Elsevier

Addictive Behaviors

Volume 55, April 2016, Pages 19-24
Addictive Behaviors

Getting the party started — Alone: Solitary predrinking mediates the effect of social anxiety on alcohol-related problems

https://doi.org/10.1016/j.addbeh.2015.12.013Get rights and content

Highlights

  • Solitary predrinking tested as a mediator of the social anxiety-alcohol relation.

  • High-risk pathway via solitary predrinking.

  • Low-risk pathway via social predrinking.

  • Solitary predrinking may be a target for clinical interventions.

Abstract

Predrinking (or pregaming) is common among undergraduates and has been linked with problem alcohol use. While many students predrink to save money, evidence suggests that some students predrink to cope with social anxiety (SA). Tension reduction and cognitive theories predict that those high in SA may predrink to reduce anticipatory anxiety before attending social events and their predrinking may be done alone rather than in normative social contexts. Available data suggest that, relative to social drinking, solitary drinking elevates risk for alcohol use and related problems. Informed by this evidence, we speculated that context for predrinking may be an important mechanism by which SA-risk for alcohol use unfolds. Specifically, we offered the novel hypothesis that those high in SA would engage frequently in solitary predrinking and this in turn would be associated with elevated alcohol use and related problems. Undergraduate drinkers (N = 293; 70% women) completed self-reports of social anxiety, predrinking context (social, solitary), alcohol use, and alcohol-related problems. In partial support of our hypotheses, SA was a positive predictor of solitary predrinking, which in turn predicted elevated alcohol-related problems, but not alcohol use. While not hypothesized, we also found that SA was a negative predictor of social predrinking, which in turn reduced risk for alcohol use and related problems. Our study is the first in the literature to show that solitary predrinking helps explain the well-documented association between SA and alcohol-related problems. These findings may inform etiological models and clinical interventions, suggesting that SA-risk for problem drinking begins even before the party starts.

Introduction

Consuming alcohol before a social event is called predrinking or pregaming and is common among undergraduates. An estimated 85–95% of student drinkers reported predrinking at least once in the past month (Labrie and Pedersen, 2008, Zamboanga et al., 2010). Of concern, predrinking predicts heavy drinking over the course of a night, which leads to higher blood alcohol concentrations in those who predrink compared to those who do not (Clapp et al., 2009). Further, predrinking is linked to alcohol-related problems, such as physical injury and unplanned sex (Barnett et al., 2013, Paves et al., 2012). This relation has been found even when controlling for other known risk factors for problem drinking such as binge drinking (Haas, Smith, Kagan, & Jacob, 2012). An improved understanding of undergraduate predrinking is an important direction for research, with findings having clinical as well as policy-level implications (Wells, Graham, & Purcell, 2009).

Social anxiety (SA) is an individual-level difference that has been found to relate to problem alcohol use (including predrinking) (see Schry & White, 2013 for a meta-analysis; Stewart, Morris, Mellings, & Komar, 2006). SA may be a particularly relevant risk factor for undergraduate drinking, as many students feel socially anxious at least occasionally, with 10–20% meeting criteria for Social Anxiety Disorder (SAD; Purdon et al., 2001, Strahan, 2003). Given that alcohol has anxiolytic effects, it has been theoretically argued that those high in SA drink to alleviate physiological and psychological symptoms of anxiety (Morris, Stewart, & Ham, 2005).

Many theories have been applied to understand the positive association between SA and drinking behavior. Of central relevance, tension reduction theory (TRT; Conger, 1956, Kushner et al., 1990) and the stress response-dampening model (SRD; Levenson, Sher, Grossman, Newman, & Newlin, 1980) predict that some (e.g., those high in SA) are particularly responsive to the anxiolytic effects of alcohol use and thus drink for negative reinforcement purposes. In turn, socially anxious individuals come to expect anxiety reduction from alcohol use and this increases alcohol use when anticipating or experiencing anxiety-provoking social situations (see Carrigan & Randall, 2003 for a review; Ham and Hope, 2005, Morris et al., 2005). Supporting this theory, research shows that SAD and alcohol use disorders are highly comorbid in clinical populations (Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996). Also, research on non-clinical undergraduates reveals that elevated SA is consistently associated with alcohol-related problems, whereas SA's link to frequency of alcohol use in students is less clear (Buckner et al., 2011, Buckner et al., 2013). Yet, to date, much remains unknown about the key mechanisms underlying SA-related drinking in young adults.

