schmidt NB. Social anxiety and problematic alcohol consumption: The mediating role of drinking motives and situations. Behavior therapy. 2006;37:381–391. [PubMed]
  • Buckner JD, Heimberg RG. Drinking behaviors in social situations account for alcohol-related problems among socially anxious individuals. Psychology of Addictive Behaviors. 2010;24:640–648. doi: 10.1037/a0020968. [PubMed] [Cross Ref]
  • Buckner JD, Heimberg RG, Schmidt NB. Social anxiety and marijuana-related problems: The role of social avoidance. Addictive Behaviors. 2011;36:129–132. [PMC free article] [PubMed]
  • 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;42:230–239. doi: 10.1016/j.jpsychires.2007.01.002. [PMC free article] [PubMed] [Cross Ref]
  • 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;100:128–137. doi: 10.1016/j.drugalcdep.2008.09.018. [PMC free article] [PubMed] [Cross Ref]
  • Buske-Kirschbaum A, Jobst S, Wustmans A, Kirschbaum C, Rauh W, Hellhammer D. Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosomatic Medicine. 1997;59:419–426. [PubMed]
  • Carpenter KM, Hasin DS. A prospective evaluation of the relationship between reasons for drinking and DSM-IV alcohol-use disorders. Addictive Behaviors. 1998;23(97):41–46. 00015–4. doi: 10.1016/S0306-4603. [PubMed] [Cross Ref]
  • Carpenter KM, Hasin DS. Drinking to cope with negative affect and DSM-IV alcohol use disorders: A test of three alternative explanations. Journal of Studies on Alcohol and Drugs. 1999;60:694–704. [PubMed]
  • Carrigan MH, Randall CL. Self-medication in social phobia: a review of the alcohol literature. Addictive Behaviors. 2003;28(2):269–284. [PubMed]
  • Castellanos N, Conrod P. Brief interventions targeting personality risk factors for adolescent substance misuse reduce depression, panic, and risk-taking behaviors. Journal of Mental Health. 2006;15:645–658. doi: 10.1080/09638230600998912. [Cross Ref]
  • Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance – United States, 2005. Morbidity and Mortality Weekly Report. 2006;55(SS-5)
  • Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SA. Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale. Behavior Research and Therapy. 2000;38(99):835–855. 00130–8. doi: 10.1016/S0005-7967. [PubMed] [Cross Ref]
  • Christiansen BA, Goldman MS, Inn A. Development of alcohol-related expectancies in adolescents: Separating pharmacological from social-learning influences. Journal of Consulting and Clinical Psychology. 1982;50:336–344. doi: 10.1037/0022-006X.50.3.336. [PubMed] [Cross Ref]
  • Clark DB, Bukstein OG, Smith MG, Kaczynski NA, Mezzich AC, Donovan JE. Identifying anxiety disorders in adolescents hospitalized for alcohol abuse or dependence. Psychiatric Services. 1995;46:618–620. [PubMed]
  • Cludius B, Stevens S, Bantin T, Gerlach AL, Hermann C. The motive to drink due to social anxiety and its relation to hazardous alcohol use. Psychology of Addictive Behaviors. 2013;27(3):806–813. doi: 10.1037/a0032295806. [PubMed] [Cross Ref]
  • Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH, Wadsworth ME. Coping with stress during childhood and adolescence: problems progress and potential in theory and research. Psychological Bulletin. 2001;127:87–127. doi: 10.1037//0033-2909.127.187. [PubMed] [Cross Ref]
  • Connor-Smith JK, Compas BE. Vulnerability to social stress: Coping as a mediator or moderator of sociotropy and symptoms of anxiety and depression. Cognitive Therapy and Research. 2002;26:39–55.
