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.
Triggers for panic attacks can vary widely from person to person. Common triggers include:
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.
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.
Evidence-based treatments for panic disorder and substance use disorder typically include cognitive-behavioral therapy (CBT). A specific form called cognitive-behavioral therapy for panic disorder (CBT-PD) may be more helpful. 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.
COPE, another form of therapy, combines CBT and exposure therapy. It can be very effective for people who have panic attacks in addition to PTSD and substance use disorder. It includes education on PTSD and SUD, exposure to both imagined and real life triggers for PTSD and relapse prevention for substance use.
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 has also been used successfully to treat substance use problems. It asks loved ones to commit to their goals despite panic attacks and to sit with uncomfortable feelings rather than using substances to escape them. For example, 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 for their well-being, they will be asked to attend anyway.
Medications can 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, they are generally not considered the best treatment for panic disorder, especially if a person has a substance use problem.
Medications are also available to address alcohol, opioids and nicotine use. These medications can help with withdrawal symptoms and reduce cravings. Healthcare providers should consider both disorders when deciding on which medications to prescribe and what kind of therapy to offer.
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:
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:
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.