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Clinical Translation: An Experimental Investigation of Peer Rejection and Social Anxiety on Alcohol and Cannabis Use Willingness: Accounting for Social Contexts and Use Cues in the Laboratory

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Research Briefs

Summer 2021

Renee M. Cloutier, PhD, Kristen G. Anderson, PhD, Nathan T. Kearns, PhD, Caitlyn N. Carey, & Heidemarie Blumenthal, PhD

An Experimental Investigation of Peer Rejection and Social Anxiety on Alcohol and Cannabis Use Willingness: Accounting for Social Contexts and Use Cues in the Laboratory

a,bRenee M. Cloutier, cKristen G. Anderson, b,dNathan T. Kearns, aCaitlyn N. Carey, and aHeidemarie Blumenthal
aThe Prevention Research Center, The Pennsylvania State University, 320 Biobehavioral Health Development Building, University Park, PA 16802, United States of America (Present Address)
bTeen Stress and Alcohol Research Laboratory, Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States of America
cDepartment of Psychology, Reed College, 3203 SE Woodstock Blvd. Portland, OR 97202
d Center for Alcohol and Addiction Studies, Brown University, Providence, RI, 02912

Alcohol and cannabis are the two most widely used substances in the U.S., with initial rates of use and use-related disorders peaking between ages 18 - 25 years (Franco et al., 2019; Grant et al., 2015; Hasin et al., 2016; Schulenberg et al., 2019). Emerging adults in college are at particularly high risk for substance use, in part, because college campuses provide more opportunities to use substances in higher-risk contexts (e.g., at parties with people they do not know well) and regularly engage with substance-using peers (Allen et al., 2017; Arnett, 2005; Lewis et al., 2019). Because socially anxious individuals fear negative evaluation, they are often hypersensitive to social cues, which may increase their risk for developing substance use-related problems (Buckner et al., 2012; Conway et al., 2016).

Many theoretical models emphasize risk for emerging substance use disorders and comorbid conditions as a planned, intentional process (e.g., to cope with social anxiety symptoms, in response to craving; Buckner et al., 2013; Carrigan & Randall, 2003; Khantzian, 1997). However, these pathways may not represent the experiences of individuals in contexts ideal for earlier prevention (Cloutier et al., 2016; Lemyre et al., 2019). Individuals who have not yet developed a substance use disorder may not experience the physiological urge of craving nor report intentional, coping motives and still be at increased risk. Many empirical studies also tend to test risk pathways for substance use as broad categories (i.e., any substance use) or by individual substance (e.g., alcohol only, cannabis only) - neither of which reflects individuals who use multiple substances (e.g., alcohol and cannabis) nor how they respond to real-world situations where multiple substances are often available (Egan et al., 2019; Yurasek et al., 2017).

We recently published a paper in the Psychology of Addictive Behaviors to experimentally investigate the relative influence of individuals' social anxiety symptoms in response to peer rejection on their willingness to use alcohol and cannabis within a simulated party setting. Specifically, 80 emerging adults (18–25 years; 70% women) endorsing lifetime alcohol and cannabis use were randomly assigned to experience rejection or neutral social cues. They rated their willingness to use alcohol and cannabis before and after cue exposure within the simulated party. We then statistically controlled for how often they reported using alcohol and cannabis in the last year, as well as their real-time willingness to accept non-substance use offers, such as food and nonalcoholic drinks. Results showed that individuals with elevated social anxiety symptoms were more willing to use cannabis (but not alcohol) across social contexts, regardless of rejection exposure, while rejection exposure increased cannabis use willingness similarly across levels of social anxiety.

In other words, young adults with elevated social anxiety were more willing to use cannabis in social situations, even without experiencing rejection or elevated anxiety symptoms. Likewise, experiencing rejection also increased young adults' willingness to use cannabis, regardless of their social anxiety symptoms. That associations were found for cannabis but not alcohol reinforces the need to consider individuals polysubstance use history, current patterns, and contexts of use behaviors. While more research is needed, the major lesson that clinicians working with emerging adults can take away from our brief report and the prototype-willingness literature more broadly is:

  • Collect detailed substance-specific and poly- or co- use histories and current use patterns from clients that includes substance, frequency, quantity, and contexts.

  • When targeting substance use behaviors in treatment, cognitions should be considered within the contexts that they occur:

    • At early/infrequent levels, there should be a greater emphasis on how clients react to a given situation or their willingness to engage in a particular behavior.

    • With more experience at higher frequency/quantity, interventions should emphasize more reasoned routes of processing.

