Relationship Between Substance Abuse and Panic Attacks

Here’s what you need to know about panic disorders and their relationship with substance abuse.

What Is a Panic Disorder?

There is a distinct relationship between substance use disorders and psychiatric conditions. Referred to as a dual diagnosis, this often requires additional treatment beyond addiction counseling. Without exploring and understanding the psychiatric conditions that fuel drug abuse, relapse is common.

A panic disorder is a severe and acute anxiety disorder characterized by recurrent and sudden episodes of extreme fear accompanied by physical symptoms. Some of these symptoms include:

Heart palpitations.
Shortness of breath.
Chest pain.
Abdominal distress.
Dizziness.
Sweating.
Nausea.
Hot flashes or chills.
Trouble swallowing.
Feeling disconnected (depersonalization).
Headache.
Dry mouth.

Panic disorder episodes are often unexpected and aren’t linked with any known fear or stressor. This causes many people additional anxiety, and it can trigger the fear of having another one that will affect their behavior in public. Some people who experience a panic attack avoid places and situations that could result in another panic attack or cause them embarrassment.

Panic Disorder Vs. Anxiety: Is Panic Disorder the Same as Anxiety?

Anxiety is incredibly common today. It’s the most common mental illness and continues to increase in the United States. Over 28% of American adults reported anxiety disorder symptoms in the previous week.¹

While anxiety and panic attacks may have overlapping symptoms, they’re distinct. Anxiety attacks usually follow excessive worry, and symptoms build over minutes or hours. The symptoms of an anxiety attack are milder and can last days to months before subsiding.

Panic disorder, on the other hand, appears suddenly without an obvious trigger. The symptoms are more acute and build over minutes and typically start to subside within 20 minutes. However, it’s possible to have multiple attacks in a row. While the episode itself is short, many people feel stressed or different days after the panic attack.

How Common are Panic Attacks?

If you or your loved one suffer from panic attacks, you’re not alone. According to the Cleveland Clinic, approximately 11% of U.S. adults experience a panic attack in any given year.²

However, it’s unfortunately underdiagnosed and under-treated: only 37% of people who experience anxiety receive treatment on average.³

How To Help Someone with Panic Disorder?

Witnessing a loved one experience a panic attack can be distressing. Many feel that they’re helpless, but there are ways to provide support:

Recognize Symptoms and Seek Help

Recognize the symptoms of a panic attack. They can be like a heart or asthma attack, so be aware of this while assessing the situation.
If it’s their first time having a panic attack or other underlying conditions, such as diabetes or asthma, seek emergency medical attention. If you’re in doubt at all, it’s always best to get them immediate medical attention.
Take them to a quiet area only if they ask. Often, people experience an overwhelming desire to leave the situation. However, it could worsen their anxiety if you take them somewhere without telling them. Ask for their permission first and tell them where you are taking them.

Remain Calm

Don’t touch a person experiencing a panic attack without receiving explicit permission first. Touching a person could increase panic and worsen the situation.
Those who have a panic disorder often have techniques or medication that help them during the attack. Ask them if you can help in any way. They may need assistance or a place they would prefer to be.
Remain calm and speak in a reassuring but firm manner. Ask the person to remain still, but do not grab or even gently restrain them. If they cannot stay still, suggest that they stretch, go on a brisk walk, or do jumping jacks.
If they’re in their home, help them direct their excess energy to a constructive task, such as cleaning or organizing. The activity can help break the anxiety. If they’re outside of their home, suggest something that enables them to focus. Even something as straightforward as lifting their arms up and down can help.

Be Understanding

Don’t dismiss their fears. Implying that the panic is in their head could make their panic worse. The fear is real to them, so the best way to help is to enable them to cope. Ask calmly if they’re reacting to the present moment or something in the past. Asking questions and letting them figure out what they’re responding to is a great way to support them.
Encourage them to control their breathing. Focusing and controlling their breath is a great way to help calm them. Consider box breathing or getting them to breathe into a bag.⁴
Panic attacks should be treated by professionals. Encourage them to find therapy. A therapist will help the person better understand the physiological side of panic disorders and help them pinpoint any specific triggers.

Panic Attacks Causes and Complications

There is no one underlying cause of a panic disorder. However, some factors may play into panic attacks:

Genetics. Those with a family member with a panic disorder are more likely to have one themselves.
Mental health issues. Underlying untreated mental health issues, such as depression, make a person more likely to experience a panic disorder.
Substance abuse. Drug use can exacerbate and trigger panic attacks. Stimulants especially can make anxiety symptoms and panic attacks worse.

