Panic Disorder & Substance Abuse

Panic Disorder header
Last Edited: February 27, 2020

Patricia Howard, LMFT, CADC

Clinically Reviewed
Edward Jamison, MS, CAP, ICADC, LADC

All of the information on this page has been reviewed and certified by an addiction professional.

Panic disorder and panic attacks are psychological disorders classified in the Diagnostic and Statistical Manual of Mental Disorders as anxiety disorders severe enough to interfere significantly with a person’s life. A panic attack is the hallmark feature of panic disorder and can be identified by five primary symptoms: paralyzing fear, rapid heartbeat, hyperventilation, racing thoughts, and immobility.

When someone is experiencing a panic attack, they cannot control their physiological symptoms and often think they are going to have a heart attack and die. Worsened by obsessive thoughts of dying, panic attacks frequently send people to hospital emergency rooms where they are given a sedative, monitored for possible heart abnormalities, and sent home after the panic attack subsides.

Many people suffering panic disorder fail to receive the professional treatment necessary for preventing panic attacks and devastating their quality of life. Panic disorder is a recently recognized mental illness that is only beginning to be taken seriously. Consequently, panic disorder sufferers are often told there’s nothing wrong with them, that they’re just being dramatic or seeking attention.

Instead of benefiting from psychological counseling and antidepressants. they rely on psychoactive drugs and Alcohol to suppress and cope with recurring panic attacks. In fact, studies show that nearly 35 percent of people with panic disorder regularly turn to Alcohol, Marijuana, and even Heroin to self-medicate recurring panic attacks.

Panic Disorder Types

Expected Panic Attacks

Panic disorder falls under two distinct types—expected and unexpected. People suffering from expected panic attacks harbor an overwhelming fear of a situation, such as flying in an airplane or being in open or enclosed spaces, both forms of agoraphobia. Those suffering the expected kind of panic disorder will go to great lengths to avoid certain situations or environments by completely re-structuring their life using avoidant behaviors. The fear of being trapped in wide-open spaces or in an elevator or automobile is so strong that most people with severe expected panic disorder may not leave their home for years, relying on friends and family to take care of their needs.

Unexpected Panic Attacks

Unexpected panic disorder involves panic attacks that strike arbitrarily and without warning. Because they do not know when the next panic attack will occur, people suffering from unexpected panic disorder constantly feel extreme anxiety and fear due to obsessively worrying about when the next panic attack will happen. Unexpected or anticipatory panic disorder is even more crippling than expected panic disorder because it cannot be predicted or avoided. Sufferers of this type of panic disorder often abuse addictive drugs such as Marijuana and Alcohol to suppress the paralyzing fear of having a panic attack.

Nocturnal Panic Attacks

Panic attacks that affect people while they are asleep are classified as nocturnal panic attacks. People suffering severe panic disorder, more than five panic attacks per day, will often fall asleep, only to be awakened an hour or two later by a panic attack. Upon falling back asleep, they may suffer yet another panic attack before morning. Duration of a nocturnal panic attack is typically around 10 to 15 minutes but if takes the person much longer to calm down enough to fall back asleep. In addition, people experiencing recurring nocturnal panic attacks, as well as daytime panic attacks, will drink Alcohol or take drugs during the night. Continuously waking up and feeling extremely groggy is a primary reason many addicts suffering panic disorder overdose on pain pills, Heroin, or Alcohol.

Panic Disorder Symptoms

Symptoms of a panic attack can begin slowly or strike with intensity in a few seconds. To be classified as a true panic attack, the individuals needs to have four or more of the following symptoms:

  • Accelerated heart rate/pounding heart/palpitations
  • Excessive perspiring
  • Nausea/stomach pain
  • Uncontrollable shaking/trembling
  • Inability to move/feeling frozen/afraid to move
  • Tightening of the chest/chest pain
  • Hyperventilation/shortness of breath
  • Dizziness/light-headedness
  • Numbness and tingling of the hands and/or face
  • Feeling detached from the body, yet still feeling fear
  • Feeling like they are going crazy or losing control of themselves

Since victims of recurring panic attacks cannot calm themselves down, they often make frequent visits to the emergency room. Following a physical exam by the ER doctor, panic disorder sufferers may be given a sedative or kept overnight for observation, depending on their psychological condition. What usually happens is the panic attack begins subsiding by the time the person reaches the emergency room, leaving the person feeling embarrassed about their inability to manage their symptoms. Unfortunately, the persistent fear of being embarrassed by another panic attack just worsens the individual’s anxiety, making it highly probable they will have more panic attacks and use addictive drugs unless professionally treated.