While students often report predrinking to save money and to get “buzzed” prior to social events, another commonly endorsed reason for predrinking is to reduce SA (DeJong et al., 2010, Pedersen and LaBrie, 2007, Pedersen et al., 2009). Complimenting TRT and SRD, Clark and Wells (1995) cognitive model of social phobia posits that socially anxious persons experience considerable anxiety before attending social gatherings due to anticipatory negative self-appraisal. To illustrate, before an event, those high in SA are likely to review what the event may be like and during this process, their thoughts tend to be consumed by past social failures, by negative images of themselves at the upcoming social event, and by beliefs about upcoming poor social performance and rejection from peers (Clark, 2001, Eckman and Shean, 1997). This negative self-appraisal process results in elevated social anxiety and may even result in avoidance of the event altogether (Mellings & Alden, 2000). For those who do attend the event, anticipatory processing primes them to be critical of their social competence/performance and be less likely to notice signs of peer acceptance (Battista and Kocovski, 2010, Clark, 2001).

The above-mentioned theories predict that anticipatory anxiety may be a central trigger for predrinking in socially anxious individuals. Predrinking may serve to dampen anticipatory anxiety and to disrupt the ruminative, negative self-appraisal process — thus, increasing the likelihood of attending the social event and reducing self-focus. Moreover, given that those high in SA fear social interactions, they are likely to predrink alone before encountering others. While no studies to date have examined solitary predrinking in the SA-alcohol problem pathway, a growing literature on drinking context supports differential risk associated with solitary versus social drinking. Many students drink in social situations (e.g., with friends) and this type of drinking is linked to problem drinking. However, 15% of students drink outside normative social contexts (Neff, 1997, O'Hare, 1990) and this is thought to be especially risky (Keough, O'Connor, Sherry, & Stewart, 2015). Solitary drinkers tend to consume alcohol more often and have more alcohol-related problems than social drinkers (Christiansen et al., 2002, Holyfield et al., 1995). Also, those who view alcohol as a means of reducing anxiety or stress are twice as likely as those without such beliefs to engage in solitary drinking (Bourgault & Demers, 1997). Relatedly, compared to normative social drinking, solitary drinking has been shown to prospectively predict increased alcohol problems later in life (Abbey et al., 1993, Creswell et al., 2013, Gonzalez and Skewes, 2012).

Based on theory, we propose that solitary predrinking may help explain the positive association between SA and problematic drinking. Specifically, it may be through frequent solitary predrinking that SA leads to heavy alcohol use and alcohol-related problems. In other words, the tendency of socially anxious young people to engage in solitary predrinking prior to feared social events may mediate their risk for adverse drinking outcomes. We hypothesized that elevated SA would predict more frequent solitary predrinking, which in turn would predict heavy use and experiencing alcohol-related problems.

Section snippets

Procedure and participants

The current study was approved by the Health Sciences Research Ethics Board at Dalhousie University. Data for the current study was pulled from a larger study on personality and drinking motives (Mackinnon, Kehayes, Clark, Sherry, & Stewart, 2014). Some participants were recruited from an online psychology participant pool at Dalhousie, while others were recruited using flyers posted around the community where the study took place. The only inclusion criteria were that individuals had to be

Data screening

Data screening revealed that some variables were not normally distributed (see Table 1) (skew > 3.0; kurtosis > 10; Kline, 2010), which frequently occurs with drinking variables in non-clinical samples (Miller et al., 2002). To correct for this, we used robust maximum likelihood estimation (MLR) in MPlus 7.0 to calculate path coefficients and fit indices. MLR and bootstrapping are robust to violations of multivariate normality (Muthén & Muthén, 2012).

Descriptive statistics and bivariate correlations

See Table 1 for descriptive statistics and

Discussion

Our goal was to examine the mediating role of solitary predrinking in the SA pathway to alcohol use and related problems. Supporting hypotheses, we found that SA was associated with relatively more solitary predrinking and this in turn predicted experiencing elevated alcohol-related problems. However, this effect was not observed for alcohol use. Interestingly, although not initially hypothesized, SA was associated with infrequent social predrinking and this in turn protected against heavy

Role of funding sources

This research was supported by an operating grant from the Social Sciences and Humanities Research Council of Canada (SSHRC) awarded to Sherry H. Stewart and Simon B. Sherry. During completion of this work, Matthew T. Keough was supported by a Vanier Canada Graduate Scholarship from the Canadian Institutes of Health Research (CIHR), and Roisin M. O'Connor was supported in-part by a CIHR New Investigator Award. The financial support had no role in the study design, collection, analysis or

Contributors

All authors contributed meaningfully to the conceptual model presented in the manuscript. Matthew T. Keough conducted literature searches and wrote the first draft of the manuscript with Dr. O'Connor's constant and significant feedback on all aspects of the paper. Dr. Battista contributed to writing the introduction, methods, and results. Drs. Stewart and Sherry designed the study, collected the data as a part of a larger longitudinal study, and provided significant edits on the entire

Conflict of interest

All authors declare that they have no conflicts of interest.

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