Marijuana-Related Problems and Social Anxiety: The Role of Marijuana Behaviors in Social Situations

    BRIEF REPORT
    Marijuana-Related Problems and Social Anxiety: The Role of Marijuana
    Behaviors in Social Situations
    Julia D. Buckner
    Louisiana State University
    Richard G. Heimberg
    Temple University
    Russell A. Matthews and Jose Silgado
    Louisiana State University
    Individuals with elevated social anxiety appear particularly vulnerable to marijuana-related problems. In
    fact, individuals with social anxiety may be more likely to experience marijuana-related impairment than
    individuals with other types of anxiety. It is therefore important to determine whether constructs
    particularly relevant to socially anxious individuals play a role in the expression of marijuana-related
    problems in this vulnerable population. Given that both social avoidance and using marijuana to cope
    with negative affect broadly have been found to play a role in marijuana-related problems, the current
    study utilized a new measure designed to simultaneously assess social avoidance and using marijuana to
    cope in situations previously identified as anxiety-provoking among those with elevated social anxiety.
    The Marijuana Use to Cope with Social Anxiety Scale (MCSAS) assessed behaviors regarding 24 social
    situations: marijuana use to cope in social situations (MCSAS-Cope) and avoidance of social situations
    if marijuana was unavailable. In Study 1, we found preliminary support for the convergent and
    discriminant validity and internal consistency of the MCSAS scales. In Study 2, we examined if MCSAS
    scores were related to marijuana problems among those with (n 44) and without (n 44) clinically
    elevated social anxiety. Individuals with clinically meaningful social anxiety were more likely to use
    marijuana to cope in social situations and to avoid social situations if marijuana was unavailable. Of
    importance, MCSAS-Cope uniquely mediated the relationship between social anxiety group status and
    marijuana-related problems. Results highlight the importance of contextual factors in assessing
    marijuana-related behaviors among high-risk populations.
    Keywords: social anxiety, social phobia, marijuana, cannabis, coping motives, social avoidance
    Individuals with elevated social anxiety appear particularly vulnerable
    to marijuana-related problems (Buckner et al., 2008).
    Nearly one third of people with cannabis dependence also have
    social anxiety disorder (SAD), a rate higher than for any other
    anxiety disorder (Agosti, Nunes, & Levin, 2002). Social anxiety is
    related to faster transition from first use to experiencing marijuanarelated
    problems among adolescent boys (Marmorstein, White,
    Loeber, & Stouthamer.Loeber, 2010). Further, adolescents with
    SAD were nearly 5 times more likely to develop cannabis dependence
    in young adulthood after controlling for other Axis I disorders
    (Buckner et al., 2008). No other mood or anxiety disorder
    remained significantly related to subsequent cannabis dependence
    after controlling for Axis I disorder comorbidity, suggesting that
    clinically elevated social anxiety is an important risk factor for
    marijuana-related problems.
    Consistent with tension-reduction models (Conger, 1956), socially
    anxious individuals may use marijuana to manage chronically
    elevated anxiety, and using marijuana in this way may place
    them at risk for developing marijuana-related problems. In partial
    support of this hypothesis, elevated social anxiety was related to
    using marijuana to cope with negative affect, which mediated the
    relationship between social anxiety and marijuana-related problems
    (Buckner, Bonn.Miller, Zvolensky, & Schmidt, 2007). Yet,
    social anxiety and SAD were unrelated to the expectation that
    using marijuana would result in reductions in negative affect
    (Buckner & Schmidt, 2008, 2009), suggesting the link between
    social anxiety and marijuana-related problems may be more complex
    than simply using marijuana to decrease anxiety. Another
    limitation of this hypothesis is that it does not address the question
    as to why people with elevated social anxiety (as opposed to other
    types of negative affect) have such high rates of marijuana-related
    problems. Also, if socially anxious individuals use marijuana for
    tension reduction, it follows that they would use marijuana more
    frequently than nonsocially anxious individuals. Yet, findings regarding
    the relationship between social anxiety and frequency of
    This article was published Online First October 17, 2011.
