FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER SHOULD SEE DOCTOR ABOUT ANXIETY, NOT SELF-MEDICATE WITH ALCOHOL

Question: Is there any type of medicine that I can take that will make me feel relaxed and not shy, kind of like what a little bit of alcohol can do?

Answer: Infants go through a normal phase of development when they are afraid of others. They cling to mom when there are strangers present, but they soon learn that most situations are not dangerous and can be managed more effectively without such anxiety.

As adults, all of us experience some situations causing stress during interactions with others. This is a totally natural and desirable response. When that wide-eyed aggressive looking individual comes toward you, you want to be ready to flee or fight -- if there are no other options. This type of situation produces what we doctors call the "fight-or-flight" reaction that involves an increased heart rate, increased breathing, dilated pupils, sweaty palms and nervousness.

Your question suggests to me that you are experiencing emotional stress in social settings even though your judgment tells you that you should not be. We doctors call this a "social phobia," and these occur in various degrees of severity.

A surprisingly large number of individuals experience a social phobia about a specific activity. Speaking in public or performing on stage are common examples. Despite a mild phobia, most people manage to perform their assigned task, although they may fail to come off looking and sounding as smooth as a politician does. (That may not be a bad thing, depending upon your view of politicians!) An individual with a more intense phobia may feel overwhelmed by the mere possibility of someday having to speak in public. This person may begin to tremble and experience sweaty palms at the very moment that the prospect of giving a talk crosses his or her mind. You probably have a mild social phobia since a "little bit" of alcohol is a sufficiently strong sedative to reduce your anxiety level. Many people use alcohol for this purpose. That is why it is often served at parties! There are some reasons why it isn't a perfect drug for dealing with your social phobia, however. The amount of alcohol necessary to reduce anxiety is also enough to cause impairment in judgment. Since alcohol is readily available, and often in very pleasingly flavored drinks, it is easy to consume enough to impair judgment to the point that you do some truly dumb things. Driving drunk or "hitting on" the boss' spouse (regardless of your gender) are just two examples.

There are several prescription medicines that are effective at reducing social phobias, although none of them cure the underlying condition. Each of them has some potential for causing undesirable effects, just like alcohol does, but the risk-to-benefit ratio is much better for the prescription products. Even some non-prescription herbal preparations can be helpful. In addition, counseling to learn to deal with the stressful situation in a more effective way is also generally beneficial. I suggest that you talk to your family doctor, a psychologist or a psychiatrist about your social phobia. This will help you clarify the nature of the problem and make sure that it is not just the most noticeable symptom of a more significant disorder. He or she can also help you learn to effectively interact in social situations without the risks of impaired judgment.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.