What Causes Panic Attacks to Develop?

Psychologists agree that panic disorder consists of several causes rather than just one cause. These include:

  • Genetics—panic disorder is known to run in families much like other mental illnesses
  • Stress—people experiencing ongoing stress in their lives often develop panic disorder due to alterations in thinking patterns, elevated levels of cortisol in the blood and fluctuations in brain chemistry
  • Suffering a serious illness which necessitates taking medications that may provoke panic attacks
  • People diagnosed with post-traumatic stress disorder frequently suffer unexpected panic attacks
  • Physical problems such as hyperthyroidism, mitral valve prolapse, hypoglycemia and respiratory conditions that make it hard to breath often trigger panic attacks

The medical model describes the mechanisms behind panic attacks as stemming from limbic system chemical imbalances involving a regulatory chemical called GABA. Responsible for inhibiting certain behaviors, GABA wrongly signals the amygdala, the organelle in the brain controlling emotions and motivational behavior, when there isn’t enough GABA to prevent the amygdala from initiating the fight or flight response during a panic attack. Instinctual to all animals encountering a life-threatening situation, the fight or flight response floods the body with adrenaline, which is why people suffering panic attacks experience rapid heartbeat, rapid breathing and a strong sense of impending doom and death.

Risks of Substance Abuse and Panic Disorder

People seeking treatment for panic disorder from their family physician usually receive a prescription for an antidepressant, Paxil or Effexor, for example. If the antidepressant fails to relieve panic attacks, doctors may then prescribe a Benzodiazepine such as Ativan, Xanax, or Valium. Benzodiazepines are highly addictive and do nothing to eliminate the root cause of panic disorder. In fact, research indicates that the link between panic disorder and substance abuse is statistically significant, especially in people using Valium or Xanax for panic disorder.

Unfortunately, drugs and Alcohol intensify symptoms of panic disorder by further disrupting brain chemistry. Attempting to self-medicate inevitably leads to a full-blown addiction to Alcohol, anti-anxiety pills bought off the street, Oxycontin, Heroin and any other drug that suppresses panic attacks. In addition, avoidant behaviors used by people with panic disorders usually continue even when they are taking drugs or Alcohol. Consequently, they cannot maintain unemployment, may become agoraphobic or homeless due to their addiction and mental illness. Although taking Valium or drinking throughout the day may prevent panic attacks, self-medicating does nothing to improve their quality of life or their ability to fully engage with living normally in the real world.

People who are addicted to street drugs, prescription medications or Alcohol because of a panic disorder can get the professional and compassionate help they need at detoxification and rehab center. Our addiction specialists and experienced psychotherapists provide treatment programs individualized to each patient’s needs and specific mental health issues. We understand that panic disorder is not something a client can easily control and are empathetic toward clients who may have been told it is all in his or her head or that there is nothing wrong by emergency room personnel.

Treatment approaches to panic disorder and addiction involve cognitive behavioral therapy, psychotherapy, stress management techniques, individual and group counseling, and medically supervised detoxification. Once a patient is detoxed, we begin therapy by educating the patient about the biological process behind a panic attack. Upon understanding why a panic attack occurs, many patients feel immense relief knowing they are not suffering from heart problems or that a panic attack will not cause them to die.

If you are one of the millions of people losing precious hours of the day to panic disorder and addiction, don’t let this illness prevent you from living a full and happy life another minute. Contact our addiction specialists today to talk to someone who can provide information about how you can free yourself from panic disorder and addiction.