  • Connor-Smith JK, Compas BE, Wadsworth ME, Thomsen AH, Saltzman H. Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology. 2000;68:976–992. doi: 10.1037//0022-006X.68.6.976. [PubMed] [Cross Ref]
  • Conrod PJ, Castellanos-Ryan N, Mackie C. Long-term effects of personality-targeted intervention to reduce alcohol use in adolescents. Journal of Consulting and Clinical Psychology. 2011;79:296–306. doi: 10.1037/a0022997. [PubMed] [Cross Ref]
  • Conrod PJ, Stewart SH, Comeau N, Maclean AM. Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child & Adolescent Psychology. 2006;35:550–563. doi: 10.1207/s15374424jccp3504_6. [PubMed] [Cross Ref]
  • Cooper ML, Frone MR, Russell M, Mudar P. Drinking to regulate positive and negative emotions: A motivational model of alcohol use. Journal of Personality and Social Psychology. 1995;69:990–1005. doi: 10.1037/0022-3514.69.5.990. [PubMed] [Cross Ref]
  • Cooper ML. Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychological Assessment. 1994;6:117–128. doi: 10.1037/1040-3590.6.2.117. [Cross Ref]
  • Cooper ML, Krull JL, Agocha VB, Flanagan ME, Orcutt HK, Jackson M. Motivational pathways to alcohol use and abuse among Black and White adolescents. Journal of Abnormal Psychology. 2008;117:485–501. doi: 10.1037/a0012592. [PubMed] [Cross Ref]
  • Deas D, Riggs P, Langenbucher J, Goldman M, Brown S. Adolescents are not adults: Developmental considerations in alcohol users. Alcoholism: Clinical and Experimental Research. 2000;24(2):232–237. doi: 10.1111/j.1530-0277.2000.tb04596.x. [PubMed] [Cross Ref]
  • Duka T, Jackson A, Smith DC, Stephens DN. Relationship of components of an alcohol interoceptive stimulus to induction of desire for alcohol in social drinkers. Pharmacology, Biochemistry & Behavior. 1999;64:301–309. [PubMed]
  • Elkind D. Egocentrism in adolescence. Child Development. 1967;38:1025–1034. [PubMed]
  • Essau CA, Conradt J, Petermann F. Frequency and comorbidity of social phobia and social fears in adolescents. Behavior Research and Therapy. 1999;37:831–843. doi: 10.1016/S0005-7967(98)00179-X. [PubMed] [Cross Ref]
  • Gottfredson DC, Wilson DB. Characteristics of effective school-based substance abuse prevention. Prevention Science. 2003;4:27–38. doi: 10.1023/A:1021782710278. [PubMed] [Cross Ref]
  • Gunnar MR, Wewerka S, Frenn K, Long JD, Griggs C. Developmental changes in hypothalamus-pituitary-adrenal activity over the transition to adolescence: Normative changes and associations with puberty. Development & Psychopathology. 2009;21:69–85. doi: 10.1017/S0954579409000054. [PMC free article] [PubMed] [Cross Ref]
  • Ham LS, Bonin M, Hope DA. The role of drinking motives in social anxiety and alcohol use. Journal of Anxiety Disorders. 2007;21:991–1003. doi: 10.1016/j.janxdis.2006.10.014. [PubMed] [Cross Ref]
  • Ham LS, Zamboanga BL, Bacon AK, Garcia TA. Drinking motives as mediators of social anxiety and hazardous drinking among college students. Cognitive Behaviour Therapy. 2009;38:133–145. doi: 10.1080/16506070802610889. [PubMed] [Cross Ref]
  • Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press; 2008.
  • Hingson R, Kenkel D. Social, health, and economic consequences of underage drinking. In: Bonnie RJ, O’Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academies Press; 2004. pp. 251–383.