    Julia D. Buckner, Russell A. Matthews, and Jose Silgado, Department of
    Psychology, Louisiana State University; Richard G. Heimberg, Department
    of Psychology, Temple University.
    Correspondence concerning this article should be addressed to Julia D.
    Buckner, Department of Psychology, Louisiana State University, 236
    Audubon Hall, Baton Rouge, LA 70803. E-mail: [email protected]
    Psychology of Addictive Behaviors c 2011 American Psychological Association
    2012, Vol. 26, No. 1, 151.156 0893-164X/12/$12.00 DOI: 10.1037/a0025822
    151
    marijuana use are mixed (Buckner et al., 2007; Buckner, Ecker, &
    Cohen, 2010; Fergusson, Horwood, & Beautrais, 2003; Griffin,
    Botvin, Scheier, & Nichols, 2002; Oyefeso, 1991).
    It may be that marijuana-related behaviors specifically concerning
    social situations place individuals with clinically elevated social anxiety
    at particular risk for experiencing marijuana-related problems. In
    partial support of this hypothesis, marijuana users with SAD (but not
    those without SAD) reported increases in marijuana craving during
    periods of elevated state social anxiety (Buckner, Silgado, & Schmidt,
    2011). Yet although using marijuana to manage social anxiety was
    related to marijuana problems, this link was reduced to nonsignificance
    once other marijuana use motives were considered (Lee, Neighbors,
    Hendershot, & Grossbard, 2009).
    One limitation to the extant research is that the majority used
    measures developed to examine global marijuana use behaviors.
    For instance, the Marijuana Motives Measure (Simons, Correia,
    Carey, & Borsari, 1998) used in prior work (Buckner et al., 2007)
    assesses marijuana use to manage negative affect broadly. Yet,
    individuals with elevated social anxiety may use marijuana to
    manage negative affect related specifically to social anxietyprovoking
    situations and may not be especially likely to use
    marijuana to manage negative affect in other situations. Although
    Lee et al. (2009) attempted to address this limitation by examining
    marijuana use in more specific situations, they did not directly
    assess whether marijuana was used to manage anxiety in social
    situations. Furthermore, avoidance of social situations may be
    especially related to marijuana-related problems (Buckner, Heimberg,
    & Schmidt, 2011), suggesting the need to examine both
    marijuana use to cope in social situations as well as avoidance of
    social situations if marijuana is unavailable. It may also be necessary
    to measure marijuana use behaviors related to situations
    known to be associated with elevated social anxiety and social
    avoidance among socially anxious individuals. This approach has
    been used to understand the high rates of alcohol-related problems
    among those with clinically elevated social anxiety (Buckner &
    Heimberg, 2010; Thomas, Randall, & Carrigan, 2003).
    The present study tested whether using marijuana to cope specifically
    in social situations and avoidance of social situations if
    marijuana was not available were associated with marijuanarelated
    problems among socially anxious individuals. Given the
    lack of measures designed to assess these constructs, two studies
    were conducted. In Study 1, we examined the psychometric properties
    of the Marijuana Use to Cope with Social Anxiety Scale
    (MCSAS), a self-report measure developed for this study to assess
    using marijuana to cope in social situations and avoidance of social
    situations in the absence of marijuana. In Study 2, we examined if
    socially anxious individuals used marijuana to cope in more social
    situations and avoided more social situations if marijuana was
    unavailable. We also tested whether these constructs mediated the
    link between social anxiety and marijuana problems. We examined
    these variables in undergraduates given this age cohort is especially
    vulnerable to marijuana problems. Specifically, age of cannabis
    use disorder (CUD) onset peaks at this age followed by a
    sharp decline (Stinson, Ruan, Pickering, & Grant, 2006) and
    marijuana use rates are similar between undergraduates and noncollege
    peers (Johnston, OfMalley, Bachman, & Schulenberg,
    2007).
