Obsessive-Compulsive Disorder (OCD) and Substance Abuse

When someone struggles with OCD and a co-occurring addiction, recovery can seem impossible. Fortunately, effective treatment options are available.

Obsessive-compulsive disorder (OCD) can put people at a greater risk for developing a substance use disorder, also known as addiction. Research shows that around one-quarter of patients seeking care for OCD meet lifetime criteria for an alcohol use disorder, while 18% meet lifetime criteria for a drug use disorder.

In particular, alcohol addiction and anxiety disorders like OCD can influence one another. Further, the presence of either disorder increases a person’s vulnerability to the other. 

People with OCD and a co-occurring addiction often have a greater level of impairment in day-to-day functioning than those who only have OCD. Additionally, people with both disorders are more at risk for suicide than those who only have one of these disorders. For these reasons, both conditions must be treated for a person to recover effectively.

The Connection Between OCD and Drug Addiction

For many people, OCD begins before an addiction. OCD and other anxiety disorders can start in childhood or the early teen years, while most drug or alcohol addictions begin later. Research shows this likely occurs because people with OCD often use substances as a way to self-medicate.

Self-medication can begin as a way to either manage the severity of compulsions and thoughts or to handle the distress OCD can cause in a person’s life. It’s a coping strategy that may help reduce symptoms and distress early on. As OCD and substance use continues to escalate, however, the coping strategy starts to fail.

Many people escalate their drug or alcohol use in an attempt to handle increasing obsessions and compulsions, leading to substance abuse issues. Using substances while receiving OCD treatment can mask anxiety, which interferes with some treatment approaches.

Treating Addiction With Obsessive-Compulsive Disorder

When OCD and addiction occur together, it’s important to treat both conditions simultaneously. Failing to treat both conditions at the same time can hinder a person’s recovery from either condition. 

Assessment, treatment and recovery are more complicated when OCD and addiction co-occur. It is important to help clients understand how their co-occurring disorders affect one another and how they can be treated. 

Both disorders deal with compulsive behaviors, but there are distinct differences in these behaviors. With addiction, a person initially uses a substance to feel pleasure or help cope with their OCD. This substance use can lead to addiction, which is characterized by a compulsive need to use drugs or alcohol despite negative consequences. With OCD, a person engages in compulsive behaviors to help handle the distress of their thoughts; often, they believe these behaviors will protect them from some catastrophe.

The severity of both disorders should be part of a client’s initial assessment. Often, one disorder may be more severe or impairing than the other, which may impact the timing and nature of the treatment.

Medication may be needed during the early part of treatment, as detox can heighten feelings of anxiety. Several medications have been effective in treating both disorders, although SSRIs may take longer to take effect in a person with OCD. Medications for OCD include:

• Clomipramine, a tricyclic antidepressant
• Selective serotonin reuptake inhibitors (SSRIs) such as:
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline

Psychotherapy is crucial for OCD and addiction. Cognitive behavioral therapy (CBT) is extremely effective with both disorders. Exposure and ritual prevention (ERP) therapy is a type of CBT that is quite effective with anxiety disorders like OCD. It involves carefully exposing the client to the feared situation while preventing them from engaging in their preferred compulsive behavior.

For both disorders, it is important to gradually transition the focus of treatment to wellness and recovery. CBT is a hallmark of this focus and helps clients implement positive changes and coping mechanisms to replace their failing coping strategies.

CBT can be used to help a client:

• Improve physical health through exercise, healthy eating and sleep habits
• Create and maintain relationships and support systems
• Engage in healthy and satisfying activities and hobbies
• Expand their sense of purpose and meaning within their community
• Develop relapse prevention strategies

More and more treatment centers are also including mindfulness-based interventions as part of their treatment plans for co-occurring disorders. Mindfulness interventions like yoga and meditation can successfully calm anxiety and help reduce and end substance use. 

What Is Obsessive-Compulsive Disorder?

OCD is a mental health disorder that causes a person to experience recurring and unwanted thoughts, ideas or sensations. These thoughts or obsessions make them feel driven to do something repetitively. Examples of repetitive behaviors include handwashing or repeatedly checking to make sure a stove, appliance or light fixture is off. These repetitive behaviors begin to take up more and more of a person’s time and energy, interfering with their daily life.

OCD is complex, and its direct causes are currently unknown. However, risk factors for OCD can include:

• Genetics: OCD risks are higher for a person with a first-degree relative who has OCD, especially if that relative was diagnosed with OCD during their childhood or teen years.
• Brain structure and Functioning: Studies show there are some differences in the brain scans of OCD patients compared to the general population. This is not clearly understood, however, and more research is needed.
• Environment: Childhood trauma may be associated with later development of OCD, but this also requires further research.