  • Huselid RF, Cooper ML. Gender roles as mediators of sex differences in adolescent alcohol use and abuse. Journal of Health and Social Behavior. 1992;33:348–362. doi: 10.2307/2137313. [PubMed] [Cross Ref]
  • Hussong AM, Chassin L. The stress-negative affect model of adolescent alcohol use: Disaggregating negative affect. Journal of Studies on Alcohol and Drugs. 1994;55:707–718. [PubMed]
  • Jackson KM. Heavy episodic drinking: Determining the predictive utility of five or more drinks. Psychology of Addictive Behaviors. 2008;22:68–77. [PMC free article] [PubMed]
  • Kraemer HC, Yesavage JA, Taylor JL, Kupfer D. How can we learn about developmental processes from cross-sectional studies, or can we? The American Journal of Psychiatry. 2000;157:163–171. doi: 10.1176/appi.ajp.157.2.163. [PubMed] [Cross Ref]
  • Kuntsche E, Knibbe R, Gmel G, Engels R. Why do young people drink? A review of drinking motives. Clinical Psychology Review. 2005;25:841–861. doi: 10.1016/j.cpr.2005.06.002. [PubMed] [Cross Ref]
  • Kuntsche E, Knibbe R, Gmel G, Engels R. Who drinks and why? A review of socio-demographic, personality, and contextual issues behind the drinking motives in young people. Addictive Behaviors. 2006;31:1844–1857. doi: 10.1016/j.addbeh.2005.12.028. [PubMed] [Cross Ref]
  • Kuntsche E, Stewart SH, Cooper ML. How stable is the motive-alcohol use link? A cross-national validation of the Drinking Motives Questionnaire Revised among adolescents from Switzerland, Canada, and the United States. Journal of Studies on Alcohol and Drugs. 2008;69:388–396. [PubMed]
  • Kushner MG, Abrams K, Borchardt C. The relationship between anxiety disorders and alcohol use disorders: A review of major perspectives and findings. Clinical Psychology Review. 2000;20(2):149–171. doi: 10.1016/S0272-7358(99)00027-6. [PubMed] [Cross Ref]
  • Labouvie E, White HR. Drug sequences, age of onset, and use trajectories as predictors of drug abuse/dependence in young adulthood. In: Kandel DB, editor. Stages and pathways of drug involvement: examining the gateway hypothesis. 2002. pp. 19–41.
  • Leen-Feldner EW, Reardon LE, Zvolensky MJ. Pubertal status and emotional reactivity to a voluntary hyperventilation challenge predicting panic symptoms and somatic complaints: A laboratory-based multi-informant test. Behavior Modification. 2007;31:8–31. [PubMed]
  • Lewis MA, Hove MC, Whiteside U. Fitting in and feeling fine: Conformity and coping motives as mediators of the relationship between social anxiety and problematic drinking. Psychology of Addictive Behaviors. 2008;22:58–67. doi: 10.1037/0893-164X.22.1.58. [PubMed] [Cross Ref]
  • Love A, James D, Willner P. A comparison of two alcohol craving questionnaires. Addiction. 1998;93:1091–1102. doi: 10.1046/j.1360-0443.1998.937109113.x. [PubMed] [Cross Ref]
  • Lowman C, Hunt WA, Litten RZ, Drummond DC. Research perspectives on alcohol craving: An overview. Addiction. 2000;95:S45–S54. [PubMed]
  • Masten A, Faden V, Zucker R, Spear L. A developmental perspective on underage alcohol use. Alcohol Research & Health. 2009;32(1):3–15. [PMC free article] [PubMed]
  • Moberg DP. The Adolescent Alcohol and Drug Involvement Scale: An instrument for measuring adolescent use and misuse of alcohol. Journal of Studies on Alcohol. 2000;40:291–300. [PubMed]
  • Morris EP, Stewart SH, Ham LS. The relationship between social anxiety disorder and alcohol use disorders: A critical review. Clinical Psychology Review. 2005;25:734–760. doi: 10.1016/j.cpr.2005.05.004. [PubMed] [Cross Ref]
  • National Institute on Alcohol Abuse and Alcoholism. Tenth special report to the U.S. Congress on alcohol and health. Washington, DC: National Institutes of Health; 2000. (NIH Publication No. 00-1583).
