Panic Disorder and Substance Use: Signs Families Should Know and Treatment Options

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

A pounding heart, breathlessness, chest tightness, trembling hands, sweating, dizziness, and a feeling that something severe is about to happen are symptoms that frighten many people into going to the hospital. When tests come back showing no physical illness, some begin to wonder whether they are experiencing “panic.”

Panic symptoms can arise quickly and intensely, to the point that the person feels completely out of control. After a first episode, some people begin fearing it will happen again, and start avoiding travel, being alone, taking the train, flying, or going to places where they think it would be hard to get out if symptoms occurred.

When substance use is also involved, distinguishing the cause becomes more complicated, because yaba, ice, cocaine, cannabis, large amounts of caffeine, and the effects or withdrawal of certain substances can all cause a racing heart, restlessness, rapid breathing, and intense fear resembling panic. Conversely, someone who has experienced panic before may start using alcohol, anti-anxiety medication, or other substances to try to prevent symptoms from occurring.

Families should therefore avoid jumping to the conclusion that all of this is simply “panic disorder” or “just the drugs.” What matters is assessing when the symptoms occur, how they relate to substance use, whether they have occurred during periods without substance use, and whether they still recur once the drug’s effects or withdrawal have passed.

What Are the Symptoms of Panic Disorder, and How Is It Different From Ordinary Anxiety?

A panic attack is a period during which fear or distress rises rapidly, along with a range of physical symptoms. The person may feel as though their body is facing an emergency, even though in many cases there is no actual danger matching what they feel.

Symptoms can include:

A racing heart or a feeling of pounding heartbeats
Heavy sweating
Trembling hands or shaking
Shortness of breath or a feeling of not being able to breathe fast enough
Tightness or discomfort in the chest
Nausea or stomach discomfort
Dizziness, unsteadiness, or a feeling of being about to faint
Hot flashes or chills
Numbness or tingling sensations in the body
A feeling that one’s surroundings are unreal, or feeling detached from oneself
Fear of losing control
Fear that something severely dangerous is about to happen to oneself

Having a single panic attack does not always mean someone has panic disorder. Panic attacks can occur in ordinary people in certain situations, and the same symptoms can also come from substances, medications, or certain physical conditions.

What makes panic develop into a bigger problem is that after having had an episode, the person begins to worry continuously that it will happen again, or changes their behavior to avoid it — not daring to drive, not daring to be alone, avoiding elevators, avoiding malls, or avoiding long trips, out of fear that if symptoms occur, no one will be able to help.

Some people therefore don’t only suffer during the panic attack itself, but spend most of their time “afraid of being afraid again,” until their life becomes increasingly restricted.

Can Yaba, Ice, Cannabis, and Other Substances Cause Symptoms That Look Like Panic Attacks?

Yes, and this is an important issue that must be assessed before concluding that someone has panic disorder.

Stimulants such as yaba, ice, and cocaine can heighten the body’s alertness — a racing heart, trembling hands, sweating, restlessness, and insomnia. When a person notices their heart beating abnormally or breathing quickly, they may become even more afraid that something dangerous is happening, so the physical symptoms and the fear feed off each other until it resembles a panic attack.

If stimulant use continues along with sleep deprivation, severe anxiety, paranoia, or other psychotic symptoms may also occur, and these need to be assessed separately from panic disorder.

Cannabis can also cause anxiety or panic-like symptoms in some people, particularly when accompanied by a racing heart, a feeling of losing control of one’s thoughts, or a feeling that one’s surroundings are not quite right. Some people who have had a bad experience with cannabis before may become extremely afraid as soon as they start noticing changes in their body.

Caffeine and other stimulant-containing drinks, when consumed in large amounts by someone sensitive to their effects, can cause a racing heart, trembling hands, restlessness, and insomnia, which can also trigger anxiety.

Another factor is withdrawal. Someone who has used alcohol or certain sedatives continuously may experience a racing heart, trembling hands, sweating, restlessness, anxiety, and insomnia when reducing or stopping use, and these symptoms can look similar to panic.