    Study 1
    Sample and Procedures
    Participants (N 35; 60% female; 82.9% Caucasian) were
    recruited through the psychology student participant pool based on
    responses to an online screening question assessing current (past 3
    months) marijuana use. This sample was composed of current
    marijuana users, with 57.1% endorsing weekly marijuana use. The
    mean [M] age was 19.8 (standard deviation [SD] 2.9). Participants
    completed computerized versions of measures using surveymonkey.
    com and received referrals to university-affiliated psychological
    outpatient clinics and research credit for study completion.
    This study was approved by the universityfs Institutional Review
    Board.
    Measures
    MCSAS. The MCSAS is a modification of a similar scale of the
    use of drinking-related behaviors (see Buckner & Heimberg, 2010).
    Items were modified from the Liebowitz Social Anxiety Scale
    (LSAS; Liebowitz, 1987), a highly reliable and valid measure of
    anxiety in specific social situations (e.g., Fresco et al., 2001; Heimberg
    & Holaway, 2007), thereby providing items ideally suited for
    assessing social situations that have been found to be related to greater
    distress and avoidance among socially anxious individuals. Participants
    rated the degree to which they use marijuana to cope in the 24
    LSAS social situations (e.g., participating in small groups, going to a
    party, being the center of attention) as 0 never, 1 occasionally
    (1.33%), 2 often (34.67%), or 3 usually (68.100%). The same
    scale was used to assess the degree of avoidance if marijuana was
    unavailable in each of the 24 social situations. Consistent with prior
    work (Thomas et al., 2003), each item was scored dichotomously
    indicating whether an individual did (1) or did not (0) endorse each
    item. The gdidh responses were summed to provide the total number
    of situations in which marijuana was used to cope (MCSAS-Cope) or
    were avoided if marijuana was unavailable (MCSAS-Avoid).
    Other measures. Participants completed the self-report version
    of the LSAS (Liebowitz, 1987). Frequency of past 3-month marijuana
    use was assessed with the Marijuana Use Form (Buckner et al., 2007)
    on a 0 (never) to 10 (at least 21 times per week) rating scale.
    Frequency of past-week tobacco smoking was assessed with the
    Smoking History Questionnaire (SHQ; Brown, Lejuez, Kahler, &
    Strong, 2002) and typical drinking quantity was assessed by asking
    participants to indicate how much alcohol they drank on a typical
    weekend evening in the past month. Participants completed the Marijuana
    Problems Scale (MPS; Stephens, Roffman, & Curtin, 2000), a
    list of 19 negative consequences related to marijuana use in the past
    90 days. Participants rated each marijuana problem as 0 (no problem),
    1 (minor problem), or 2 (serious problem). The Marijuana Effect
    Expectancies Questionnaire (MEEQ) is a list of 48 expectations
    regarding marijuana use rated from 1 (strongly disagree) to 5
    (strongly agree; Aarons, Brown, Stice, & Coe, 2001). It is composed
    of six subscales: Cognitive and Behavioral Impairment, Relaxation
    and Tension Reduction, Social and Sexual Facilitation, Perceptual and
    Cognitive Enhancement, Global Negative Effects, and Craving and
    Negative Effects. These subscales have demonstrated adequate reliability
    (e.g., Aarons et al., 2001; Buckner & Schmidt, 2008). The
    Marijuana Motives Measure (MMM; Simons et al., 1998) is a 25-item
    152 BUCKNER, HEIMBERG, MATTHEWS, AND SILGADO
    measure assessing the following marijuana use motives: enhancement,
    coping, social, conformity, and expansion. Participants indicate
    the degree to which they have smoked marijuana for particular reasons
    from 1 (almost never/never) to 5 (almost always/always).MMM
    subscales have demonstrated excellent internal consistency (Chabrol,
    DucongeL, Casas, Roura, & Carey, 2005).
    Study 1 Results
    See Table 1 for means, standard deviations, alphas, and correlations
    of MCSAS scales with LSAS and substance use variables.
    MCSAS-Cope was significantly related to MEEQ-Social and Sexual
    Facilitation and MEEQ-Relaxation and Tension Reduction.