  • Neighbors C, Walters ST, Lee CM, Vader AM, Vehige T, Szigethy T, DeJong W. Event-specific prevention: Addressing college student drinking during known windows of risk. Addictive Behaviors. 2007;32:2667–2680. doi: 10.1016/j.addbeh.2007.05.010. [PMC free article] [PubMed] [Cross Ref]
  • Nelson EC, Grant JD, Bucholz KK, Glowinski A, Madden PAF, Reich W, Heath AC. Social phobia in a population-based female adolescent twin sample: Co-morbidity and associated suicide-related symptoms. Psychological Medicine. 2000;30:797–804. doi: 10.1017/S0033291799002275. [PubMed] [Cross Ref]
  • Nisbett RE, Ross L. Human inference: Strategies and shortcomings of social judgment. Prentice-Hall; Englewood Cliffs, NJ: 1980.
  • Ollendick TH, Hirshfeld-Becker DR. The developmental psychopathology of social anxiety disorder. Biological Psychiatry. 2002;51:44–58. [PubMed]
  • Ottenbreit ND, Dobson KS, Quigley L. An examination of avoidance in major depression in comparison to social anxiety disorder. Behaviour Research & Therapy. 2014;56:82–90. [PubMed]
  • Plasencia ML, Alden LE, Taylor CT. Differential effects of safety behaviour subtypes in social anxiety disorder. Behaviour Research & Therapy. 2011;49:665–675. [PubMed]
  • Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods. 2008;40:879–891. [PubMed]
  • Rohde P, Lewinsohn PM, Kahler CW, Seeley JR, Brown RA. Natural course of alcohol use disorders from adolescence to young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry. 2001;40:83–90. doi: 10.1097/00004583-200101000-00020. [PubMed] [Cross Ref]
  • Sayette MA. Does drinking reduce stress? Alcohol Research and Health. 1999;23:250–255. Retrieved from http://secure.ce-credit.com/articles/100623/Reduce_Stress.pdf. [PubMed]
  • Schell TL, Martino SC, Ellickson PL, Collins RL, McCaffrey D. Measuring developmental changes in alcohol expectancies. Psychology of Addictive Behaviors. 2005;19:217–220. doi: 10.1037/0893-164X.19.2.217. [PubMed] [Cross Ref]
  • Schulze D, Jones BT. Desire for alcohol and outcome expectancies as measures of alcohol cue-reactivity in social drinkers. Addiction. 2000;95:1015–1020. doi: 10.1046/j.1360-0443.2000.95710154.x. [PubMed] [Cross Ref]
  • Schwartz PD, Maynard AM, Uzelac SM. Adolescent egocentrism: A contemporary view. Adolescence. 2008;43:441–448. [PubMed]
  • Silverman WK, Albano AM. The Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. San Antonio, TX: Physiological Corporation; 1996.
  • Sobell LC, Sobell MB. Timeline Followback (TLFB) for Alcohol. Toronto, Ontario, Canada: Addiction Research Foundation; 1996. [PubMed]
  • Stroud LR, Tanofsky-Kraff M, Wilfley DE, Salovey P. The Yale Interpersonal Stressor (YIPS): Affective, physiological, and behavioral responses to a novel interpersonal rejection paradigm. Annals of Behavioral Medicine. 2000;22:204–213. doi: 10.1007/BF02895115. [PubMed] [Cross Ref]
  • Tapert SF, Caldwell L, Burke C. Alcohol and the adolescent brain: Human studies. Alcohol Research & Health. 2004:205–212. Retrieved from http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm.
