Panic Disorder with the Dual Diagnosis of Addiction
Before we describe dual diagnosis, we will shortly discuss what panic disorder and addiction is and then confer about the link of panic disorder and addiction in terms of treatment.
Panic Disorder:
Panic disorder is characterized by intense anxiety attacks reaching to the peak within seconds which may last for 10min. During the attack, a variety of physical, emotional and cognitive symptoms are experienced. Emotional symptoms include fear of losing control, getting faint or dying. The patient feels agitated, restless and anxious. Cognitive symptoms include, a rush of thoughts expecting a real danger. They misinterpret and catastrophize a minor sensation such as rapid heartbeat as having a heart attack or going crazy. Physical symptoms which are particularly prominent in panic attack include sweating, numbness in limbs, rapid heartbeat, lump in throat, chest pain or congestion, hot flashes or chills, heavy breathing, trembling or shaking, and nausea etc. Once, a person experiences a panic attack, he becomes fearful of having another attack. They may start avoiding situations where escape would be difficult during panic attack such as shopping malls, crowded areas, rush places, enclosed places such as plane or car etc. This condition is called Panic disorder with Agoraphobia.
Due to repeated panic attacks, it becomes very difficult for to focus on anything else. Headaches, lightheadedness, sleep disturbance and high blood pressure are commonly reported by patients. The symptoms of panic disorder are disturbing to the extent they mimic heart-attack. Such people go for extensive medical check-ups while their reports show normal results. Their psychosocial life gets disturbed to the extent that they become home-bound. Sometimes they suffer from associated symptoms of depression and eating disturbance.
The effective treatment of panic disorder is supposed to be cognitive behavioural therapy (Mehwish & Uzma, 2015). Psychotropic medications used for Panic attacks include anti-anxiety drugs and benzodiazepines. Benzodiazepines are the group of psychoactive drugs which are highly addictive and may produce withdrawal effects when a patient stops taking medicine. Moreover, when these drugs are taken along with substances such as alcohol/ sedatives, analgesics, or tranquilizers may cause lethal effects. These may also cause severe side effects.
Addiction:
Addiction involves compulsive use of something which is considered gratifying despite its adverse consequences. It is considered rewarding and pleasurable therefore person uses it repeatedly. Addiction can be chemical (i.e. drugs) or non-chemical (i.e. gambling, gaming, internet, smartphone etc.). In any form, addiction is a brain disease involving dysfunction of reward system. Drug addiction is characterized by use of single or multiple addictive substances such as sedatives, stimulants, hallucinogens, opioids, and prescription or non-prescription drugs. Upon increased intake of these drugs, person’s brain and body develop tolerance or dependence. Gradually the person needs more amount of drug to maintain the previous level of pleasure. When the substance is abused in heavy amount, it can produce intoxication i.e. development of psychological symptoms such as hallucination, delusions, grandiosity, sleep disturbance and many others depending upon the nature of drug taken. When a person tries to quit the substance, his body produces withdrawal symptoms such as agitation, irritation, depression, anxiety etc. Thus, an addict gets trapped by the drug and can’t stop its use because of the changes brought up in his brain due to that drug.
Why people get into drugs can vary according to the life situations and stressors they face. One of the reason could be peer pressure. Because their friends take drugs or they insist, a teenager gets involved in drugs. There could be experimental use e.g. person is curious about the taste of drug but after taking once, he gets addicted. Some people are vulnerable to develop addiction because any of their family members use that. Someone might have early exposure to one or more substances such as during pregnancy their mothers take drugs.
Panic Disorder and Drug Addiction:
Some of the links between panic disorder and addiction are demonstrated through the prescription drugs. For example, generally, Xanax is prescribed to treat panic symptoms. This drug is addictive in nature. Taking the medicine in extra amount than it was prescribed by the doctor is considered as drug abuse. It can be through other ways such as sharing medicine with someone who has similar symptoms. Even if not prescribed by the doctor, anyone can purchase from medical store. The illegal or non-prescriptive use of medicines is a major reason of drug addiction.
Some people are even not aware that they have developed any psychological disorder. They simply take drugs because they feel good after taking drugs. They start using alcohol because it temporarily release their anxiety and calm them down. In our society, it is very common that people self-medicate to reduce stress or get into sleep. They are unaware of the addictive nature of drugs. Some of the very common drugs used for this purpose are Valium, Xanax, tranquilizers etc. Person taking benzodiazepines unknowingly develop dependence because of its addictive effects.
Dual Diagnosis with Panic Disorder:
Dual diagnosis is a term used to denote drug addiction along with the presence of any other psychological disorder e.g. in this case, a panic disorder. Other relevant terms used to explain this phenomenon can be co-occurring disorders or comorbid disorders. Panic disorder and addiction can be simultaneous. The drug use may precede panic disorder or it can be vice versa. When the two conditions are found in a patient, it gets very difficult for clinicians to differentiate the primary disorder.
There may be a situation where panic disorder was present at first place after which individual developed addiction. This could be in the form of self-medication which gets worsened to develop multiple addictions.
On the other hand, drug addiction can lead to panic disorder. There are various drugs which produce panic-like symptoms such as, cocaine is associated with restlessness, irritability and panic attacks. In this way, panic disorder can be produced if primarily a person is addicted to certain drugs.
When a patient who is already suffering from panic disorder takes stimulants, his problem gets worse. He can develop a variety of other psychiatric symptoms. If cocaine is abused by panic disorder patient, severe symptoms of psychosis and paranoia can be produced by the drug.
Treatment of Dual Diagnosis—Addiction and Panic Disorder:
For a patient having panic disorder, there is enough impediment due to drug addiction. Such patients encounter so much difficulties in life. However, they are less likely to seek treatments, are less compliant towards treatment, and less focused on recovery because severe anxiety associated with panic keeps them uneasy. It has been found in rehabilitation centres that dropout rates are very high among dually diagnosed patients. According to some statistical findings in America, among those having dual diagnosis, very few percentage (i.e. 8%) of patients get treatment for both of the conditions. Whereas, nearly 56% of the patients remain untreated.
When person has single diagnosed condition either panic disorder or drug addiction, the treatment can include simple range of techniques which are considered to be effective. On the other hand, when both the conditions are present, the treatment gets complicated. Previously in treatment regimes, both of the conditions were treated separately. Most of those drug addiction patients although experiencing mental disorders were not even diagnosed for mental illness. Rehabs considered only addiction as treatable condition and they considered mental illness as secondary. They provided treatment for addiction and supposed that associated mental illness will recover automatically. However, recent advancement in psychiatric and addiction treatments have brought about awareness that dual diagnosis is commonly occurring condition in most of the addicts for which specialized treatment is it necessary.
It has been found that effective treatments for dual diagnosis are those treating both disorders simultaneously and thus ensuring long-term recovery. A research showing the effectiveness of specialized treatment for dually diagnosed patients indicated that after completing treatment program, 39% of the patients remained sober and 68% of the patients recovered from psychiatric problems. The combined treatment for both the conditions decreased the risk of relapse and increased duration of recovery. It showed better treatment outcomes in long run.
An effective treatment for dual diagnosis provides following facilities:
• Provides therapeutic interventions for panic disorder and specific substance use at the same time in similar rehab centre.
• Has professionally trained staff who are specialized in both addiction and psychiatric management. Some of those rehabs hire staff having one speciality and train them in other modality.
• They provide empowerment and support to patients who are dually diagnosed and encourage their admission in rehab.
• They educate patient and their family members about the panic disorder and the effects of specific substance the client uses.
• They treat both the conditions simultaneously so that patients get recover completely.
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