Addiction and Agoraphobia
Agoraphobia is an anxiety disorder that makes leaving the home difficult if not impossible. To cope with their feelings of stress and anxiety, men and women with agoraphobia may begin using and abusing drugs and alcohol, putting themselves at risk for chemical dependency. Thankfully, agoraphobia and addiction can both be overcome, through integrated treatment and rehabilitation programs that address both conditions and all the underlying factors that help create them.
What Is Addiction and Agoraphobia?
People who suffer from panic disorder or other types of severe anxiety may develop a range of protective strategies. This primarily involves the avoidance of environments or circumstances that are likely to provoke an intense anxiety attack.
Once it develops from the seeds of panic, agoraphobia becomes the motivating factor behind these avoidance strategies. People with agoraphobia become so paralyzed with fear and dread at the thought of a panic attack that it imprisons them in their homes or other places where they feel comfortable and protected. Agoraphobia itself is a form of anxiety disorder, and those who have it will experience the onset of panic symptoms as soon as they stray outside of their self-defined safe zones.
Many people use drugs and alcohol in a misguided attempt to manage their anxiety, and that is frequently true for agoraphobia sufferers. Whatever its initial effects, substance abuse brings long-term misery, and drugs and alcohol have nothing good to offer people struggling with the disabling symptoms of agoraphobia.
Facts and Statistics
Each year, approximately 20 million Americans aged 12 and over suffer from a substance use disorder. More than eight million will have co-occurring substance use disorders and mental health disorders, and about one-third of those who develop agoraphobia will be included in this group.
According to statistics compiled by the National Comorbidity Survey Replication, a comprehensive report on substance abuse and mental illness in the United States:
- In any given year, approximately 0.9 percent (one out of every 110) of American adults will meet the diagnostic criteria for agoraphobia.
- The lifetime prevalence of agoraphobia for adults in the United States is 1.3 percent.
- Among adults with agoraphobia, 40.6 percent will suffer from highly debilitating symptoms.
- The lifetime prevalence of agoraphobia among American adolescents is 2.4 percent, with virtually all cases causing severe symptoms.
Adult women are slightly more vulnerable to agoraphobia than adult men, but adolescent girls suffer from the disorder at more than twice the rate of boys.
Symptoms and Diagnosis of Addiction and Agoraphobia
Men and women with agoraphobia are often assumed to be shut-ins, but that is an extreme result. Most agoraphobia sufferers can leave their homes on occasion, or have more than one location they can visit without stress or discomfort.
Nevertheless, the anxiety they experience in places that aren’t considered safe and secure is real, significant, and problematic.
The signs that indicate a person may have agoraphobia include:
- The inability to leave safe spaces without the immediate onset of anxiety
- A progressive worsening of anxiety and fear the longer a person is away from safe locations
- Panic attacks in a wide variety of situations, usually where opportunities for escape are limited
- Panic symptoms that develop randomly, but only outside safe areas
- Fear of crowded or enclosed spaces, or excessively open spaces
- Feelings of being stared at or noticed when anxious and in public
- Overdependence on others for help with daily tasks
- Inability to go out in public without worrying about having a panic attack
Substance abuse is not a symptom of agoraphobia per se, but it is a potential risk and a sign that agoraphobia sufferers are going through a difficult time.
The symptoms of a substance use disorder include:
- Growing tolerance for the substance, meaning more must be used to achieve the same results
- Experiencing cravings and withdrawal symptoms if drug or alcohol use is interrupted
- Use of drugs or alcohol that becomes a daily habit, or occurs on a regular schedule
- A loss of ability to function that affects every area of a person’s life
- Secretive behavior that revolves around drinking or drug use
- Arrests for driving while intoxicated, or encounters with law enforcement related to other alcohol- or drug-related behavior
- A disheveled appearance and a decline in physical health in general
- Obsession with drugs or alcohol, which leads to neglect of other interests and/or responsibilities
- Loss of jobs, friendships, or opportunities because of drug or alcohol overconsumption
People with agoraphobia who abuse drugs or alcohol generally do so as a way to counteract their symptoms of anxiety, and the more frequently they repeat this behavior the more likely they are to succumb to addiction.
Diagnosing Agoraphobia and Addiction
To be diagnosed with agoraphobia, a person must experience panic or severe anxiety in two of these five environments:
- Open spaces
- Enclosed public places
- Public transportation
- Crowded places or standing in lines
- Locations outside the home in general
Meanwhile, drug or alcohol addiction can be diagnosed if three of these criteria are met:
- Growing tolerance for the drug (or alcohol)
- Withdrawal symptoms that manifest after a few hours of sobriety
- Multiple unsuccessful attempts to quit using drugs or drinking
- Frequent, higher-than-anticipated consumption
- Significant time spent acquiring drugs and alcohol, or recovering from their effects
- Neglect of occupational, social, and recreational activities in favor of drugs and alcohol
- Continual use of drugs and alcohol despite the user suffering severe life consequences
Agoraphobia and addiction are diagnosed separately, but when both are present they must be treated together.
