Substance-dependent patients with and without social anxiety disorder: occurrence and clinical differences. A study of a consecutive sample of alcohol-dependent and poly-substance-dependent patients treated in two counties in Norway.

AIMS: (1) To identify clinically important differences between patients with and without social anxiety disorder (SAD) among alcohol-dependent and poly-substance-dependent patients. (2) To explore if primary SAD is a predictor of alcohol-dependency or poly-substance dependency when controlling for other Axes I and II disorders.
METHODS: A consecutive sample of in- and outpatient alcohol-dependent (N = 146) and poly-substance-dependent patients (N = 114) from public treatment programmes in two catchment areas was assessed by personal interview, the Composite International Diagnostic Interview and the Millon Clinical Multiaxial Inventory.
RESULTS: The frequency of current SAD was 42%; SAD was significantly more frequent among poly-substance-dependent patients (51%) than among alcohol-dependent patients (34%). Patients with SAD do not represent a distinct clinical subgroup, but the occurrence of SAD is combined with the occurrence of other anxiety disorders, affective disorders and personality disorders in both substance groups. The analysis showed a trend towards primary SAD as a predictor for developing poly-substance dependency.
CONCLUSIONS: Patients with SAD in both substance groups exhibited more comorbid Axis I and II disorders. They may need specific psychiatric treatment for such disorders in addition to treatment for SAD. Treatment of primary SAD could be a target for preventing poly-substance dependency in young populations.