Fear is a natural response to a real danger to yourself or someone else. A specific phobia, on the other hand, is an extreme fear of an object or situation that has little or no basis in reality.
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While a phobia might be triggered by a real experience — such as a spider bite, an airline disaster, or an elevator accident — the fear eventually becomes disproportionate to reality. The distress associated with a phobia is so great that it can interfere with all aspects of a person’s life, including relationships, jobs, or social activities.

Specific phobias often go hand in hand with other disorders, such as generalized anxiety, obsessive-compulsive disorder, depression, or post-traumatic stress disorder. They are also frequently associated with substance abuse. Drugs and alcohol may be used to soothe the intense reactions or a phobia, or to calm the obsessive dread about encountering the object of fear. Alternatively, substance abuse may make the individual more vulnerable to phobias and other anxiety disorders by altering the brain chemicals that regulate moods and emotions.

Prevalence and statistics

Phobias affect a significant percentage of the US population. According to the National Institute of Mental Health:

  • Over 8.5 percent of American adults suffer from the symptoms of a specific phobia in any given year.
  • Out of this group, the largest percentage is between the ages of 45 and 59.
  • In nearly 22 percent of these cases, symptoms can be classified as severe.
  • Just over 32 percent of the Americans with specific phobia are receiving treatment for the disorder.
  • On average, Americans experience the symptoms of phobia for the first time at the age of 7.

While some people may experience only mildly phobic symptoms when they encounter the object of their fear, over 20 percent have reactions so intense that they may verge on a panic attack. The symptoms include sweating, dizziness, fainting, chest tightness, choking sensations, tremors, nausea, and overwhelming feelings of dread.

The word “phobia” comes from a Greek word that means “fear” or “aversion.” Numerous phobias have been identified, ranging from intense fears of familiar situations, like acrophobia (fear of heights), to a dread of common creatures, such as ophidiophobia (fear of snakes). WebMD divides these phobias into several broad categories:

  • Fear of animals, birds, or insects, such as spiders (arachnophobia)
  • Fear of specific situations, such as being in water (aquaphobia), being in public places (agoraphobia), or being trapped in an enclosed space (claustrophobia)
  • Fear of natural phenomenon, such as thunder and lightning (astraphobia)
  • Fear of blood (hematophobia) or injuries
  • Fear of other things, such as vomiting, choking, dirt and germs (mysophobia), or clowns (coulrophobia) 

Out of the dozens of phobias that have been identified, there are a few that predominate in our culture. According to Current Opinion in Psychiatry, the most common phobias involve animals, closed spaces, high places, being alone, or being injured. But just because these fears occur the most frequently doesn’t mean that they are necessarily more debilitating than the more exotic phobias.

How can you tell whether someone in your life has a phobia, or whether they are just suffering from excessive worry or fear? Unlike most anxiety disorders, which can be triggered by a variety of things, phobias are isolated to very specific situations. In order to meet the diagnostic criteria for a phobia, the individual must display the following:

  • An extreme, irrational fear triggered by an encounter with a specific situation or object, or by thoughts of encountering that object
  • Physical symptoms of anxiety — shortness of breath, rapid heart rate, dizziness, sweating, or tremors — in the presence of the source of fear
  • Deliberate avoidance of the object or situation, to the point of limiting one’s own activities
  • An inability to control one’s response to the subject of fear, in spite of being aware that the fear is irrational

People with specific phobias usually understand that their reactions are exaggerated and out of proportion to reality. However, they are unable to rationalize their fear or to reassure themselves when they are faced with the subject of their phobia.

To qualify as a phobia from a clinical standpoint, the fear must not be attributable to another disorder, such as obsessive-compulsive disorder, social anxiety, or PTSD. Physical symptoms like dizziness, sweating, or chest pain must not be related to a medical condition such as high blood pressure, diabetes, or lung disease.

Like other anxiety disorders, specific phobias often co-occur with substance abuse. Alcohol and drugs may be used to take the edge off the individual’s persistent fears, or to help him or her cope with the depression caused by self-isolation. Substance abuse can also mask the presence of a phobia — and vice versa. Neuropsychological evaluation is often required to distinguish between the symptoms of an anxiety disorder and the side effects of drug or alcohol abuse.