    MCSAS-Avoid was related to MEEQ-Social and Sexual Facilitation
    and MEEQ-Perceptual and Cognitive Enhancement. MCSASCope
    was significantly related to MMM-Social, MMM-Coping,
    and MMM-Enhancement. MCSAS-Avoid was related to MMMSocial,
    MMM-Coping, and MMM-Expansion. Marijuana problems
    were related to MCSAS-Cope but not MCSAS.Avoid.
    Weekly marijuana users (M 7.00, SD 7.30) had higher
    MCSAS-Cope scores than infrequent users (M 0.60, SD
    1.24), F(1, 34) 11.21, p .002, d 1.18. Weekly marijuana
    users (M 8.55, SD 15.12) did not significantly differ from
    infrequent users (M 3.53, SD 9.16) on MCSAS-Avoid, F(1,
    34) 1.28, p .266, d .40. Both MCSAS scales were unrelated
    to alcohol and tobacco use (see Table 1).
    Study 1 Discussion
    Results provide preliminary support for the internal consistency
    and convergent validity of the MCSAS scales given that both
    scales were significantly related to MEEQ-Social and Sexual Facilitation,
    MMM-Coping, and MMM-Social. MCSAS-Cope was
    also significantly related to MEEQ-Relaxation and Tension Reduction.
    Of note, the magnitude of these correlations suggests that
    although these constructs were related, the MCSAS subscales
    appear to assess constructs that differ from those assessed by the
    MEEQ and MMM. MCSAS-Cope (but not Avoid) scores were
    related to marijuana problems and were higher among weekly
    users. There was some support for discriminant validity.although
    MCSAS-Cope was related to marijuana use frequency, it was
    unrelated to frequency of tobacco or alcohol use.
    Study 2 Method
    Sample and Participant Selection
    To test if MCSAS scores play a role in the relation between
    social anxiety and marijuana problems, 1,156 potential participants
    were recruited through the psychology student participant pool to
    complete an online survey. Of these, 252 (22%) endorsed current
    (past 3 months) marijuana use and were included in the present
    study. This sample was predominantly female (63.6%) and non-
    Hispanic/Latino (96.4%). Racial composition was 8.0% African
    American, 0.4% American Indian, 2.4% Asian American, 84.0%
    Caucasian, 4.0% gmixed,h and 1.2% gother.h Ages ranged from
    18.35 (M 19.93, SD 2.17) and 34.7% endorsed weekly
    marijuana use. Participants completed measures using surveymonkey.
    com and received referrals to university-affiliated psychological
    outpatient clinics and research credit for study completion.
    This study was approved by the universityfs Institutional Review
    Board.
    Table 1
    Relations Between MCSAS Scales and Measures of Social Anxiety and Marijuana Behaviors in
    Study 1
    M SD
    MCSAS MCSAS
    Cope Avoid
    MCSAS-Cope 2.94 3.96 .89
    MCSAS-Avoid 3.49 6.32 .96 .43
    LSAS-Anxiety 17.31 8.40 .89 .32 .67
    LSAS-Avoidance 15.26 11.13 .89 .49 .79
    MEEQ cognitive/behavioral impairment 31.71 6.01 .76 .00 .30
    MEEQ relaxation/tension reduction 29.20 4.81 .75 .37 .23
    MEEQ social and sexual facilitation 27.20 5.92 .74 .54 .48
    MEEQ perceptual/cognitive enhancement 26.57 5.04 .71 .20 .35
    MEEQ global negative effects 15.43 4.45 .65 .21 .15
    MEEQ craving/physical effects 24.74 3.55 .74 .08 .24
    MMM social motives 11.57 5.14 .86 .65 .36
    MMM coping motives 9.40 4.76 .86 .54 .34
    MMM enhancement motives 17.91 5.73 .89 .39 .13
    MMM conformity motives 6.17 2.16 .61 .04 .03
    MMM expansion motives 9.37 4.89 .94 .21 .34
    Marijuana problems 2.77 2.81 .79 .48 .20
    Tobacco usea 2.67 5.27 NA .14 .32
    Typical drinking quantity 6.57 3.33 NA .19 .15
    Note. MCSAS Marijuana Use to Cope with Social Anxiety Scale; LSAS Liebowitz Social Anxiety Scale;
    MEEQ Marijuana Effect Expectancy Questionnaire; MMM Marijuana Motives Measure; NA not
    applicable (single item measure).
    a Assessed for current tobacco users only (n 20).
    p .05. p .01. p .001.
