Mental health and substance abuse disorders are inextricably linked and widespread. In fact, the 2014 National Survey on Drug Use and Health estimated that 7.9 million people in the U.S. had a mental health and substance use disorder simultaneously.
What’s more, about 20 percent of Americans with an anxiety or mood disorder also have an alcohol or substance abuse issue. Conversely, about 20 percent of those with an alcohol or substance use disorder also have an anxiety or mood disorder.
When mental health issues collide with alcohol or drug dependence, it’s a chicken or egg scenario. Which came first?
Research suggests that the odds of alcohol dependence being diagnosed are two to three times higher in patients with anxiety disorders, which include panic disorders. The correlations between drug dependence and anxiety disorders are even greater.
What’s more, when someone engages in extensive substance abuse, they run the risk of developing an anxiety disorder, which is also a side effect that comes with drug or alcohol abuse.
Whatever the case, professional treatment is available for people who have co-occurring disorders involving panic attacks and substance abuse. Dual diagnosis, an evidence-based treatment approach, can effectively address both disorders at the same time.
What is a Panic Disorder?
When someone has a panic disorder, they often feel like they are losing all control. They experience these “out of the blue,” repeated episodes of intense fear that are not caused by discernible or known stressors.
People with panic disorders exhibit the following symptoms:
- Feeling hot or a cold chill
- Tingly or numb hands
- Rapid heartbeat
- Chest or stomach pain
- Breathing difficulty
- Weakness or dizziness
When the panic attacks occur, it’s usually without warning. The disorder manifests in people when they live in fear of another attack or avoid places where they have experienced one.
According to the Anxiety and Depression Association of America, about 2 to 3 percent of Americans experience a panic disorder in a given year. Plus, it’s a diagnosis that is twice as common in women than in men.
When Substance Abuse is Present
The World Health Organization defines substance abuse as harmful or hazardous use of psychoactive substances like drugs or alcohol, with that use morphing into dependence and finally addiction.
It characterizes addiction as “a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.”
The signs of abuse and addiction manifest in the compulsive and destructive behaviors that a user exhibits. The APA’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the principal authority for psychiatric diagnoses, establishes 10 or 11 criteria, depending on the substance, that describes “a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress” occurring within a 12-month period.
When someone meets two or three of the following criteria, they have a “mild” disorder. If they meet four or five of them, then their disorder is considered “moderate.” Six or more rates as “severe.”
The Criteria Include:
- The substance is often taken in larger amounts or over a longer period than was intended.
- There is a persistent desire or unsuccessful effort to cut down or control the use of the substance.
- A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
- Craving, or a strong desire or urge to use the substance, occurs.
- Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
- Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
- Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
- Use of the substance is recurrent in situations in which it is physically hazardous.
- Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the substance to achieve intoxication or desired effect
- A markedly diminished effect with continued use of the same amount of the substance.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
- The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.
When Panic Disorder and Substance Abuse Interact
It can be difficult to determine which problem came first, the panic disorder or the substance abuse. However, there are some possibilities as to why they co-occur.
According to the National Institute on Drug Abuse (NIDA), those possibilities include:
Genetic predisposition: People can possess genes that can heighten the risk of developing a substance use disorder and a mental illness like panic disorder.
Environmental stressors: These manifest as trauma or stress, which cause genetic changes that can be passed down through multiple generations.
Present panic disorder and other mental health issues: People with mental health issues like panic disorder will resort to abusing drugs or alcohol to manage symptoms on their own, a practice known as self-medication. This practice can actually make panic disorders worse. However, when a mental illness occurs, the brain shifts that occur can heighten the effects of drugs or alcohol. This will prompt a person to continue to use.
Substance abuse that leads to mental illness: Certain substances like opioids and alcohol can profoundly impact the brain, making someone more prone to developing a mental illness.
Substances That May Cause Anxiety and Panic Attacks
Relatively benign substances such as caffeine, nicotine, and sugar can produce mild symptoms of anxiety. The reactions they elicit are nowhere near that of alcohol, cocaine, marijuana, and opioids.
Alcohol Abuse and Panic Attacks
People drink alcohol to relax, but it can very likely exacerbate anxiety and panic. Alcohol withdrawal symptoms can cause panic attacks, anxiety, and other complications. People who already have an anxiety disorder will drink to alleviate their symptoms. This practice only exacerbates panic attacks.
Cocaine or Methamphetamine Abuse and Panic Attacks
By their very nature, stimulants such as cocaine and methamphetamines incite the central nervous system. They elevate blood pressure, increase breathing, and heart rate. In addition to the negative effects they generate like paranoia and violent behavior, these substances can cause panic attacks and other serious effects like heart attack, stroke, and coma.
Marijuana Abuse and Panic Attacks
Whether marijuana is smoked, consumed, or “dabbed” — which refers to the vaporization of cannabis extracts that have the highest levels of tetrahydrocannabinol (THC) — it can speed up the heart rate for up to three hours after ingestion. This can increase the chances of someone getting a heart attack. In addition to those effects, marijuana abuse can cause panic attacks and anxiety, along with mood swings and a lack of motivation.
Opioid Drug Abuse and Panic Attacks
Opioids, which include prescription painkillers like oxycodone and illicit street drugs like heroin, can induce intense feelings of euphoria, sedation, and pain relief. Yet, they produce adverse psychological effects like depression and anxiety, as well as physical effects. Opioid withdrawal symptoms include panic attacks and anxiety, which can linger for weeks.
If you have a panic disorder and a co-occurring substance use disorder, professional addiction treatment can offer you the best chance at recovery.
Dual Diagnosis Treatment
Dual diagnosis is a specialized treatment plan that addresses co-occurring substance use and mental health disorders.
The express purpose of dual diagnosis treatment is to get you mentally and physically stabilized by removing the substance from your body via medical detoxification. The other purpose is to treat the psychological aspect of addiction by providing you with an array of therapy and counseling services. These evidence-based therapies are designed to treat mental illness and identify and address the root causes of addiction.
Dual diagnosis offers ongoing care via residential treatment, where you will receive therapy and counseling at a treatment facility. At this phase, you will have access to cognitive behavioral therapy (CBT) and alternative therapies to treat your mental health condition.
Along with support from addiction specialists, you will learn coping skills and mental health education to improve your well-being and maintain your sobriety.
Dual diagnosis provides access to aftercare treatment via alumni recovery programs. These programs will provide you with a supportive community that can help you sustain your sobriety.