Treating Phobias and Drinking Problems

The Anxiety and Depression Association of America (ADAA) reports that around 19 million Americans struggle with a specific phobia, which is the most common type of all of the anxiety disorders. It is normal, and even healthy, to fear certain things or situations; however, someone suffering from a phobia will have an irrational fear that interferes with their ability to function normally in everyday life. These fears are intense, and of things or situations that actually present little to no real threat or danger.

Common phobias include:

• Agoraphobia: fear of public places
• Claustrophobia: fear of enclosed spaces
• Arachnophobia: fear of spiders
• Aerophobia: fear of flying
• Social phobia: fear of social situations and of being judged or viewed negatively
• Acrophobia: fear of heights
• Hemophobia: fear of blood
• Ophidiophobia: fear of snakes
• Zoophobia: fear of animals

A specific phobia can involve a certain thing, place, animal, event, or situation. The National Institute of Mental Health (NIMH) reports that close to 9 percent of adults in the United States battle a specific phobia, and more than 20 percent of the time it is classified as “severe.”

There is not usually one certain “cause” for a phobia to present itself. Mayo Clinic reports that there are several potential contributing factors, including exposure to something that causes the phobia (i.e., a negative experience), genetic and biological factors, brain chemistry, and environmental aspects. Phobias usually present first in childhood or early adolescence.

Individuals struggling with a phobia may attempt to cope on their own and commonly turn to alcohol as a method of self-soothing. ADAA warns that someone who struggles with an anxiety disorder is around 2-3 times more at risk to also battle an alcohol or drug abuse disorder as well.

Concerns of Self-Medicating Phobias with Alcohol

Someone who suffers from a phobia may turn to alcohol as a coping mechanism, as a way to self-medicate the difficult symptoms of anxiety. Alcohol is a central nervous system depressant, which means that it slows down the “fight-or-flight” stress reaction that is often heightened in someone who struggles with intense anxiety. When a person feels fear, things like heart rate, respiration level, body temperature, blood pressure, focus, attention, and energy levels are all heightened. In someone who struggles with a phobia, the stress response may be intensified when presented with the object of their fear, and it may be difficult for them to control these feelings.

Generally, a person will then work very hard to avoid feeling this way, going out of their way to ensure that the fear is not triggered. This can disrupt a person’s life when they are unable to do certain things or go to certain places. Jobs may be lost, relationships can suffer, and physical health may decline, as appetite and sleep functions are often impacted by fear and anxiety.

The US Department of Health and Human Services (HHS) publishes that phobias can cause the following side effects:

• Shortness of breath
• Tightness in the chest
• Accelerated heart rate
• Shaking or tremors and muscle tension
• Intense fear and panic
• Awareness that fear is irrational, but a lack of control over it
• Feeling the strong urge to avoid or get away from certain places, things, events, or situations

Alcohol may then temporarily reduce anxiety and help a person to relax and calm down. It may also help a person to feel more empowered and less afraid, and therefore, it may seem like a method of coping with the phobia. Unfortunately, alcohol is only a temporary salve that does nothing to actually manage specific phobias or anxiety.

Regular consumption of alcohol and excessive drinking can lead to physical dependence on alcohol. Side effects of alcohol dependence include withdrawal symptoms, which can include anxiety. So, in effect, alcohol can actually intensify anxiety and symptoms of a specific phobia, making them worse than they were before.

The journal Psychiatric Times publishes that individuals battling a specific phobia have a high rate of also struggling with alcohol dependence at the same time. Around one-third of those who struggle with an anxiety disorder also battle alcohol dependence, the Harvard Review of Psychiatry reports. Phobias and alcohol abuse regularly co-occur and serve to intensify the possible side effects of each other.

Treatment Considerations for Co-Occurring Phobias and Alcohol Abuse

Alcohol may seem to help a person to relax and calm down; therefore, drinking can be very desirable for someone struggling with a phobia. Alcohol only serves as an avoidance tactic, however, and does not actually address the root of the anxiety or help to manage the symptoms and side effects of the phobia.

Alcohol abuse can also lead to more problems, including financial strain, health issues, interpersonal relationship troubles, and difficulties fulfilling life obligations, potentially causing unemployment and homelessness. Continued alcohol abuse can also lead to addiction and increased emotional strain.

The National Survey on Drug Use and Health (NSDUH) reports that, in 2016, around 15 million adults in the United States struggled with alcohol addiction. Around 8 million American adults battled co-occurring mental illness and a substance use disorder as well. A person who struggles with both alcohol addiction and a mental disorder at the same time will benefit most from integrated co-occurring disorders treatment that is comprehensive, helping to manage both the alcohol abuse and the anxiety at the same time.

Phobias are generally treated with therapies and sometimes with medications. Cognitive Behavioral Therapy, or CBT, is a common method used to treat phobias, as it helps a person to better understand which thoughts may be negative and self-destructive, and how these thoughts then interact with subsequent behaviors. By recognizing maladaptive thought patterns, a person can learn how to make positive changes in their behaviors.

Phobias are usually triggered by specific things, places, or situations, and CBT can help individuals to work through stressors in a safe environment. CBT is also helpful for the treatment of substance abuse and addiction, and it can help individuals learn tools to manage stress and work through difficult emotions without needing to use alcohol to self-medicate.

Another form of therapy, exposure therapy, is often beneficial for treating phobias as well. With exposure therapy, a trained professional will slowly and safely help a person to face their phobia, in a controlled environment, in order to learn how to manage their fear and anxiety. Exposure therapy is usually progressive, meaning that the exposure to the fear-inducing situation or thing is slowly introduced, perhaps just by talking about it at first, then by looking at pictures, and then slowly and carefully facing actual exposure to it. Along the way, clients are taught how to recognize their specific emotional and physical reactions, and learn tactics for controlling them.

Holistic methods are also useful for both the treatment of phobias and alcohol abuse. For example, meditation, yoga, and breathing techniques can help a person to calm their anxiety and thus minimize stress naturally. By being more in tune with oneself physically, a person can learn to recognize bodily reactions and get a handle on the anxiety before it gets overwhelming. Relaxation techniques and physical exercise can help to manage anxiety and also serve as tools for minimizing relapse.

Anti-anxiety medications may help a person struggling with a phobia, and medications may also serve to manage alcohol withdrawal symptoms and cravings. Individuals struggling with co-occurring alcohol abuse and a mental disorder may face special considerations when it comes to medications. This is one of the reasons that it is important for all treatment providers to work together to manage both disorders simultaneously.