    MARIJUANA PROBLEMS AND SOCIAL ANXIETY 153
    Measures
    Social anxiety. The Social Interaction Anxiety Scale (SIAS;
    Mattick & Clarke, 1998) is a measure of general social interaction
    fears that demonstrates high levels of internal consistency and
    test.retest reliability across clinical, community, and student samples
    (Mattick & Clarke, 1998; Osman, Gutierrez, Barrios, Kopper,
    & Chiros, 1998). To increase generalizability to individuals with
    SAD, an empirically supported cutoff score (34; see Heimberg,
    Mueller, Holt, Hope, & Liebowitz, 1992) was used to identify
    those with clinically meaningful levels of social anxiety (high
    social anxiety [HSA] n 44). To facilitate the comparison of
    those with clinically meaningful social anxiety to those with normative
    levels of social anxiety, a randomly selected unmatched
    group of 44 participants scoring below the Heimberg et al. (1992)
    SIAS community sample mean (20) was selected to comprise the
    lower social anxiety (LSA) group. The SIASfs internal consistency
    was adequate for the entire sample ( .93) and our clinical
    analogue sample ( .96). Information regarding demographic
    characteristics, social anxiety, and marijuana use of the HSA and
    LSA groups is presented in Table 2.
    Substance use measures. Internal consistency was adequate
    for the MCSAS Scales for entire sample (MCSAS-Cope .95;
    MCSAS-Avoid .96) and our clinical analogue sample
    (MCSAS-Cope .95; MCSAS-Avoid .96). It was also
    adequate for the Marijuana Problems Scale (Stephens et al., 2000)
    for entire sample ( .84) and our clinical analogue sample (
    .87). Participants also completed the Marijuana Use Form (Buckner
    et al., 2007).
    Study 2 Results
    Among all current marijuana users, social anxiety was positively,
    significantly correlated with both MCSAS-Cope (r .19,
    p .002) and MCSAS-Avoid (r .25, p .001) as well as
    marijuana problems (r .18, p .005). However, the magnitude
    of the relation of social anxiety with marijuana problems was
    small. The magnitude of the relation between social anxiety and
    marijuana problems was larger in our clinical analogue sample
    (see Table 2). The most common problems endorsed by HSA
    participants were procrastination (endorsed by 45.5% of HSA
    participants), lower productivity (45.5%), and lower energy
    (36.4%). Marijuana problems were correlated with MCSAS-Cope
    (r .56, p .001) and MCSAS-Avoid (r .27, p .011). It is
    interesting that both LSA and HSA participants reported using
    marijuana to cope in social situations and avoiding social situations
    if marijuana was unavailable (see Table 2). As compared
    with the LSA group, a significantly larger percentage of the HSA
    group was likely to use marijuana to cope in social situations (p
    .006) and avoid social situations if marijuana was unavailable (p
    .055). HSA participants reported use of marijuana to cope in
    significantly more social situations (p .033) and avoiding a
    significantly greater number of social situations if marijuana was
    unavailable (p .007) as compared with the LSA group.
    Given that the relation between social anxiety and marijuana
    problems was larger in our clinical analogue sample, we tested
    whether MCSAS scalesf total scores mediated this relationship
    using maximum likelihood bootstrapping (5,000 samples were
    drawn) within the structural equation modeling program AMOS 17
    (McCabe et al., 2004); estimated standard errors and confidence
    intervals (90%) were calculated for all indirect, direct, and total
    effects. Three fully mediated models were tested (see Figure 1).
    Specifically, we tested the mediational effects of MCSAS-Avoid
    (Model A), MCSAS-Cope (Model B), and given the bivariate
    relationship between MCSAS-Avoid and MCSAS-Cope, we examined
    the two proposed mediators simultaneously (Model C) to
    better understand their additive contributions.