Clinically, there are no official subtypes of OCD. Still, compulsive behaviors can be categorized into subtypes according to the type of behavior involved.

What are Some Common OCD Subtypes?

Contamination Obsessions With Washing/Cleaning

Compulsive hand-washing or cleaning is usually associated with obsessive thoughts of contamination. If you fear germs, you might wash your hands every time you come into contact with something that could have germs on it.

Harm Obsessions With Checking

People with this subtype are concerned about the danger that might be present if the stove is left on, for example. To reduce the stress of the concern, a person may continually check the stove to make sure that it has been turned off.

Obsessions Without Visible

A person with this subtype may experience intrusive obsessions of a sexual, religious or aggressive nature. They may experience intrusive thoughts about their sinful behaviors and pray continually to calm the obsession.

Symmetry Obsessions With Ordering, Arranging and Counting

People with this subtype tend to continually count or rearrange objects to ward off a potential threat of danger. For example, a person might arrange objects on a desk until they feel that they are in just the right order.

Hoarding

Hoarding is now a recognized separate diagnosis in the DSM-5. It involves collecting items to the point where a person’s living space is so cluttered with objects that it becomes unlivable. People who hoard often suffer from greater levels of anxiety and depression.

Other FAQs

How does OCD cause drug abuse?

OCD often occurs before a person begins using substances. Substances like alcohol are often used by people with OCD to calm obsessive thoughts. Over time, however, substances become less effective at blocking obsessive thoughts. A person may begin using drugs or alcohol more and more in an attempt to feel the effects they did before.

Is substance abuse a symptom of OCD?

No, although the two are often related.

Are people with OCD more susceptible to addiction?

They can be, yes. Both disorders are grounded in compulsive behaviors.

Are medications for treating OCD addictive?

The most common medications for OCD are antidepressants, which are not considered to be addictive.

OCD Symptoms

OCD was once listed as a type of anxiety disorder, but it now has its own category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The disorder is grounded in the presence of obsessions, compulsions or both. It is described as a condition in which a person experiences recurrent, intrusive and persistent thoughts, urges or images that cause anxiety or distress.

A person with OCD will try to ignore or suppress these thoughts, urges and images. They may also try to neutralize them with thoughts or actions that involve repetitive compulsive behaviors (handwashing, praying, counting). The person feels driven to perform these behaviors in response to an obsession.

These ritualized behaviors are meant to reduce or prevent distress or fear, or to prevent a feared event from occurring. However, the behaviors are usually excessive and not connected to the feared event in any realistic way.

The person knows that their thoughts and fears are irrational, but they are unable to control them. The obsessions, compulsions and behaviors are time-consuming for the person and often cause significant distress or impairment in daily life.

In general, OCD symptoms and examples may include:

• Obsessive and intrusive thoughts: Believing that the presence of germs will kill you
• Compulsive behaviors: Washing all visible surfaces repeatedly

Effects of Substance Use on OCD Symptoms

Taking certain substances, such as cocaine or methamphetamine, may worsen OCD symptoms. Others, such as opioids, may potentially alleviate OCD symptoms. Talk to your doctor before using any substance or medication to treat OCD.

Alcohol use can initially appear to calm the intrusive thought patterns in OCD. However, both alcohol use and OCD are grounded in compulsivity, and using alcohol when you have OCD increases compulsivity rather than reducing it. This can also increase other OCD symptoms.

Some evidence suggests that marijuana may help calm intrusive thoughts in people with OCD. It may positively affect serotonin levels in OCD patients as well, but more research is necessary.

There is some anecdotal evidence that using stimulants can make OCD symptoms worse. However, conflicting evidence exists showing that treating ADHD with stimulants also improves co-occurring OCD symptoms. Further research is needed.

Certain opioids may help OCD symptoms in some individuals. However, opioids are highly addictive, and care needs to be taken when prescribing these drugs to someone with OCD and a co-occurring addiction.

Helping Someone With OCD and Drug Addiction

The presence of both OCD and addiction creates particular challenges in treatment, but care that treats both disorders can help improve recovery outcomes. In the New Jersey area, you can find effective treatment for OCD and co-occurring substance use disorders at The Recovery Village Cherry Hill at Cooper.

Our professional rehab center provides both inpatient and outpatient services for addiction and a variety of mental health disorders. Contact us today to learn more about co-occurring disorders treatment programs that can work well for your situation.