Obsessive-compulsive disorder (OCD) is one of the most common mental illnesses, estimated to affect 1 in 40 adults in the United States. Like several anxiety and mood disorders, people with OCD have a higher risk than the general population of developing substance abuse problems.
Substance abuse commonly leads to addiction, which can make it hard for a person to quit their drug or alcohol use. Struggling with OCD can make this even more complicated, as substance abuse often begins as a means of easing OCD symptoms.
Treating co-occurring OCD and addiction is most effective when both issues are treated together, rather than separately. This is referred to as integrated or dual-diagnosis treatment. The first step for many people seeking help for OCD and addiction is to enter an inpatient treatment program.
What Is Obsessive Compulsive Disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a mental disorder characterized by symptoms of obsessions, compulsions, or both.
In this context, obsessions are reoccurring, intrusive thoughts that can feel uncontrollable and may be irrational. Compulsions are behaviors that people feel compelled to act on to reduce anxiety, or because they believe something bad will happen if they do not.
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In some instances, obsessions and compulsions may be referred to as ‘fears’ and ‘rituals.’
Obsessive thoughts and compulsions can manifest and affect people in different ways. The typical onset of OCD occurs before age 19, but symptoms can also emerge in mid-to-late adulthood.
Common obsession symptoms in people with OCD include:
- fear of germs
- needing to have things organized in a certain order
- obsessive about cleanliness
- need for symmetry
- aggressive thoughts towards themselves or others
- believing that specific numbers are “good” or “bad”
- uncontrollable thoughts/images of sexual acts
- excessive hand-washing or cleaning
- compulsive counting
- repeatedly double-checking things (e.g. if a door is locked, stove or light switches turned off)
- excessive praying
- hoarding trash or useless items
- motor/verbal tics (e.g. excessive blinking, throat-clearing, or jerky body movements)
These obsessive and compulsive symptoms can take up hours of a person’s day, resulting in severe negative impact on their personal and professional lives. This can affect a person’s ability to work, attend school, take care of family members, and more.
It is also common for people to feel embarrassed about their symptoms. This can result in people isolating from others, leading to feelings of loneliness, depression, and hopelessness.
What Is The Link Between OCD And Substance Abuse?
Living day-to-day with OCD symptoms can be exhausting, and make a person feel a lack of control over their thoughts and behaviors. This can increase the risk of turning to substances like drugs or alcohol in order to relieve and distract from symptoms.
The most common substances of abuse among people with OCD are those with relaxing effects that can slow their obsessive thoughts. Alcohol and marijuana are two common examples.
However, these substances can also have effects that are similar to symptoms of OCD. OCD and alcohol abuse, for instance, can both cause symptoms of anxiety, restlessness, paranoia, and insomnia. This is the same with many drugs.
In this way, symptoms of both OCD and substance use disorders (SUDs) can feed into each other, creating a dangerous and ongoing cycle of obsessions and compulsions. Over time, this can become difficult to manage and cause harm to both physical and mental wellbeing.
What Are The Dangers Of Untreated OCD And Substance Abuse?
Many mental disorders, including OCD, are stigmatized. This can make it difficult for people to identify when they have a problem, or complicate their decision to seek help. Without treatment, OCD symptoms can become even more debilitating, especially when combined with substance abuse.
Self-medicating with drugs or alcohol can feel helpful at first to relieve severe OCD symptoms. With time, however, drugs and alcohol can make symptoms even worse. They can also have negative effects on mood, damage vital organs in the body, and pose other consequences.
Other dangers of untreated OCD and substance abuse:
- Overdose: Both substance abuse and OCD can make a person feel less in control of their thoughts and actions. This can lead to unsafe and risky decisions. People that are self-medicating with drugs or alcohol to relieve OCD symptoms can be at greater risk for taking excessive doses. Having too much alcohol or drugs in your system can lead to overdose, which in severe cases can be fatal.
- Dependence And Addiction: Chronic abuse of drugs and alcohol can lead to dependence. This is when the body adapts to the presence of a substance in your system. It can also lead to a psychological addiction. Dependence and addiction can make it difficult for a person to stop using a substance, and cause mild to severe withdrawal symptoms.
- Severe Withdrawal: Drug and alcohol withdrawal can cause significant mental stress, similar in nature to symptoms of OCD. This includes symptoms of severe anxiety, restlessness, and paranoia. In severe cases, and with certain drugs, withdrawal can be dangerous without medical support. The most effective method for detoxing from drug and alcohol dependence is medically assisted detox.
Treatment Options For OCD And Addiction
The most effective option for treating co-occurring OCD and addiction is dual-diagnosis treatment. This treats both disorders at the same time rather than treating each disorder as a separate issue.
Treating substance abuse without addressing co-occurring OCD can increase a person’s risk for relapse. People are also more likely to stop treatment sooner than recommended.
Treatment for OCD and addiction typically begins with inpatient treatment. This is the safest setting for people to detox from drugs and alcohol, offering 24-hour supervision.
Following detox, patients may participate in more intensive treatment for their OCD and substance use disorder as part of a dual-diagnosis treatment program. This usually includes a combination of behavioral therapy and antidepressants (SSRIs).
Cognitive Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is a common form of therapy for treating mental health and substance use disorders. This involves identifying how thoughts can impact emotions and behaviors.
People undergoing CBT for substance abuse and OCD are guided on how to cope with their thoughts and emotions in healthier ways. This involves learning to manage obsessions and compulsions, and avoid turning to drugs or alcohol for symptom relief.
Medication-Assisted Therapy (MAT)
In addition to therapy, medications with low abuse potential can also be helpful in treating OCD and substance abuse. The most common medications for treating OCD symptoms are antidepressants. These are prescribed on an individual basis depending on the needs of each patient.
Recovery from addiction and the management of OCD symptoms is a lifelong process that begins with reaching out for help. From there, you can develop a treatment plan with specialists to find treatment options that suit your needs.
- National Institute of Mental Health — Obsessive-Compulsive Disorder
- U.S. National Library of Medicine: PubMedCentral — Anxiety Disorders with Comorbid Substance Use Disorders: Diagnostic and Treatment Considerations