About 30% of people with panic disorder use alcohol and 17% use other psychoactive drugs. Utilisation of recreational drugs or alcohol generally make symptoms worse (American Psychiatric Association: Practice guideline for the treatment of patients with panic disorder.)
Most stimulant drugs (caffeine, nicotine, cocaine) would be expected to worsen the condition, since they directly increase the symptoms of panic, such as heart rate. Cannabis commonly precipitates panic in panic patients.
People take recreational drugs to ‘heighten’ pleasurable sensations and feelings. However, the problem is that if we have been experiencing a low level of stress or anxiety (that we may not have even been aware of) then ‘recreational’ drugs can exaggerate THOSE feelings as well.
Then low level fight or flight symptoms can suddenly become very intense and this can lead to misinterpretation, catastrophisation and the formation of the cycle of fear.
CASE STUDY
John was a 24 year old student who imagined himself ‘stress free’. However, he was at university and was worried about his upcoming exams and had felt some feelings of anxiety but wasn’t overly concerned.
He had been taking Marijuana to relax but had experienced some ‘bad trips’ where he felt very paranoid and his body trembled uncontrollably. One morning after a night of taking drugs along with alcohol he awoke with feelings of numbness in his hands, arms and feet.
He felt very alarmed because he felt that even though the drug should have worn off he felt as if he was still having a ‘bad trip’. He started thinking “what if I am going to stuck with this feeling FOREVER?, what if I have damaged my brain?, what if there is something seriously wrong with me?
These thoughts escalated his anxiety, the symptoms increased and he went into ‘panic’. He took to his bed and for the next few days worried continuously about his ‘condition’. He became particularly anxious when he woke up each morning. It was from this point that he started to experience regular panic attacks.