    For each model, three measures of model fit were calculated; 2,
    comparative fit index (CFI), and standardized root mean square
    residual (SRMR). A nonsignificant 2 indicates good model fit;
    however, 2 is sensitive to sample size. A CFI value of .95 or
    higher and an SRMR value of .08 or lower are indicative of good
    model fit (Lasser et al., 2000). As reported in Figure 1, Models B
    and C demonstrated acceptable fit; Model A demonstrated poor fit.
    Standardized path estimates are reported for each model. In Model
    A, social anxiety group had an unstandardized indirect effect (via
    MCSAS-Avoid) on marijuana-related problems of .62 (p .05),
    suggesting that when social anxiety group goes up by one (from
    LSA to HSA), marijuana-related problems goes up by .62; how-
    Table 2
    Demographic Characteristics, Social Anxiety, and Marijuana Use Behaviors by Social Anxiety Group
    Classification (Study 2)
    LSA (n 44) HSA (n 44)
    F or 2 M or % SD M or % SD p dor
    Age (years) 20.14 1.42 20.05 1.84 0.07 .791 0.06
    Sex (% female) 67.4 63.6 0.14 .709 0.04
    Race (% Caucasian) 86.0 84.1 0.07 .798 0.03
    Employed (%) 55.8 56.8 0.01 .925 0.01
    Typical drinking frequency 2.75 1.63 3.05 1.64 0.72 .399 0.18
    Marijuana use (% use marijuana weekly) 29.5 38.6 0.81 .368 0.10
    Marijuana problem severity 2.32 2.49 4.23 4.95 5.21 .025 0.49
    Social anxiety 13.36 4.69 41.27 8.40 370.38 .001 4.15
    % Use marijuana to cope in social situations 36.4 65.9 7.69 .006 0.30
    % Avoid social situations if marijuana unavailable 40.9 60.0 3.68 .055 0.21
    # Social situations in which marijuana used to cope 2.07 4.46 4.57 6.20 4.71 .033 0.47
    # Social situations avoided if marijuana unavailable 2.00 3.56 5.59 7.78 7.75 .007 0.60
    Note. Social anxiety was assessed with the Social Interaction Anxiety Scale. LSA lower social anxiety; HSA
    higher social anxiety.
    154 BUCKNER, HEIMBERG, MATTHEWS, AND SILGADO
    ever, this indirect effect should be interpreted with caution given
    the CFI value. In Model B, social anxiety group had an unstandardized
    indirect effect (via MCSAS-Cope) on marijuana-related
    problems of 1.01 (p .05). When these two mediators were
    combined in Model C, only MCSAS-Cope demonstrated a significant
    direct effect on marijuana-related problems ( .56, p
    .01). In this model, the social anxiety group again demonstrated an
    indirect effect on marijuana-related problems; the unstandardized
    indirect effect was 1.00 (p .01). These results suggest that the
    primary mediational effect is via MCSAS-Cope.1
    Given the limitations of conducting mediational analyses using
    cross-sectional data, one method of increasing confidence in the
    observed effects is to reverse the proposed mediator with the
    criterion variable (Sheets & Braver, 1999). We evaluated whether
    marijuana problems mediated the relation between social anxiety
    group and each MCSAS scale. The MCSAS-Avoid analysis was
    not consistent with mediation in this direction as the model was a
    poor fit, 2 5.08, p .024, CFI .71, SRMR .09. However,
    the MCSAS-Cope model was a good fit, 2 1.21, p .271,
    CFI .99, SRMR .04. In this model, social anxiety group had
    an unstandardized indirect effect (via marijuana problems) on
    MCSAS-Cope of .13 (p .001).