Suddenly stopping alcohol or certain sedatives after heavy, continuous use can carry medical risk, so severe withdrawal symptoms should never be managed or stopped on one’s own.

Why Might Someone With Panic Disorder Start Relying on Alcohol or Anti-Anxiety Medication?

After a first panic attack, the memory of the experience can leave a person very afraid — remembering, for example, how their heart raced so much they thought something was seriously wrong, or how they felt unable to breathe while on the train.

The next time they’re about to enter a similar situation, anxiety can arise even before any symptoms appear. Some people start carrying medication with them at all times, some feel they need someone to accompany them, and some find that after drinking alcohol they feel less anxious — so they start using a substance as a tool to build confidence.

A cycle can develop like this:

“Afraid a panic attack will happen, so I drink or take medication to feel safe. Once I get through the situation, I believe it’s because I had the substance or medication that nothing happened, which makes me even less confident I can handle it the next time without it.”

As this repeats, the person may start feeling they need to drink before flying, need medication before traveling, or cannot leave the house without medication on hand.

This does not mean that taking medication as prescribed by a doctor is wrong — but buying anti-anxiety medication to use on one’s own, increasing the dose without guidance, or using a substance to control fear without any assessment can create additional problems, especially with certain classes of anti-anxiety medication that carry a risk of dependence when used inappropriately.

Treatment should therefore help the person learn what a panic attack actually is, understand the relationship between thoughts, fear, and the body’s responses, and build confidence that they can cope with the symptoms without relying on a substance as their main method.

How Is Panic Disorder Treated When It Occurs Together With Addiction?

Treatment must begin by distinguishing the cause as clearly as possible, because a racing heart, chest tightness, shortness of breath, and dizziness are not caused by panic disorder alone.

Assessing Physical Illness, Substance Effects, and Panic Symptoms

If someone experiences a racing heart, chest pain or tightness, abnormal breathing, fainting, or symptoms that are severe and different from before, these should not simply be assumed to be panic — especially when the person has just used a stimulant or a substance of unknown composition. A medical assessment should be obtained as appropriate.

Once any physical emergency has been assessed, the care team will consider whether the symptoms occurred while using a substance, after using, or during withdrawal; whether they have ever occurred during periods without substance use; and whether they still recur after stopping use.

This information helps distinguish between panic disorder, panic-like symptoms caused by a substance, and having both panic disorder and a substance-use problem together.

Cognitive Behavioral Therapy to Break the “Fear of Fear” Cycle

Cognitive behavioral therapy is a key approach to treating panic disorder, because after having one episode, many people become more sensitive to sensations in their own body.

For example, when the heart beats slightly faster, the person may think, “Something’s wrong with my heart.” This thought increases fear; as fear increases, the heart beats even faster and breathing quickens, which reinforces the belief that danger is occurring.

Therapy helps someone understand this cycle and gradually change how they interpret their physical symptoms, while practicing ways to cope with fear without rushing to escape every time.

For those who have begun avoiding places such as trains, malls, elevators, or long trips, treatment may involve gradually practicing a return to facing these situations at an appropriate pace. The goal is not to force the person to do the thing they fear most right away, but to help them gain a new experience — that anxiety can arise and then subside without needing to escape or rely on a substance every time.

Treating Substance Use Alongside Panic Disorder

If the person is using alcohol, anti-anxiety medication, or other substances to prevent panic, it’s necessary to find out which situations trigger the urge to use — for example, before flying, before leaving the house, before a meeting, or when the heart starts beating quickly.

Therapy helps build other ways of coping and plans to prevent a return to substance use, especially in situations the person used to believe they could only get through with the help of a substance.

If there is clear addiction, treating panic disorder alone may not be enough, because if the person returns to using again, the drug’s effects or withdrawal can bring back physical symptoms and anxiety.

Using Medication for Panic Disorder When Indicated

Panic disorder can be treated with medication. A psychiatrist will consider the frequency and severity of symptoms, the impact on the person’s life, any co-occurring conditions, and their history of substance use.

Certain classes of medication used to treat panic disorder need to be taken continuously for a period of time before an effect is seen — they are not medications that make all symptoms disappear immediately after the first dose.

