If your loved one is having panic attacks, they are not alone. Panic attacks are relatively common with up to 11% of the population experiencing them in any given year.^[1] Panic disorder, marked by recurring panic attacks, affects about 2-3% of adults in the United States annually.^[2] However, isolated panic attacks can occur in individuals without a panic disorder diagnosis.

Imagine you’re standing on a beach, and suddenly, without warning, a powerful wave comes crashing over you. It’s overwhelming, disorienting and feels like it might sweep you away. Your heart races, your breath becomes shallow, and you struggle to keep your balance as the wave overwhelms you.

Similarly, during a panic attack, it can feel like you’re suddenly hit by a surge of intense fear or anxiety that comes out of nowhere, much like an unexpected wave. This wave of panic can be so strong that it feels like it’s going to overwhelm you, both mentally and physically. In addition to your heart pounding and difficulty breathing, you may feel sweaty, dizzy, sick to your stomach, have chest pain and more. In short, it may feel like you are having a heart attack or worse, dying.

Just as a storm can pass quickly or linger for a while, panic attacks can vary in duration and intensity. Some may be brief and intense, lasting about 5 minutes. Still others may last longer and feel more relentless.

What triggers a panic attack?

Triggers for panic attacks can vary widely from person to person. Common triggers include:

• Stressful life events
• Phobias (extreme fears about needles, heights, snakes, crowds, etc.)
• Certain medications (e.g., antidepressants, corticosteroids, cough medications, stimulant medications)
• Stimulants including caffeine, cocaine and amphetamines
• Withdrawal especially from alcohol or benzodiazepines (e.g., Xanax, Klonopin, Valium)
• Fear of having another panic attack
• Environment (for example, a loved one in recovery revisiting a place where they used to use substances)

How are panic attacks linked to substance use?

The link between panic attacks and substance use is complex. It can involve a variety of factors. Firstly, some loved ones may use substances like alcohol, nicotine, cocaine, opioids and/or marijuana as a way to cope with their symptoms of anxiety and panic attacks. These substances can work quickly and well at least at first to provide a sense of relief. However, over time they can lead to a substance use disorder and worsen anxiety symptoms. Ultimately, they can increase the frequency and severity of panic attacks.

Additionally, certain substances, such as stimulants like cocaine or amphetamines, can directly trigger panic attacks in some people. These substances can increase heart rate, blood pressure and arousal levels, which may mimic the physical symptoms of a panic attack.  Similarly, withdrawal from substances like alcohol or benzodiazepines can also result in panic attacks as the body adjusts to the absence of the substance.

Substance use and panic attacks often co-occur as part of other mental health conditions. Examples include anxiety disorders, depression or post-traumatic stress disorder (PTSD). Loved ones with these conditions may be at increased risk of using substances as a way to cope with distressing symptoms, including panic attacks. Substance use can make the treatment of panic attacks more difficult by interfering with the effectiveness of therapy and medications.

Treatment

Addressing both panic attacks and substance use within a loved one’s treatment plan is essential.  It will help to not only manage symptoms but also promote long-term recovery. This may involve counseling, medications and support groups in addition to family support.

Counseling approaches

Evidence-based treatments for panic disorder typically include cognitive-behavioral therapy (CBT), particularly a specific form called cognitive-behavioral therapy for panic disorder (CBT-PD). This therapy can help loved ones recognize and change patterns of thinking and behavior that contribute to panic attacks. It takes practice, but many people find that it helps them feel more in control and able to enjoy life without fear holding them back.

Another effective treatment is exposure therapy, which involves gradually exposing individuals to feared situations or sensations in a controlled environment.

Acceptance and commitment therapy (ACT) is a form of therapy that calls for the acceptance of uncomfortable thoughts and feelings that your loved one might feel during a panic attack. It also asks loved ones to commit to their goals despite panic attacks. For example, if a loved one might avoid a support group meeting that they feel will help them because of a possible or actual panic attack. Since the meeting is important to them, they will be asked to attend anyway.

Medications

Medications can also be used in addition to therapy. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed antidepressants that can help address panic attacks.

Benzodiazepines like Xanax are sometimes used for acute symptom relief during a panic attack but they are generally not recommended for long-term use. They can provide temporary relief from panic attack symptoms due to their sedative effects. However, they carry a high risk of dependence and misuse, and their effectiveness lessens over time.

Long-term use of Xanax or other benzodiazepines can lead to needing more of it to get relief, addiction, and withdrawal symptoms. Therefore, while they may offer short-term relief, it is generally not considered the best treatment for panic disorder.

What you can do to help

Families can play an important role in supporting a loved one who is struggling with both substance use and panic attacks or panic disorder. Here are some ways you can help:

• Educate yourself: Learn about panic disorder, substance use disorders, and how they interact. Understanding the challenges your loved one is facing can help family members offer more effective support.
• Be supportive and non-judgmental: It’s important to create a supportive and non-judgmental environment where your loved one feels safe discussing their struggles. Try to offer empathy, encouragement, and reassurance without criticizing or blaming. Help a loved one label what is happening to them. Validate or honor their feelings and experiences. And then, encourage them to do what they need to do instead of avoiding it even though they are having a panic attack.
• Encourage treatment: You can encourage your loved one to seek professional help from a therapist or counselor who specializes in treating both panic disorder and substance use disorders. You may offer to assist with practical tasks related to seeking treatment, such as helping them find a therapist who accepts their insurance, attending therapy sessions with them for support or helping them adhere to medication schedules if prescribed.

Even small steps to reduce the risks of a loved one’s substance use or increase safety may be helpful. If a loved one is reluctant to engage in treatment, you can still support them:

• Promote healthy coping: Encourage your loved one to engage in healthy coping strategies to manage stress and anxiety. Regular exercise, relaxation techniques, hobbies and spending time with supportive friends and family members can make a difference.
• Set boundaries: While offering support, it’s also important to set boundaries to protect your own well-being.
• Foster open communication: Encourage open and honest communication within the family, where everyone feels comfortable expressing their thoughts, concerns and feelings. Family therapy can be helpful in improving communication and addressing family

Remember that supporting a loved one with co-occurring panic disorder and substance use requires patience, understanding and ongoing effort. By providing consistent support and encouragement, families can play a vital role in their loved one’s journey toward recovery.