  • Monitor how substance use patterns may change across the course of treatment, even when substance use problems are not the target of intervention because:

    • Treatment plans that increase social exposures may impact the cannabis use of clients who have elevated social anxiety symptoms, even when those clients do not meet diagnostic criteria for a social anxiety disorder.

    • Increased exposure to rejection may impact the cannabis use of clients, even those who do not report elevated social anxiety symptoms.


Allen, H. K., Caldeira, K. M., Bugbee, B. A., Vincent, K. B., O’Grady, K. E., & Arria, A. M. (2017). Drug involvement during and after college: Estimates of opportunity and use given opportunity. Drug and Alcohol Dependence, 174, 150–157.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Arnett, E. J. (2005). The developmental context of substance use in emerging adulthood. Journal of Drug Issues, 35(2), 235–253.

Buckner, J. D., Heimberg, R. G., Ecker, A. H., & Vinci, C. (2013). A biopsychosocial model of social anxiety and substance use. Depression and Anxiety, 30(3), 276–284.

Buckner, J. D., Heimberg, R. G., Schneier, F. R., Liu, S. M., Wang, S., & Blanco, C. (2012). The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence, 124(1–2), 128–134.

Carrigan, M. H., & Randall, C. L. (2003). Self-medication in social phobia: A review of the alcohol literature. Addictive Behaviors, 28(2), 269–284.

Cloutier, R. M., Anderson, K. G., Kearns, N. T., Carey, C. N., & Blumenthal, H. (2021). An experimental investigation of peer rejection and social anxiety on alcohol and cannabis use willingness: Accounting for social contexts and use cues in the laboratory. Psychology of Addictive Behaviors. Advance online publication.

Cloutier, R. M., Blumenthal, H., & Mischel, E. R. (2016). An examination of social anxiety in marijuana and cigarette use motives among adolescents. Substance Use and Misuse, 51(3), 408–418.

Conway, K. P., Swendsen, J., Husky, M. M., He, J. P., & Merikangas, K. R. (2016). Association of lifetime mental disorders and subsequent alcohol and illicit drug use: Results from the National Comorbidity Survey-Adolescent Supplement. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 280–288.

Egan, K. L., Cox, M. J., Suerken, C. K., Reboussin, B. A., Song, E. Y., Wagoner, K. G., & Wolfson, M. (2019). More drugs, more problems? Simultaneous use of alcohol and marijuana at parties among youth and young adults. Drug and Alcohol Dependence, 202(February), 69–75.

Franco, S., Olfson, M., Wall, M. M., Wang, S., Hoertel, N., & Blanco, C. (2019). Shared and specific associations of substance use disorders on adverse outcomes: A national prospective study. Drug and Alcohol Dependence, 201(April), 212–219.

Gerrard, M., Gibbons, F. X., Houlihan, A. E., Stock, M. L., & Pomery, E. A. (2008). A dual-process approach to health risk decision making: The prototype willingness model. Developmental Review, 28(1), 29–61.

Grant, B. F., Goldstein, R. B., Saha, T. D., Patricia Chou, S., Jung, J., Zhang, H., Pickering, R. P., June Ruan, W., Smith, S. M., Huang, B., & Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry, 72(8), 757–766.

Hasin, D. S., Kerridge, B. T., Saha, T. D., Huang, B., Pickering, R., Smith, S. M., Jung, J., Zhang, H., & Grant, B. F. (2016). Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: Findings from the national epidemiologic survey on alcohol and related conditions-III. American Journal of Psychiatry, 173(6), 588–599.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231–244.

Lemyre, A., Gauthier-Légaré, A., & Bélanger, R. E. (2019). Shyness, social anxiety, social anxiety disorder, and substance use among normative adolescent populations: A systematic review. American Journal of Drug and Alcohol Abuse, 45(3), 230–247.

Lewis, M. A., Litt, D. M., King, K. M., Fairlie, A. M., Waldron, K. A., Garcia, T. A., Loparco, C., Lee, C. M., Lewis, M. A., Litt, D. M., King, K. M., Fairlie, A. M., Garcia, T. A., & Lee, C. M. (2019). Examining the ecological validity of the prototype willingness model for adolescent and young adult alcohol use adolescent and young adult alcohol use. Psychology of Addictive Behaviors.

Yurasek, A. M., Aston, E. R., & Metrik, J. (2017). Co-use of alcohol and cannabis: A review. Current Addiction Reports, 4(2), 184–193.

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