For someone with a history of substance use, medication choice requires greater caution, particularly with certain anti-anxiety medications that can lead to dependence if used inappropriately. The person should tell their psychiatrist honestly about any history of using alcohol, sleep medication, anti-anxiety medication, or other substances.

Medication should never be bought and taken independently, borrowed from someone else, increased in dose on one’s own, or suddenly stopped after long-term continuous use without a doctor’s guidance.

How Should Families Help Someone Who Has Panic Disorder and Uses Substances?

When a family member has a panic attack, one thing not to do is rush to criticize with comments like “you’re just imagining it,” “it’s nothing,” or “why can’t you control yourself” — because in that moment, the physical symptoms and fear the person is experiencing are genuinely intense.

At the same time, families do not need to confirm the fear that something severely dangerous is happening every single time. Once a medical assessment has confirmed panic disorder, it’s more helpful to keep the environment calm, speak in a normal tone, and help the person follow the plan recommended by the care team.

Once the episode has settled, it’s worth discussing the pattern that has emerged, such as, “Lately we’ve noticed you need to drink every time before leaving the house because you’re afraid symptoms will happen — we’re worried this is becoming something you depend on.”

If the person doesn’t accept that substance use is a problem, there’s no need to start by arguing over the words “addiction” or “alcoholism.” It may help to start from a goal they themselves want, such as wanting to be able to drive again, wanting to travel, wanting to go to work without fear, or wanting to sleep without relying on a substance.

Families should avoid permanently helping the person escape every feared situation, because although this may bring short-term relief, avoiding everything can keep alive the belief that “this situation is dangerous and I can’t handle it.”

If the family is unsure whether what they’re seeing is panic, an effect of substance use, or what level of treatment is needed, they can consult a specialist first, even if the person is not yet ready to come along.

Where Should Someone Start Getting Help for Panic Disorder Together With Substance Use?

If panic symptoms are the main issue, and there is a history of occasional alcohol, cannabis, or other substance use without a clear pattern of addiction yet, a mental-health and substance-use assessment can help determine what level of treatment is needed.

If the person is not yet ready for treatment, or if panic is the main problem and substance use is only occasional without clear signs of addiction, families can start by consulting at Piti Clinic on Pradiphat Road, Saphan Khwai, Bangkok, to understand the symptoms, gather initial information, and plan how to talk with or encourage the person to seek appropriate treatment.

But if a pattern of repeated substance use begins to appear — an inability to control use, needing the substance to leave the house or prevent panic, using increasing amounts, stopping and relapsing multiple times, withdrawal symptoms, or substance use affecting school, work, relationships, and daily life — assessment and treatment of the addiction should be taken seriously.

Especially for someone who has both panic disorder and addiction, residential treatment may help break the cycle between fear, substance use, withdrawal, and relapse more clearly than addressing panic symptoms alone.

Treating Panic Disorder and Addiction Together at Day One Rehabilitation Center

For someone with co-occurring addiction and panic disorder, Day One Rehabilitation Center places importance on treating both problems together, because panic symptoms can trigger a return to substance use, while the effects and withdrawal of substances can themselves cause a racing heart, insomnia, anxiety, and panic-like symptoms again.

Residential treatment reduces access to substances and triggers in the early stage, allowing the care team to continuously monitor symptoms after stopping use, sleep, anxiety, physical symptoms, and cravings.

A psychiatrist can assess which symptoms are likely related to panic disorder and which are related to substance use, and whether any other psychiatric conditions are present, while considering medication when indicated.

Individual therapy helps the person in treatment understand the cycle between bodily sensations, thoughts that interpret them as dangerous, fear, avoidance, and substance use, while practicing new ways of coping that do not require relying on a substance.

Relapse prevention prepares the person for real situations after leaving the center — such as what to do if their heart starts racing again, how to cope with the urge to use medication or drink to prevent panic, and how to plan for returning to places where symptoms have occurred before.

The goal of recovery, therefore, is not simply to calm panic symptoms while the person is at the center, but to help the person in treatment return to living their life without having to organize everything around the fear of panic, and without needing to rely on a substance to create a feeling of safety.