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Causes and Risk Factors for Addiction and Agoraphobia
The primary risk factor for agoraphobia is a history of panic disorder. Agoraphobia is one possible consequence of panic disorder, if the latter is left untreated.
Other risk factors for agoraphobia include a family history of mental illness, which relates primarily to genetic factors, and a personal history of depression. Anxiety disorders and depression frequently co-occur, and in one study 35 percent of people diagnosed with major depression were also manifesting symptoms consistent with a panic disorder.
Addiction thrives wherever mental illness is present, and the connection is especially strong with agoraphobia. In fact, people who carry a panic disorder with agoraphobia diagnosis have a higher risk for alcohol addiction than those who suffer from any other type of anxiety disorder. They also have the second-highest rate of drug use disorders, trailing only those with generalized anxiety disorder.
Risks of Overdose
People who abuse drugs and alcohol face a serious risk for overdose, and alcohol and opioid overdoses in particular can be fatal if medical treatment is not provided as soon as an overdose is suspected.
The symptoms of a drug or alcohol overdose may include:
- Extreme sluggishness and lethargy
- Mental confusion and forgetfulness
- Loss of balance and equilibrium
- Verbal unresponsiveness
- Dramatic and uncontrolled shifts in mood (i.e., deep depression or hyperactivity)
- Hallucinations or delusions
When an overdose is suspected, there is no time to waste. Companions should call 911 immediately and inform the operator of the nature of the emergency.
Withdrawal and Detox
Chemical dependency can be overcome, but when a person first stops using drugs or alcohol they are likely to experience withdrawal symptoms.
Besides powerful cravings for the source of the addiction, people experiencing withdrawal may become highly agitated or nervous, suffer from muscle aches and pains, experience swift and troubling mood swings, have a difficult time thinking clearly or concentrating, and possibly suffer from delusions or hallucinations if their substance abuse problem was severe.
These debilitating and unpleasant side effects of early-stage sobriety may be unavoidable, but they can be managed and controlled through medically-assisted detox, administered by trained personnel in clinical settings designed to meet the needs of people new to recovery. Residential treatment facilities usually have detox facilities onsite, and they often start new clients in detox before transitioning them to full-time addiction treatment programs.
During detox medications may be administered that can help relieve the intensity of withdrawal symptoms. Withdrawal at home, cold turkey-style, is not recommended, since serious health complications can arise if medical care is not available when withdrawal symptoms are most acute.
Up to two-thirds of people who seek treatment for a panic disorder will show at least some symptoms of agoraphobia. This explains why panic disorder is diagnosed either with or without agoraphobia, although the latter is still recognized as a separate mental health condition.
The list of other conditions that frequently co-occur with agoraphobia, in order of prevalence, include:
- Specific phobias
- Social anxiety disorder
- Major depression
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
- Generalized anxiety disorder
In 2016, about 20 percent (8.2 million) of the 44.7 million people who experienced symptoms of mental illness also battled a substance use disorder. This reveals how frequently people with agoraphobia and other mental health disorders turn to drugs and alcohol to help them cope with thoughts, emotions, and behaviors they can’t control and don’t understand.
Treatment and Prognosis for Addiction and Agoraphobia
A dual diagnosis for agoraphobia and addiction will require integrated treatment that addresses both conditions at the same time. Each disorder reinforces the other, and true healing will not be possible without specialized treatment that recognizes this fact.
A dual diagnosis treatment program for co-occurring agoraphobia and addiction will likely include some combination of:
- Psychotherapy (individual, group, and family). Cognitive-behavioral therapy (CBT) is standard for the treatment of anxiety disorders.
- Medication. Agoraphobia often responds positively to anti-depressants, and there are certain medications that can help relieve cravings and withdrawal symptoms for those who are dependent on drugs or alcohol.
- Holistic stress management treatments. Through mind-body wellness practices like acupuncture, massage therapy, meditation, yoga, and biofeedback, patients learn to control their anxiety while becoming more consciously aware of their feelings and decision-making processes.
- Life skills and coping skills classes. These types of initiatives help prevent drug and alcohol relapse, and they can help agoraphobia sufferers identify and alter patterns of thought and behavior that tend to provoke their symptoms of panic.
Recovery from addiction and agoraphobia is a long-term process, and aftercare services will be required after inpatient or intensive outpatient treatment programs reach their conclusion. But through a deep and abiding commitment to their treatment plans, people with a dual diagnosis for addiction and agoraphobia can overcome both conditions and return to living normally, safely, and freely.