Risk Factors

Certain factors that increase the risk of developing a panic disorder:

History of trauma. Panic is often a response to previous trauma, such as exposure to violence or child abuse.
Family history. A person with a parent or relative with a panic disorder is more likely to experience it themselves.
Overexposure to stress. People who have consistently high-stress levels are more likely to have a panic disorder. Major life stress, such as the death or severe illness of a loved one, can also trigger panic attacks.
Temperament. Those who are more sensitive to stress or predisposed to negative emotions are more likely to experience panic attacks.

Complications Caused by Panic Disorders

Without treatment, panic disorders can significantly impact an individual’s life. Complications include:

Frequent medical care for health concerns.
Avoidance of social situations, leading to depression.
Issues at work or school.
Increased risk of suicide and suicidal ideation.
Financial troubles.
Development of phobias, such as leaving the house or driving.
Increased risk of substance misuse.

Panic Disorder and Pregnancy

Pregnancy can trigger panic attacks, as well as lead to potential complications. One study found that women who experienced a panic attack during pregnancy were more likely to have a small infant for their gestational age. Women treated for a panic attack in the emergency room were more likely to have a preterm birth than mothers who didn’t go to the emergency room.⁵

Relationship Between Substance Abuse and Panic Attacks

While drug use isn’t often the cause of panic attacks, it can worsen a panic disorder. Some people with panic disorders may try substances to help calm them, but it often triggers symptoms. In addition, alcohol or drug misuse can result in structural changes to the brain that causes a panic disorder.

Panic Disorder and Alcohol

Alcohol is both a depressant and a stimulant, which can trigger the emotions that lead to a panic attack. In addition, people often become more stressed while intoxicated because they lose control of their minds and bodies.

Trying to abstain from alcohol can also trigger feelings of anxiety and panic. Panic attacks are one withdrawal symptom as the body adjusts to functioning without alcohol. Relapses can occur in response to withdrawal-related panic attacks.

Panic Disorder Marijuana

While marijuana is often known for its relaxing qualities, it’s also a stimulant. For many people, it can trigger feelings of anxiety and even panic.

Panic Disorder and Stimulants

Stimulant drugs are more likely to trigger panic attacks. These substances include MDMA, amphetamines such as Adderall, ephedrine, cocaine, and methamphetamine.

Whether a substance misuse or panic disorder came first isn’t the same for everyone. Those with anxiety disorders are at higher risk of substance abuse. However, substance use changes structures within the brain that can lead to a panic disorder. Either way, both must be treated.

Panic Attacks and Substance Abuse Signs and Symptoms

It’s critical to understand the symptoms of both panic disorders and substance abuse for both you and your loved ones.

Common signs and symptoms of panic disorder:

Recurring and random panic attacks that result in overwhelming anxiety and fear.
Feeling out of control, impending doom, or fear of death during an attack.
An intense worry over when another panic attack will occur.
Avoiding places where panic attacks have occurred in the past.
Common signs and symptoms of substance abuse
Needing to use drugs regularly, daily, or several times a week.
Needed more substances to produce the same effect and taking larger amounts over time.
Issues at work or school, such as missing work or school or a sudden decrease in performance.
Neglected appearance, such as a lack of interest in grooming or clothing.
Changes or erratic behavior, such as excessive secrecy or drastic changes in relationships with family and friends.
Financial problems, such as requests for money without an explanation or stealing money or items.
Physical health issues, such as lack of energy, motivation, or weight loss.

Diagnosis and Treatment of Panic Disorder

Typically, individuals fill out a psychological self-assessment or questionnaire. In addition, doctors will rule out other potential conditions (such as thyroid or heart problems) with:

A physical exam.
Blood tests and tests on the heart.
A psychological evaluation to talk about symptoms, fears, stressful situations, relationship problems, etc.

To meet the diagnostic criteria for a panic disorder, an individual needs to experience recurrent and unexpected panic attacks. They also must be followed by one month or more of ongoing worry about an attack.

Therapy

Therapy is considered the most effective first-choice treatment. It can help individuals learn about panic disorders and provide healthy coping mechanisms to deal with them.

Most of all, it helps people start to understand that panic disorders aren’t dangerous. Exposure therapy often helps individuals overcome their fear of experiencing an attack in public.

Medications

Certain medications can help manage the symptoms of a panic disorder, including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines can also be used on a short-term basis but are generally not recommended for those with a history of substance misuse.

Treatment for Co-Occurring Conditions

It’s critical when treating substance misuse and panic disorders to identify and address all other underlying conditions. Depression and substance misuse, for example, are common co-occurring conditions. Treating all conditions helps significantly improve quality of life and overall wellbeing.

Help is available. Our experts here at The PAC Program have the knowledge and expertise to address panic attack disorder and substance abuse. Contact one of our professionals today to see how we can help you.