Panic Spectrum Disorders and Substance Use

Abstract

There is beguiling evidence that panic spectrum disorders and substance use disorders co-aggregate (see Kushner, Abrams, & Borchardt, 2000; Zvolensky, Feldner, Leen-Feldner, & McLeish, 2005; Zvolensky, Schmidt, & Stewart, 2003 for reviews). Most, but not all, research shows that people with panic spectrum disorders smoke more cigarettes (e.g., Pohl, Yeragani, Balon, Lycaki, & McBride, 1992), drink alcohol more frequently (e.g., Regier et al., 1990), may drop out of alcohol (e.g., Labounty, Hatsukami, Morgon, & Nelson, 1992) and smoking cessation clinics (e.g., Covey, Hughes, Glassman, Blazer, & George, 1994) more frequently, and experiencemore severe withdrawal symptoms (e.g., Breslau, Kilbey, & Andreski, 1991) compared to people who do not have a mental disorder. Panic attacks are intense emotional reactions that may include: (1) physical symptoms such as a racing heart and difficulty breathing, and (2) psychological symptoms such as feelings of going crazy. For these emotional reactions to be classified as panic attacks they must either occur ‘‘out of the blue’’ or be excessive to a perceived threat. Panic disordermay be diagnosedwhen a person experiences ‘‘recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack’’ (American Psychiatric Association [APA]; 2000, p. 433). Panic disorder may or may not include agoraphobia, a marked tendency to avoid situations where the person fears he or she may have a panic attack. For the purposes of this chapter, panic spectrum disorders include panic attacks (a symptom of this category of disorders), panic disorder, and agoraphobia with orwithout panic attacks. Panic attacksmay occur infrequently or very frequently. Unless panic attacks occur frequently, or cause extensive worry and disruption to a person’s everyday life, they are not considered to be