Affecting around 1.5 percent of Americans in their lifetime, agoraphobia is an anxiety disorder characterized by an intense fear of both open and enclosed spaces, and situations that may be difficult to get out of or escape from, the National Institute on Mental Health (NIMH) reports. Agoraphobia can cause a person to avoid actual and anticipated situations, and public places that may make a person feel trapped.
The Anxiety and Depression Association of America (ADAA) publishes that one out of three of the nearly 6 million people in the United States who suffer from a panic disorder annually will develop agoraphobia. Panic disorders affect twice as many women as men and typically manifest in early adulthood. The National Health Service (NHS) reports that agoraphobia most often develops after a panic attack or as a side effect of a panic disorder, as individuals strive to avoid places or things that triggered the feelings of intense fear. In a very small percentage of people, agoraphobia can develop on its own without a previous history of panic attacks. Genetics and environmental factors may have roles in the onset of agoraphobia, as the condition is likely heritable and may also be triggered by traumatic events.
Symptoms of agoraphobia include:
- Fear of being alone
- Tendency to need to take a friend or relative out into public
- Anxiety surrounding crowded places
- Avoidance of things like elevators, public transportation, shopping malls, etc.
- Fear of losing control in a public space
- Adhering to specific routes or “safety zones”
- Inability to leave the house alone
- Extreme dependence on others
- Feelings of helplessness
- Suffering panic attacks (symptoms: rapid heart rate, sweating, nausea and upset stomach, diarrhea, chest pain, lightheadedness, difficulties breathing, shakiness or numbness, chills, feeling a loss of control, and intense fear of dying)
Information published in the journal Psychiatric Times indicates that anxiety disorders, including panic disorder with agoraphobia, commonly co-occur with alcohol and drug use disorders. Both addiction and agoraphobia can contribute to the onset and amplification of each other, Reuters reports. According to the ADAA, around 20 percent of those battling addiction also suffer from an anxiety or mood disorder, and the reverse is also true. Co-occurring disorders, such as agoraphobia and addiction, can complicate and exacerbate negative symptoms of each disorder. Fortunately, both are treatable and optimally cared for in an integrated and comprehensive fashion.
Self-Medication for Agoraphobic Symptoms
Individuals suffering from agoraphobia may turn to alcohol and/or drugs as a way to combat their symptoms. These are mind-altering substances that may temporarily ease anxiety and increase sociability. Unfortunately, with repeated use, they can actually serve to make anxiety symptoms worse.
Drugs and alcohol change the way chemical messengers and signals are sent throughout the brain and central nervous system. Neurotransmitters like dopamine and GABA (gamma-aminobutyric acid) are increased by the presence of central nervous system suppressants like alcohol, opioids, or benzodiazepine drugs. Dopamine increases pleasure while GABA minimizes the stress response, thus lowering feelings of anxiety. While taking these psychoactive substances, a person may feel more able to take on tough situations and go places they were afraid to before, as they may have a false sense of courage. This only covers up the issues, however, and does not actually help to dispel panic and anxiety on a long-term basis.
Also, with regular interference by alcohol and drugs, the brain stops making and transmitting these chemical messengers the same way it did before. When the drugs then wear off, anxiety may return even greater than it was before, as levels of the naturally occurring neurotransmitters are not the same as they once were. It can take time for the brain to restore balance without drugs and alcohol, and this period of time is called withdrawal.
Drug cravings and difficult withdrawal symptoms can influence how much and how often a person uses drugs or drinks alcohol. Individuals may lose their ability to control their substance abuse and be unable to stop drinking alcohol or doing drugs despite multiple attempts to do so. Circuitry in the brain that helps to regulate moods and regions involved in memory and learning functions are disrupted. This is the definition of addiction, per the American Society of Addiction Medicine (ASAM). Addiction can actually compound, or even create, agoraphobic symptoms and vice versa.
Getting Help for Agoraphobia and Addiction
In 2014, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that close to 8 million Americans aged 18 and older suffered from both addiction and a mental health disorder, which are said to be co-occurring disorders. It is important to treat both disorders in a simultaneous fashion in order to enhance recovery of both issues. Substance abuse treatment providers work closely with mental health and medical professionals in order to assess a person, devise a treatment plan, and then implement a recovery strategy and plan.
Withdrawal symptoms may be significant upon stopping drugs or alcohol once dependence has formed, so medical detox is often the first line of treatment. Medical detox often uses pharmaceutical tools like mood-stabilizing medications to reduce anxiety and other potentially intense psychological symptoms of withdrawal. Detox typically lasts only a few days to a week, and it prepares a person to enter into a complete treatment program. Treatment for these disorders may be performed on an outpatient or residential basis, depending on what will be best suited for the individual.
Mayo Clinic publishes that agoraphobia is commonly treated with a combination of medications (like antidepressants and/or anti-anxiety drugs) and therapy sessions. When addiction is also present, treatment providers will need to carefully choose medications and therapeutic methods that will complement and benefit recovery for both disorders.
During treatment for co-occurring agoraphobia and addiction, individuals will attend group and individual therapy sessions. During these sessions, new skills and coping mechanisms are learned and developed. Behavioral therapies help to retrain the way a person thinks about things, therefore altering behaviors that may be self-destructive and have negative consequences. Cognitive Behavioral Therapy (CBT) can help individuals to build on small successes and work toward returning to things and/or places that agoraphobia kept them from in the past. Exposure therapy is another method that may be employed by highly trained professionals in order to help individuals safely face their fears and learn to overcome them.
Self-help methods and education about the disorders can also go a long way, as individuals learn how to become more self-reliant and manage stress without use of drugs or alcohol. As individuals learn to better understand themselves and their own potential triggers or stressors, both disorders can be effectively managed.
Relapse prevention tools are also learned during integrated treatment programs, and support groups provide encouragement. Healthy and balanced meals, structured sleep schedules, exercise programs, and other complementary techniques used during treatment work to improve overall recovery from addiction and agoraphobia.