Party Panic: How Substance Abuse Triggers Anxiety
Updated: Oct 28, 2018
Dear Dr. Schultz:
As the sibling of a drug addict, I was against drugs for most of my life. My sibling was in rehabs and mental institutions for most of my teenage life. Mental illness runs in my family (depression, personality disorder) More than half of my family is on some sort of anti depressant. I never battled with any of these illnesses until 2 years after leaving school where I began to feel mild anxiety and so I decided to go on a mild anti-anxiety/anti-depressant.
Eventually, after coming out of my teen years, I decided to experiment a little with drug use. (This was not my first time trying drugs. I had tried drugs in high school before my sisters serious drug addiction started) I decided to stop taking my anxiety medication as I didn’t feel I needed it anymore. I stopped my medication the same day I decided to stop. I never consulted my doctor as I was told it was a mild pill that I could stop at any time.
My partner, with whom I share a home, is an avid marijuana smoker and so it was only a matter of time before I became a regular marijuana smoker as well. I smoked everyday consistently for about +- 3 months. I decided to try other drugs as well. I’ve tried a few drugs and none of them have drastically affected me besides for shrooms. My first attempt at trying shrooms, I took a small dose and barely felt any different. On my second attempt I had a good amount. I had a normal trip for about 3 hours until I decided to smoke some marijuana afterwards so that I could relax, which was the worse decision that I have ever made, I regret it to this day. I had the worst trip. It took me to the darkest place I have ever been in. I felt like I was an inanimate object, like I was one with the bed I was laying on.
When I did speak I couldn’t feel my mouth moving, I felt like I had no control of my body even though I was talking and walking completely fine. I had a huge panic attack. I felt completely disgusted with myself, I hated myself. I was so self conscious and kept telling myself that I was not good enough. In that moment I thought my families history of mental illness had finally caught up with me. I insisted that my partner drive me to the hospital as I legitimately thought I was going to die. While in the car driving to the hospital I was in and out of focus, I was boiling hot and then I was freezing. I kept yelling to my partner that I was going to die. At one point I felt as if my soul was leaving my body and I had accepted the fact that my life was ending. After being rejected help from hospitals, eventually the driving around for about an hour or two sobered me up. I went home that night and slept. The next morning I felt fine, just extremely embarrassed that I couldn’t handle my drugs.
Since that night, I had smoked marijuana again a few times but every time that I smoked I got extreme social anxiety, to the point where I would lock myself in a room just to be away from people. I decided to stop all use of drugs straight away as I could see it was effecting my life in a huge negative way.
These last few months after my bad trip I have not felt myself at all. I feel like a completely different person. I have extreme social anxiety to the point where going to work is a huge fear for me. The thought of being around people terrifies me. Communicating with people on a daily basis is a struggle for me. I feel like I have lost all social skills that I have developed over my life. I have forced myself to see friends and go out few times, sometimes I am completely fine but other times I have mild panic attacks from having to communicate with people, I have no control of when I feel social anxiety. I used to be a loud, fun, outgoing person and now I would rather lie to my friends so that I don’t have to see them and sit at home doing nothing with my partner where I don’t feel anxiety. I was an English teacher in Thailand for one year, I lived by myself in a foreign country with no one I knew for one whole year and I never felt a second of social anxiety and now I can’t even handle having to have a casual conversation with my boss.
All these symptoms I have mentioned above, I thought were just symptoms of me developing anxiety or depression but my partner keeps insisting that I have not been the same since the night of my bad trip on shrooms. I am currently back on my anti-anxiety medication. After the first two weeks of taking this medication again I felt like I was myself again as the medication was starting to work. Now I have been on it for more than a month and I feel my social anxiety is coming back again and it’s still as bad as it was before.
I don’t know what to do anymore but I feel completely depressed that I am not the person I used to be. I feel like this is the person I am now and there’s no way for me to go back to normal. I really need any help or advice that I can get. I’m desperately trying to fix myself but don’t know how. I just want to be the person that I was before I made the wrong decision to experiment with drugs.
Hello and thank you for addressing your question to me.
Let me start with the good news. With proper psychological treatment, there is every reason to believe you can experience significant improvement in your current condition. Although going back to a place in time before these problems ever existed is impossible (damned time machine is broken again), you can likely attain an even greater sense of confidence, self-esteem, and peace than you previously enjoyed.
