Panic Disorders and Addiction

What is an Anxiety Disorder?

It’s not uncommon for people to feel anxious in certain situations—before taking a test or making decisions involving finances or major life changes, for instance. For lots of people, after these stressors or situations resolve or pass, the anxiety subsides. For individuals with diagnosable anxiety disorders, these feelings of worry or fear aren’t temporary. In fact, they persist, interfere with an individual’s ability to function at home, work, and/or school, and can worsen over time.^2,3

An anxiety disorder is a mental health disorder characterized by excessive fear and anxiety that hinders a person’s ability to function in various areas of their life, including at work, home, and school.

There are multiple types of anxiety disorders. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which provides diagnostic criteria for psychiatric disorders, each anxiety disorder has its own diagnostic criteria—though certain symptoms may be present across multiple types of anxiety disorders, including panic disorders.^2,3

Signs and Symptoms of Panic Disorder

Panic disorders are characterized by acute, unexpected, and frequent panic attacks, which are sudden periods of intense fear, discomfort, or a sense of losing control even when no clear danger or trigger is present.²

Panic attacks can cause powerful symptoms, including:³

•   Palpitations, pounding heart, or accelerated heart rate.
•   Sweating.
•   Trembling or shaking.
•   Sensations of shortness of breath or smothering.
•   Feelings of choking.
•   Chest pain or discomfort.
•   Nausea or abdominal distress.
•   Feeling dizzy, unsteady, light-headed, or faint.
•   Chills or heat sensations.
•   Paresthesia (numbness or tingling sensations).
•   Derealization (feelings of unreality) or depersonalization (being detached from oneself).
•   Fear of losing control or “going crazy.”
•   Fear of dying.

Not everyone who experiences panic attacks develops a panic disorder.² To receive a panic disorder diagnosis, at least 1 of the panic attacks needs to be followed by a month or more of the following:³

• Persistent concern or worry about additional panic attacks or the consequences (such as losing control, having a heart attack, or “going crazy”) that may follow.
• A significant maladaptive change in behavior related to the attacks (such as displaying behavior designed to avoid having panic attacks, like avoiding exercise or unfamiliar situations).
• The disturbance is not attributable to the physiological effects of a substance (such as drug misuse or a medication side effect) or another medical condition (such as hyperthyroidism or cardiopulmonary disorders).
• It is not better explained by another mental disorder (meaning the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder, or in response to reminders of traumatic events, as in post-traumatic stress disorder.)

Causes of Panic Disorder

As with all mental health conditions, there isn’t just one cause of an anxiety disorder.^3,4 Research suggests that panic disorders sometimes run in families, but not everyone with a family history develops the disorder.⁴ Scientists don’t fully understand why some people develop panic disorder and some don’t, but research indicates that panic disorders can involve a complex combination of different risk factors, including:^3,5

• A person’s temperament. Some people are naturally prone to negative feelings and anxiety, which can be a risk factor for panic attacks.
• Genetics and physiological factors. Researchers believe that multiple genes may make a person more vulnerable to panic disorder, but the specific genes are not yet known. Additionally, as previously mentioned, individuals, whose parents have panic disorder, may be at an increased risk of developing the disorder, too.
• Environment. Research indicates a link between a stressful or traumatic event—such as abuse, the death of a loved one, violence, or prolonged illness—and a higher risk of the development of panic disorder.

The Connection Between Panic Disorder and Addiction

Addiction, which is diagnosed as substance use disorder (SUD), and panic disorder often occur together, although the relationship is complex and multifaceted, and can be bidirectional.^1,6 The presence of drug use disorder is associated with a 1 to 1.3 increased odds of having a panic disorder. While it’s not necessarily a causal relationship, each disorder can have an impact on the other.⁶

Researchers believe that three main pathways may contribute to co-occurring substance use and mental health disorders like panic disorder.⁷ These include:⁷

• Common risk factors can contribute to both mental health disorders and addiction.
• Mental health disorders may contribute to substance use and addiction.
• Substance use and addiction can contribute to the development of mental illness.

Studies suggest that panic disorder often precedes substance use and is also associated with increased substance use.³ For example, individuals with panic disorder may sometimes use substances to manage their panic disorder symptoms. This is referred to as self-medicating. While this may temporarily relieve symptoms, over time, substance use can worsen the symptoms associated with panic disorder and lead to substance dependence and/or addiction.⁸

On the other hand, using certain substances, such as cannabis or stimulants like cocaine or methamphetamine, can also trigger panic attacks.^3,9 Research indicates that there is a significant association between the co-occurrence of alcohol use disorder and specific anxiety disorders, such as panic disorder.^3,10 Additionally, one study showed that lifetime marijuana use was significantly associated with an increased likelihood of a lifetime history of panic attacks and panic disorder.¹¹

Co-occurring substance use and panic disorders need prompt and proper treatment to ensure the best recovery outcomes from both conditions.⁶

Treatment for Panic Disorder and Addiction

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), integrated treatment that treats both disorders at the same time is the standard of care for SUD and panic disorder treatment. Treating just the SUD is not enough to achieve optimal outcomes, and an untreated anxiety disorder can complicate treatment for addiction and make it more difficult to achieve and maintain recovery goals.⁶

An individual treatment plan is personalized to meet a person’s unique needs and situation, which means that treatment can look different for everyone.⁶

Treatment for co-occurring panic disorder and addiction can involve different types of medication, behavioral therapies that are provided in individual and group settings, and other interventions.^5,12

Healthcare providers may prescribe antidepressants, beta-blockers, or anti-anxiety medications to treat panic disorder.⁵ They may also prescribe medications to help relieve the withdrawal symptoms and manage cravings associated with alcohol use disorder and opioid use disorder.¹²

Psychoeducation, which involves teaching individuals about the bodily symptoms of panic and how treatment works to help ease these symptoms, as well as the effects of panic disorder on substance misuse, is an important component of treatment.⁶ Individuals also receive certain evidence-based behavioral therapies for addiction and panic disorder so that they can learn healthier coping skills and work on specific issues that may contribute to one or both disorders.¹² These may include one or more therapies, including:^4,12

• Cognitive-behavioral therapy (CBT). CBT helps individuals identify and change maladaptive thoughts and behaviors.
• Exposure therapy. Exposure therapy is a type of CBT that can help individuals confront and address fears and beliefs related to panic disorder.
• Contingency management (CM). CM, a therapy for SUD, provides tangible rewards for positive behavioral changes.

American Addiction Centers (AAC) is a leading provider of co-occurring disorder treatment in the U.S. If you or a loved one struggle with panic disorder and SUD, call AAC to speak to a knowledgeable admissions navigator about your treatment options and to verify insurance. All AAC facilities offer treatment for co-occurring disorders.

Frequently Asked Questions About Panic Disorder