Conceptualization
Mark is a student who suffers from social anxiety and alcohol abuse problems. As a person who grew up in a conservative, non-drinking, and socially secluded environment, he did not develop social competencies and interpersonal skills to successfully integrate into a highly psychologically demanding college community. Mark’s inadequate social-emotional development and inability to cope with anxiety-inducing situations led him to substance abuse that minimizes his negative emotions associated with failure in school. This coping process leads to a cyclical drinking pattern: social status and inability to cope with it induces anxiety in Mark and he returns to alcohol as the facilitator of his negative emotional state. As a result, he then suffers the consequences of regular weekend and day drinking that perpetuate his social exclusion and academic failure. Although he was raised in an environment that prohibited drinking, the previous teenage experience of alcohol consumption has developed a positive alcohol expectancy. Mark’s drink refusal self-efficacy, or denial to realize his alcohol consumption as an issue, indicates the severity of the substance abuse problem caused by social anxiety.
Assessment Recommendations
The assessment regime is needed to identify the cause of Mark’s substance abuse and possible therapy and prevention strategies. To correctly identify the relationship between social anxiety and drinking, three cognitive-behavioral methods of analysis are proposed.
- Measure 1: The Five Facet Mindfulness Questionnaire includes a 5-point scale that evaluates the participant’s five areas of mindfulness and their relation to substance use as a mediator of negative emotions (Baer et al., 2006). The questionnaire’s reliability and validity were ranked excellent in the proceeding trials that utilized it (Clerkin et al., 2016).
- Measure 2: Drink to cope questionnaire addresses the individual’s proneness to alcohol abuse as a strategy for social anxiety reduction by assessing patients’ s severity of anxiety during social interactions on a 20-point scale (Thomas et al., 2003). The questionnaire has been prominent in the recent decade due to its re-test viability and construct validity.
- Measure 3: Social Anxiety Questionnaire (SAQ) was designed to identify the severity and causes of social phobic behavior and is actively utilized to investigate the possible therapy options (Lakuta, 2018). The questionnaire contains 30 questions relating to five factors of social life. The method poses a high-re-test validity and intra-scale reliability.
All of the evaluative measures mentioned above pose minimal threat to the participant since they ensure secure and confidential intervention. However, data breaches, confidentiality violations, and discussions of past traumatic experiences might lead to ethical issues and have to be accounted for. Additional psychological screening and information security measures should be taken to guarantee a safe assessment regime and avoid stress.
Therapy Recommendations
Cognitive Behavioral Therapy Strategy
Although a wide variety of approaches is utilized to facilitate a successful recovery from social phobias and substance abuse, cognitive-behavioral therapy will be the most effective in Mark’s case. Cognitive-behavioral therapy (CBT) has been identified as one of the most effective in treating and preventing addiction paired with mental health issues such as depression and general anxiety disorders (Glasner et al., 2020). For instance, Carroll and Kiluk (2017) examined the effect of CBT strategies on addiction rehabilitation therapy. According to Carroll and Kiluk (2017), “all treatment conditions were associated with a significant reduction in alcohol consumption as well as symptoms of depression, with greater benefits observed among the longer treatment conditions” (p. 847). The study by Magill et al. (2019) has shown that, unlike other approaches that directly treat the issue, CBT identifies and minimizes the self-destructive behaviors and thoughts that lead to alcohol misuse. Litt et al. (2016) characterized individual and group therapy options as the strengths of CBT since they reduce substance consumption and teach patients interpersonal skills to integrate into society.
Given all the strengths of CBT and its superiority over other substance abuse prevention strategies, it should be used in current psychological intervention. Homework and collaborative efforts of both the patient and the therapist contribute to the overall effectiveness of the approach since it enables people to develop skills to fight addiction independently. As a result of CBT intervention, patients reintegrate into society quicker and their chance of relapse is lower.
Intervention Summary
Based on the conceptualization and CBT strategies described above, a planned CBT intervention of seven or more 90-minute sessions should occur to treat Mark’s substance abuse and social phobia and promote abstinence. To minimize the effect of insufficient socio-emotion competencies that Mark has acquired in the past, some sessions should be performed in a group setting rather than individually. According to Hofmann (2017), this measure serves as social skill training and helps the patient to relate to others with similar struggles, minimizing his anxiety. During the first two sessions, the therapist should communicate the plan and the intent of the CBT intervention to the patient to establish a collaborative mood for future treatment (Conrod, 2016). Precise goal setting and motivation enhancing techniques ensure patient understanding of the necessity of the positive change and minimize drink refusal self-efficacy.
The elements of homework, cause identification, and substance use cessation should be implemented in the proceeding sessions. A therapist needs to establish an understanding of the CBT model. It will enable a patient to break down the historical and contextual factors of his situation and analyze the “physical, cognitive and behavioral components of an emotional response” that led Mark to anxiety-reducing drinking (Conrod, 2016, p. 427). Consequently, Mark will be able to identify and minimize the “personality-specific cognitive distortions that lead to problematic behaviors” (Conrod, 2016, p. 430). As a result of the intervention, Mark will also develop the needed competencies in reducing the addictive behavior and increasing interpersonal skills, which will result in better academic and interpersonal behaviors.
References
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45.
Carroll, K. M., & Kiluk, B. D. (2017). Cognitive-behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychology of Addictive Behaviors, 31(8), 847–861.
Clerkin, E. M., Sarfan, L. D., Parsons, E. M., & Magee, J. C. (2016). Mindfulness facets, social anxiety, and drinking to cope with social anxiety: Testing mediators of drinking problems. Mindfulness, 8(1), 159–170.
Conrod, P. (2016). Personality-targeted interventions for substance use and misuse. Current Addiction Reports, 3(4), 426-436.
Glasner, S., Chokron Garneau, H., Ang, A., Ray, L., Venegas, A., Rawson, R., & Kalichman, S. (2020). Preliminary efficacy of a cognitive behavioral therapy intervention targeting alcohol use and antiretroviral therapy adherence: A randomized clinical trial. PLOS One, 15(3), 1-17.
Hofmann, S. (2017). Cognitive Behavioral Therapy of Social Anxiety Disorder. Taylor & Francis Group.
Lakuta, P. (2018). Social anxiety questionnaire (SAQ): Development and preliminary validation. Journal of Affective Disorders, 238(1), 233-243.
Litt, M., Kadden, R., Tennen, H., & Kabela-Cormier, E. (2016). Network support II: Randomized controlled trial of network support treatment and cognitive behavioral therapy for alcohol use disorder. Drug and Alcohol Dependence, 165(13), 203-212. Web.
Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), 1093–1105. hWeb.
Thomas, S. E., Randall, C. L., & Carrigan, M. H. (2003). Drinking to cope in socially anxious individuals: a controlled study. Alcoholism: Clinical and Experimental Research, 27(2), 1937–1943.