Frequently Asked Questions About Panic Disorder and Substance Use

Do a racing heart, shortness of breath, and chest tightness always mean panic disorder?

Not always. These symptoms can occur with panic disorder, but heart conditions, other physical problems, certain medications, and substance use can also cause similar symptoms. Especially when symptoms occur for the first time, are severe, or differ from before, they should not be assumed to be panic disorder on their own.

Is panic disorder life-threatening?

A panic attack makes a person feel as though something severely dangerous is happening, but panic attacks themselves generally do not mean the body is in a life-threatening state. However, chest pain, abnormal breathing, loss of consciousness, or symptoms that occur after substance use should not simply be assumed to be panic — they should receive a medical assessment as appropriate.

Can yaba or ice cause panic attacks?

Stimulants can cause a racing heart, trembling hands, restlessness, insomnia, and severe anxiety, which can produce symptoms resembling panic attacks or trigger them in people who are sensitive to anxiety.

Can cannabis cause panic attacks?

Yes, in some people. Cannabis can cause a racing heart, anxiety, fear, or a feeling that one’s surroundings are not quite right, which can lead to panic attacks — particularly in people who have had panic attacks before or who are sensitive to changes in their body.

If drinking alcohol makes panic symptoms feel better, does that mean it can be used as treatment?

Alcohol should not be used as a treatment for panic disorder. Although it may make some people feel temporarily relaxed, if someone starts needing to drink in order to leave the house, travel, or enter a feared situation, alcohol dependence can develop and make treatment more complicated.

Can anti-anxiety medication treat panic disorder, and can it become addictive?

Medication has a role in treating panic disorder, but certain classes of anti-anxiety medication carry a risk of dependence if used inappropriately. Medication choice should therefore be assessed by a psychiatrist, especially for someone with a history of substance use or regular alcohol drinking.

Can panic disorder be cured?

Panic disorder can be treated and its symptoms managed. Treatment helps reduce both how often symptoms occur and the fear of them recurring, and helps a person return to activities they used to avoid.

Should someone with panic disorder avoid places where symptoms have occurred before?

Avoidance may provide a short-term sense of safety, but the more someone avoids, the more limited their life can become. Treatment usually helps a person gradually return to facing situations appropriately, rather than avoiding everything.

For someone with panic disorder and addiction, which should be treated first?

In many cases, both problems should be treated at the same time, prioritized according to safety, intoxication or withdrawal, physical symptoms, and the severity of the panic disorder. If substance use is the main way the person prevents or controls panic symptoms, both sides need to be addressed together even more.

Does someone with panic disorder who also uses substances need residential treatment?

If substance use is only occasional and there is no clear pattern of addiction yet, a person can start with a mental-health assessment, or families can come consult at Piti Clinic first. But if substance use cannot be controlled, is repeated, is relied on to function in daily life, involves stopping and relapsing again, or involves withdrawal symptoms, residential addiction treatment at Day One Rehabilitation Center may be a suitable option.

Panic Disorder and Addiction Should Not Be Allowed to Let Fear Take Over Someone’s Life

What makes panic disorder disrupt life so much is not only the moments of a racing heart or shortness of breath, but the fear that symptoms will return — to the point that the person begins organizing their entire life around avoiding those feelings.

When substance use becomes part of the picture, the cycle can become more complicated, because the person may come to believe they need to drink, need medication, or need a certain substance in order to feel safe, while the substance itself can cause a racing heart, insomnia, anxiety, and panic-like symptoms.

Appropriate treatment must therefore answer two questions: “What is causing the panic symptoms?” and “What role is the substance playing in this person’s life?” — in order to distinguish between panic disorder, the effects of a substance, withdrawal, and having both problems together.

For families who are unsure where to begin seeking treatment for what they’re seeing, consultation is available without needing to wait for the person to accept every part of the problem. But once a pattern of repeated substance use, an inability to control it, or a need to rely on a substance to function in daily life becomes apparent, taking assessment and treatment of the addiction seriously from an early stage can help prevent the cycle of fear and substance use from becoming further entrenched.