Social phobia, also known as social anxiety disorder, is one of the most common phobic disorders in the US, affecting up to 5 percent of the population, according to the Journal of Clinical Psychiatry. The National Institute on Alcohol Abuse and Alcoholism estimates that as many as one-fifth of the individuals who suffer from social phobia also have an alcohol use disorder. As a sedative, alcohol can help relieve the stress associated with appearing in public and socializing with other people. After a few drinks, a person with social phobia may feel less self-conscious and more willing to interact with others.

However, repeated use of alcohol or drugs can intensify the symptoms of a phobic disorder by disrupting the user’s brain chemistry. In addition, a reliance on drugs to manage anxiety symptoms can quickly lead to addiction, which can have devastating effects on the individual’s physical and psychological health 

For someone with a phobia, the fear of the specific object or situation can cause painful social isolation, occupational impairment, and difficulty maintaining relationships.

Treating phobias and addiction

When addiction co-occurs with a specific phobia, both conditions must be treated at the same time for the individual to receive any lasting benefits. If the substance use disorder is treated separately, and the phobia is never addressed, the patient is likely to return to drug or alcohol abuse when the psychiatric symptoms flare up again.

Several therapeutic strategies have proven successful at treating specific phobias. These therapies can be integrated into a comprehensive rehab program for co-occurring disorders, so that substance abuse can be addressed along with the anxiety disorder:

  • Cognitive behavioral therapy (CBT). Originally developed for the treatment of depression, CBT has been applied to the treatment of anxiety disorders and substance use disorders. This therapeutic approach aims to change the repetitive thought patterns that lead to self-defeating behaviors and distorted perceptions of the world. A person with a specific phobia, for instance, might learn to replace persistent worries about a situation or object with positive, reassuring self-talk. Phrases such as “I can handle this situation,” “I’m stronger than that spider,” or “I’m so much better than I used to be,” may help avert a phobic reaction. In substance abuse treatment, CBT is used to help the patient overcome the self-destructive thoughts and perceptions that lead to addictive behavior.
  • Exposure therapy. In exposure therapy, the patient is gradually exposed to the object of fear in a controlled environment. The ultimate goal is to introduce the patient to the subject of the phobia in a real-world setting. A person who is afraid of enclosed spaces (claustrophobia), for example, might set a goal of riding alone in an elevator without panicking. Exposure therapy must be performed at an appropriate pace to avoid overwhelming the patient. But according to the University of Pennsylvania’s Department of Psychiatry, exposure therapy is often so effective that it may begin to work in as few as one or two sessions.
  • Psychiatric medication. Antidepressants in the SSRI (selective serotonin reuptake inhibitor) category have been used to treat specific phobias and other anxiety disorders. These medications are well tolerated by many patients and can help to relieve depressive symptoms as well as anxiety. Drugs in the benzodiazepine family, such as alprazolam (Xanax) and lorazepam (Ativan) may be prescribed on a short-term, as-needed basis for individuals whose anxiety attacks are limited to very specific situations. However, because benzodiazepines have a high potential for dependence and abuse, their use must be carefully controlled in patients with a history of drug addiction.
  • Relaxation techniques. Guided meditation, yoga, exercise therapy, music and art therapy, and massage are just a few of the relaxing practices that can help reduce stress and minimize anxiety symptoms in people with specific phobias. The leading rehab facilities offer these holistic therapies to their patients in order to encourage recovery on a spiritual and psychological level as well as a physical one.

The specialized treatment programs at The Recovery Village are designed with the individual patient in mind. Our staff members have the experience and expertise to treat the most complex, challenging disorders, including phobic disorders complicated by substance abuse. If you, or someone you love, are struggling with addiction and mental illness, we encourage you to call our intake specialists at any time for information and support.

Phobias and Addiction
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Phobias and Addiction was last modified: November 1st, 2016 by The Recovery Village