Social situations

Transient social use, characteri2ed by a short history of use in social situations, occurring mainly among individuals of average intelhgence who are age 10—16 years... 

Pharmacotherapy of SAD should lead to improvement in physiologic symptoms of anxiety and fear, functionality, and overall well-being.26 Many patients may not achieve full remission of symptoms but should have significant improvement. Monitor patients weekly during acute treatment (e.g., initiation and titration of pharmacotherapy). Once patients are stabilized, monitor monthly. Inquire about adverse effects and SAD symptoms at each visit. To aid in assessing improvement, ask patients to keep a diary to record fears, anxiety levels, and behaviors in social situations.26 You may administer the Leibowitz Social Anxiety Scale (LSAS) to rate SAD severity and change, and the Social Phobia Inventory can be used as a self-assessment tool for SAD patients. 

Symptoms must be present in two or more settings and adversely affect functioning in social situations, school, or work. 

In the generalized subtype, fear is of many social situations where embarrassment may occur. In the discrete or specific subtype, fear is limited to one or two situations (e.g., performing, public speaking). 

Generalized type fear and avoidance extend to a wide range of social situations... 

Many people with drug problems are also anxious in social situations. 

Another common roadblock to changing a drug problem is social anxiety. Many people use drugs and alcohol to alleviate anxiety in social situations. 

Many drug relapses begin with such decisions, when a client seeks an apparently irrelevant social situation or starts an apparently irrelevant quarrel. Many times the client cannot link the beginning of the behavior chain with the potentially risky outcome. Even if others can see the potential for risk, sometimes the client cannot, so it is important for counselors and therapists to teach about these decisions and help clients identify when they are making them and what to do to stop the behavior chain. 

DSM-IV defines social anxiety disorder as an excessive fear of scrutiny by others in social situations. Refer to Table 5.9 for the diagnostic criteria for social anxiety... 

B. Almost always becomes anxions in the feared social situation. 

D. Avoids social situations that cause anxiety or at least endures them with considerable distress. 

There are ten personality disorders defined in DSM-IV. In each of the disorders, one or more personality traits have become entrenched in a maladaptive pattern. This aberrant personality trait alters the way the person thinks, responds emotionally, relates to others, and/or manages impulses. In addition, it must be fixed both across time and throughout varying social situations (see Table II.I for the diag-... 

If you are single, you might experience self-consciousness when you meet someone new. If you feel nervous to speak or a bit uncomfortable about doing things wrong, you are feeling the fear of rejection. Here is a test. The next time you are in a social situation, pick someone across the room that you do not know. Walk right up to them and strike up a conversation. In many people, the level of anxiety in this scenario is in direct proportion with the level of self-consciousness you have. 

Many victims of dependence have apparently normal backgrounds. Some simply make the mistake of trying a substance in some social situation which supports the pleasurable affects, and the substance s pharmacology merely takes over, after a variable period of misuse and abuse. Other victims may have personalities which lead them to escape life s normal pressures, therefore their need for mood enhancement or alteration of consciousness can be an additional pressure on the need to continue the substance. This may be particularly true as tolerance develops and dose increase is necessary to attain the initial effect. 

Note It is a good general practice to avoid treating the symptoms of use, withdrawal and overdose with other drugs. General support and control are often adequate. On the other hand the use of anticonvulsants should be prompt and the use of other drug supports considered carefully, in relationship to the clinical, psychological and social situation. 

T. Szasz, Ideology and Insanity (Garden City, N.Y. Anchot Books, 1970) R. Laing, The Politics of Experience (New York Ballantine Books, 1967) E. Goffman, Asylums Essays on the Social Situations of Mental Patients and Other Inmates (Garden City, N.Y Doubleday Anchot, 1961). 

The terms social phobia or social anxiety disorder refer to a pattern of recurrent fear and apprehension in social situations or scenarios where an individual may be scrutinized. Before modifications in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), identification of social phobia in childhood was limited by having the condition closely aligned to both... 

These possibilities generate a series of questions amenable to study with modern neuroscience methods (Pine, 1999). For example, adults with social phobia exhibit hypersensitivity to social situations in which they may be scrutinized. This hypersensitivity may be... 

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