Shyness,social anxiety,social anxiety disorder,and substance use among normative adolescent populations: A systematic review

Researchers have increasingly studied shyness, social anxiety, and social anxiety disorder (SAD) as potential precursors of substance use. Objectives. The objective of this study was to review the relationships between these variables and tobacco use, alcohol use, and cannabis/drug use in normative adolescent populations and the extent to which these associations differ by gender. Methods. A systematic search in PsycINFO and PubMed was conducted, reference screening was performed, and five experts were consulted. Results. Fifty articles published between 1980 and 2016 were included for review. Shyness was frequently associated with lower use of tobacco, alcohol, and cannabis/drug. Similar findings emerged for social anxiety. In contrast, SAD tended to be associated with higher use of tobacco and cannabis/drug, although the association between SAD and the use of alcohol appeared inconclusive. Furthermore, limited evidence suggests that shy females use less tobacco than shy males and that males with social anxiety use less drugs than socially anxious females. Conclusions. In conclusion, these results highlight that shyness, social anxiety, and SAD may exert different effects on substance use. Higher use of substances among adolescents suffering from a SAD may be explained, among other possibilities, by a self-medication mechanism. While all adolescents should benefit from prevention efforts targeted at substance use, a systematic screening for substance use disorders during the clinical evaluation that precedes SAD treatments is advised.