  • Tapert SF, Cheung EH, Brown GG, Frank LR, Paulus MP, Schweinsburg AD, Brown SA. Neural response to alcohol stimuli in adolescents with alcohol use disorder. Archives of General Psychiatry. 2003;60:727–735. doi: 10.1001/archpsyc.60.7.727. [PubMed] [Cross Ref]
  • Thomas S, Bacon A. Stress and affective inductions in addiction research. In: MacKillop J, de Wit H, editors. The Wiley-Blackwell Handbook of Addiction Psychopharmacology. Oxford, UK: Wiley-Blackwell; 2013. [Cross Ref]
  • Thomas S, Randall C, Carrigan M. Drinking to cope in individuals with social anxiety: A controlled study. Alcoholism: Clinical and Experimental Research. 2003;27:1937–1943. doi: 10.1097/01.ALC.0000100942.30743.8C. [PubMed] [Cross Ref]
  • Tomlinson KL, Brown SA. Self-medication or social learning? A comparison of models to predict early adolescent drinking. Addictive behaviors. 2012;37(2):179–186. [PubMed]
  • Torres JM, Ortega E. Alcohol intoxication increases allopregnolone levels in male adolescent humans. Psychopharmochology. 2004;172:352–355. doi: 10.1007/s00213-003-1662-0. [PubMed] [Cross Ref]
  • U.S. Department of Health and Human Services. Healthy People 2020, Summary of Objectives: Substance abuse. 2011 Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=8.
  • Velting ON, Albano AM. Current trends in the understanding and treatment of social phobia in youth. Journal of Child Psychology and Psychiatry. 2001;42:127–140. doi: 10.1111/1469-7610.00705. [PubMed] [Cross Ref]
  • Vitaliano PP, Maiuro RD, Russo J, Becker J. Raw versus relative scores in the assessment of coping strategies. Journal of Behavioral medicine. 1987;10:1–18. [PubMed]
  • Walker EF, Walder DJ, Reynolds F. Developmental changes in cortisol secretion in normal and at-risk youth. Development and Psychopathology. 2001;13:721–732. doi: 10.1017/S0954579401003169. [PubMed] [Cross Ref]
  • Weber MD, Graham JW, Hansen WB, Flay BR, Johnson CA. Evidence for two paths of alcohol use onset in adolescents. Addictive Behavior. 1989;14:399–408. [PubMed]
  • Windle M. An alcohol involvement typology for adolescents: Convergent validity and longitudinal stability. Journal of Studies on Alcohol and Drugs. 1996;57:627–637. [PubMed]
  • Windle M, Windle RC. Testing the specificity between social anxiety disorder and drinking motives. Addictive Behaviors. 2012;37:1003–1008. doi: 10.1023/A:1011050217296. [PMC free article] [PubMed] [Cross Ref]
  • Winters KC. Screening and assessing youth for drug involvement. In: Allen J, Colombus M, editors. Assessing alcohol problems: A guide for clinicians and researchers. 2nd. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 2003. pp. 101–124.
  • Wittchen H, Behrendt S, Höfler M, Perkonnig A, Lieb R, Beesdo K. What are the high risk periods for incident substance use and transitions to abuse and dependence? Implications for early intervention and prevention. International Journal of Methods in Psychiatric Research. 2008;17:S16–S29. doi: 10.1002/mpr.254. [PubMed] [Cross Ref]
  • Zimmerman MA, Schmeelk-Cone KH. A longitudinal analysis of adolescent substance use and school motivation among African American youth. Journal of Research on Adolescence. 2003;13:185–210. doi: 10.1111/1532-7795.1302003. [Cross Ref]
  • Zimmerman P, Wittchen HU, Höfler M, Pfister H, Kessler RC, Lieb R. Primary anxiety disorders and the development of subsequent alcohol use disorders: A 4-year community study of adolescents and adults. Psychological Medicine. 2003;33:1211–1222. doi: 10.1017/S0033291703008158. [PubMed] [Cross Ref]
  • Zvolensky MJ, Lejuez CW, Stuart GL, Curtin JJ. Experimental psychopathology in psychological science. Review of General Psychology. 2001;5:371–381. doi: 10.1037/1089-2680.5.4.371. [Cross Ref]