    Study 2 Discussion
    Compared to LSA individuals, HSA individuals used marijuana to
    cope in a greater number of social situations and avoided a greater
    number of social situations if marijuana was unavailable. Importantly,
    using marijuana to cope specifically in social situations (more so than
    avoidance of social situations if marijuana was not available) at least
    partially accounts for marijuana-related problems among individuals
    with HSA, a group at particular risk for marijuana-related problems
    and CUD (Buckner et al., 2008). Yet, it is unclear why using marijuana
    to cope in more social situations was related to more marijuanarelated
    problems among HSA participants. One possibility is that
    HSA marijuana usersf reliance on marijuana to help them cope in
    social situations may interfere with the learning or use of more
    adaptive coping strategies. Furthermore, they may come to believe
    they need marijuana to cope with these situations and be particularly
    likely to continue to use marijuana despite possible negative consequences.
    This is consistent with the especially high rates of cannabis
    dependence among HSA individuals (Buckner et al., 2008). However,
    it is also feasible (and consistent with our reversed mediational model)
    that HSA participants have marijuana problems and that the experience
    of these problems for some reason increases the likelihood that
    they will use marijuana to cope in social situations. Future work is
    necessary to delineate the temporal relations between these variables.
    Our finding that marijuana-related problems were significantly
    related to avoidance of social situations if marijuana is unavailable
    is consistent with prior work finding that social avoidance is
    especially related to marijuana-related problems (Buckner, Heimberg,
    et al., 2011). Although the mediational model was a poor fit,
    our data overall suggest that avoidance of marijuana-free social
    events may be problematic for HSA individuals. HSA individuals
    avoided more social situations in which marijuana was unavailable.
    By avoiding situations in which marijuana is unavailable,
    HSA individuals may disproportionately choose to attend social
    situations in which marijuana is available. Considered in combination
    with our finding that HSA individuals are more likely to
    rely on marijuana to cope during social events, the choice to attend
    those social events involving marijuana may place them at risk for
    using marijuana to cope in these situations thereby increasing their
    risk for marijuana-related problems.
    Findings should be considered in light of limitations. The studyfs
    cross-sectional nature precludes delineation of causal relationships,
    and prospective work will be an important next step. Also, the
    samples were primarily female and undergraduate; thus replication in
    other populations is necessary. Although an empirically supported
    clinical cut-off score was used to identify participants with clinically
    elevated social anxiety, replication with patients with SAD is necessary,
    especially given that the strength of the link between social
    anxiety and marijuana problems was greater in our clinical analogue
    sample than that obtained using continuous SIAS scores. We did not
    include measures of marijuana expectancies or marijuana use motives
    in Study 2, and future work could benefit from testing if MCSAS
    scales are more strongly related to marijuana-related problems than
    these other constructs among HSA individuals. Similarly, future work
    could test whether HSA is uniquely related to MCSAS scale scores or
    whether HSA individuals are vulnerable to also using marijuana to
    cope in nonsocial situations.
    1 A similar pattern of findings emerged when analyses were conducted
    with the entire sample (N 254) using continuous SIAS scores, 2 2.23,
    p .135, CFI .99, SRMR .03. When both mediators entered
    simultaneously, only MCSAS-Cope demonstrated a significant direct effect
    on marijuana-related problems.
    Model A: Mediational Effects of MCSAS-Avoid
    Social Anxiety
    Group
    MCSASAvoid
    Marijuana-Related
    Problems
    .29** .27**
    ƒÔ2(1) = 2.69, p > .05, CFI = .88, SRMR = .07
    Model B: Mediational Effects of MCSAS-Cope
    Social Anxiety
    Group
    MCSASCope
    Marijuana-Related
    Problems
    .23** .56**
    ƒÔ2(1) = 1.69, p > .05, CFI = .98, SRMR = .05
    Model C: Additive Mediational Effects of MCSAS-Avoid & MCSAS-Cope
    Social Anxiety
    Group
    MCSASAvoid
    Marijuana-Related
    Problems
    .29** -.01
    ƒÔ2(1) = 1.81, p > .05, CFI = .99, SRMR = .04
    MCSASC.
    23** ope
    .45**
    .56**
    Figure 1. Standardized direct effects and fit statistic information for
    proposed mediational models in Study 2 for MCSAS-Avoid (Model A),
    MCSAS-Cope (Model B), and MCSAS-Avoid and MCSAS-Cope combined
    (Model C).

     
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