Based on your description, it appears that you are currently exhibiting symptoms consistent with Social Anxiety Disorder. This is defined as "a persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others." Further, "the individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating." This explains your pronounced anxiety about, and avoidance of, going to work, and of being around and communicating with others.
In addition, you appear to also have developed significant signs of depression. These are marked by your extreme self-criticism for having the anxiety problems, your feeling that you are not the person you used to be, and your hopelessness about ever recovering from these current struggles. Depression often follows anxiety as avoidance of feared situations breeds isolation. In addition, it is quite natural to become discouraged (and often self-blaming) upon noting how constricted one's range of of coping and behavior have become.
As you report a family history significant for various mental health and addiction issues, and indicate that you yourself had struggled with "mild anxiety" prior to the events you describe, pre-existing vulnerabilities to your current condition(s) were clearly present prior to your use of mushrooms and cannabis.
By way of explanation, your anxiety symptoms worsened significantly as a result of your bad mushroom trip. Not only was the panic attack (and accompanying social anxiety) itself quite traumatic, but your previously benign drug use was suddenly and powerfully paired with extreme anxiety. This form of learning is a common behavioral paradigm called Classical Conditioning (remember Pavlov and his drooling dogs?). Your thoughts and feelings during drug use, which had been largely "normal," became suddenly and powerfully associated with feeling out of control, acutely self-conscious, and fearing that you were about to die. This connection was demonstrated and further strengthened by the subsequent social anxiety-producing episodes that occurred when you used cannabis by itself.
Further, it is quite common for the fears we run from and focus upon to become stronger as a result of the attention we pay to them. For example, if one fears having a heart attack, and begins to closely monitor their heart rate, while also trying to "stay calm," an elevated heart rate will likely result. Once this is noticed, anxiety will increase, and the heart rate will become even more rapid (particularly if one is already anxiety prone). Soon, other physiological sensations may occur as a result of rapid, shallow breathing (hot or cold sweats, numbness or tingling in the extremities, dizziness, etc.), and the anxiety is further increased. You can see where this is going.
Given the concerns you then began to develop about your anxiety symptoms and your social functioning, these became a focus of fearful attention across many contexts and situations. This occurs via the process of Generalization. If the concerns manifested themselves at work, or with friends, you likely attempted to monitor, control, and avoid these situations (thereby worsening the symptoms, as described above in regard to heart rate). Through yet another learning process called Negative Reinforcement, your avoidance behaviors naturally resulted in slight and very temporary reductions of anxiety. As they were "rewarded," they naturally became more prevalent. The underlying anxiety grew stronger, however, following these momentary reductions. As a result, concerns about your general functioning (and social functioning in particular) became highly pronounced, as did your avoidance behaviors. And drugs no longer needed to even be a part of the equation. Pretty fascinating, isn't it?
So, given all of this, how to move forward and heal? First, it sounds like your decision to discontinue your recreational substance use was a wise one. This is especially true given your family history of mental illness and addiction, and your own negative experiences. Getting back on your medication was also a smart decision. As psychotropic medication alone is generally NOT considered to be as effective for most anxiety and depressive disorders as is medication PLUS psychotherapy, additional intervention is also indicated.
I therefore strongly recommend that you seek out an experienced psychologist with whom you can work. This practitioner will ideally have a strong grounding in cognitive-behavior therapy (CBT), which tends to be the "gold standard" for addressing most anxiety disorders. CBT is based on the idea that it is not the challenging events and circumstances we experience in life that determine how we feel and behave, but how we INTERPRET these events and circumstances. Please also ensure that the therapist also has demonstrated experience treating social anxiety. As the heightened symptoms of anxiety were LEARNED (as described above), they can also be UNLEARNED. Through a combination of in-session and out-of-session work, CBT-trained provider can help you to regain your social confidence and positive concept. As I noted earlier, by directly confronting and addressing what you currently fear, you will probably find that you feel even more confident and grounded than you did before these unpleasant events occurred.
Thank you again for writing and I hope that some of what I have written has been useful to you. Please do keep me posted on your progress, and feel free to direct any further questions or comments to me. I wish you peace and courage in working through your current challenges.