Panic Disorder and Alcohol Dependence

Research has shown a direct link between panic disorder and alcohol dependence, clinically known as alcohol use disorder (AUD). When both disorders are present at the same time, they need to be treated concurrently for recovery to be possible.

What Is Panic Disorder?

Panic disorder is a form of anxiety disorder characterized by unexplained panic attacks. These panic attacks produce feelings of intense fear and physical symptoms including an elevated heart rate, sweating, and shortness of breath. Sometimes people mistake these panic attacks for a heart attack, although there is nothing physically wrong with them. Attacks come on suddenly, without cause, and can even occur during sleep.

People with panic disorder often live with constant worry that another attack will come, which can interfere with their daily activities as they try to avoid anything that may trigger an attack.

Symptoms of Panic Disorder

Panic disorder presents with a host of symptoms, many of which are physical. They may include:

• Racing heart
• Shortness of breath
• Sweating or chills
• Trembling
• Lightheadedness or dizziness
• Chest pain
• Nausea
• Numbness or tingling
• A choking sensation
• A fear of being out of control
• Fear of death
• Out of body feeling
• Sense of impending danger
• Avoidance of places or situations where attacks have happened, which can interfere with daily life

Panic Disorder and Alcohol Dependence

The relationship between panic disorder and alcohol dependence is a complicated one and can manifest in a few different ways.

Some people who have panic disorder turn to alcohol to ease their symptoms. Alcohol can temporarily relieve anxiety and physical symptoms because it slows down the brain processes and central nervous system. However, over time, alcohol abuse can actually worsen the symptoms of panic disorder.

Conversely, alcohol abuse can actually cause a panic disorder to develop in people who did not suffer from it prior to abusing alcohol. This is thought to be due to the fact that alcohol abuse affects your ability to cope with stress in healthy ways, which can increase feelings of anxiety and fear. In these cases, when alcohol abuse stops, the panic disorder symptoms will gradually go away.

Do You Have an Alcohol Use Disorder?

If you suffer from panic disorder and are worried about your alcohol use, it’s important to know if you have an alcohol use disorder so that you can seek the right kind of treatment. While only a mental health professional can diagnose you with an alcohol use disorder, you can self-evaluate by examining the 11 criteria for alcohol use disorder that are specified in the clinical definition. These criteria are:

1. Drinking more than intended or for longer than intended
2. Wanting to reduce or stop alcohol use but not being able to
3. Spending excessive amounts of time drinking or recovering from drinking
4. Feeling cravings for alcohol
5. Failing to live up to responsibilities due to alcohol use
6. Having relationship problems because of alcohol use
7. Giving up activities that you enjoy in order to drink instead
8. Engaging in risky behaviors like driving while drinking or under the influence
9. Continuing to drink in spite of negative consequences like health issues
10. Needing more alcohol to get the same effects
11. Having withdrawal symptoms when you are not drinking

Having two to three of these symptoms indicates a mild AUD, four to five is considered moderate, while six or more is severe. Even a mild SUD requires treatment, but your level will determine the intensity of the treatment that you need. When you go to a treatment provider, they will do an assessment to diagnose both your alcohol use disorder and panic disorder and create a personalized treatment plan that addresses both.

Treating Panic Disorder and Alcohol Dependence

As discussed, when panic disorder and alcohol dependence co-occur, both need to be treated at the same time. Ideally, treatment begins in an inpatient setting, but outpatient treatment may be an alternative in some cases. However, if you experience withdrawal symptoms when not drinking, a period of inpatient medically supervised detox is highly recommended. Alcohol withdrawal can be very dangerous.

In any case, treatment for the panic disorder may begin with medication. Medications may include:

• Selective serotonin reuptake inhibitors (SSRIs): Antidepressants that are generally the first choice for panic disorders.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs): Another type of antidepressant.

Treatment for both the alcohol use disorder and panic disorder will also include intense therapy. The most commonly used therapy for both is cognitive behavioral therapy (CBT).

In CBT, you’ll learn ways to cope with your panic disorder and other challenges without abusing substances, as well as strategies to control your negative or irrational thoughts and emotions.

Dialectical behavior therapy (DBT) is another type of therapy that may be used in treatment. It is similar to CBT but focuses on mindfulness and challenging intense emotions with realistic thoughts.

These therapies may be used in individual sessions, or in groups. Group therapy is an important part of alcohol use disorder treatment. It gives you the opportunity to receive support from peers, and to know that you are not alone in your struggles. Often, in these groups you’ll form mutually supportive relationships that may last after treatment.

An ideal treatment program will start with a 30 to 90 day inpatient program, which will involve these therapies plus medications for the panic disorder, which may be adjusted over time to find the right dosages and combinations.

Inpatient treatment is generally followed by a partial hospitalization program (PHP). A PHP allows you to live at home while attending treatment for four to six hours per day, usually five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually.

In cases where inpatient treatment is not an option, a PHP can be an alternative.

PHP is then often followed by an intensive outpatient program (IOP) which consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held in the evenings so that you can still go to work or attend school. Treatment, again, involves individual and group therapy.

Even after IOP, support should continue through support groups, individual therapy, or both. This can support both the panic disorder and alcohol use disorder recovery.

In Closing

Panic disorder and alcohol use disorder often co-occur and require treatment for both at the same time. With help, it is possible to recover and go on to live a more fulfilling, healthier life. At Bridges of Hope, we offer many treatment options. We are committed to providing personalized, compassionate, and comprehensive care. Give us a call to learn more.