Obsessive Compulsive Disorder and Substance Abuse

When it comes to drug addiction, the incidence of co-occurring conditions – mental or physical disorders that are present alongside the substance use disorder – is quite common. Many people who abuse or are addicted to a substance also experience depression, anxiety, or other mental health conditions. When this is the case, treatment requires special consideration to address each disorder that is present.

Obsessive-compulsive disorder, or OCD, is one of the conditions that can occur alongside, and even have an effect on, addiction. In order for treatment to provide the best chance of recovery from both conditions, it is important to understand what OCD and drug addiction are, how they affect one another, and how to manage them together.

What Is OCD?

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that affects 3.3 million Americans.1 The disorder causes the sufferer to feel an overwhelming lack of control in their life. They have obsessive thoughts of things like contamination, self harm, or aggression. These thoughts and worries cause the person to perform rituals, or compulsions, such as excessive hand washing, counting, repeating, checking, arranging, and hoarding. Our society has made light of this condition in recent years with tv shows or jokes, but to someone who really suffers from OCD, the disease makes their life like a prison.

According to the International OCD Foundation, obsessive-compulsive disorder is a mental health condition that combines the presence of obsessive thoughts in a person’s mind with compulsive behaviors responding to those thoughts.2 In order to fully understand the condition, it helps to have a better understanding of the elements involved.

Obsession

Obsessions as defined in OCD are thoughts that occur over and over again, usually involving something that causes distress for the person or that the person wants to have control over. While many people can dismiss distressing thoughts, the person with obsessive thoughts is unable to control when they arise or how often they arise. This can cause an increase in the individual’s anxiety levels and create a need to do something about those thoughts.

Obsessive thoughts are often based on anxiety or fear, and they can be symptoms of a variety of different mental health conditions. Examples of these obsessive thoughts include:

• Concern that someone will break into the person’s home
• Fear of infectious diseases
• Anxiety about a loved one’s safety
• Embarrassment or concern about the effects of a mistake the person made

While most people have thoughts like these, they are usually easily dismissed. For the person with OCD, the person is unable to stop thinking about them and develops increasing anxiety around them.

Compulsion

The other element of OCD is compulsions, or compulsive behaviors. These are behaviors that the person engages in to try to get rid of the obsessive thoughts. In the case of someone struggling with OCD, compulsions become repetitive; the person often does them over and over in the hopes of getting the obsessive thoughts to go away. In that way, the compulsive behaviors are also out of the individual’s control.

Compulsive behaviors related to the above examples might include:

• Locking the doors and windows over and over, even knowing that it has already been done
• Washing hands continually, to the point of damaging the skin
• Calling or checking in with the loved one repetitively to make sure everything is okay
• Being unable to complete a task due to the need to continually review for mistakes

Again, people without OCD sometimes exhibit these behaviors. However, when obsessions and compulsions interfere with the person’s daily life, the person may be diagnosed with OCD. As described by the American Psychiatric Association, this means that these thoughts and behaviors are taking up at least one hour of the person’s time every day.

Alcohol or Drug Addiction

As described by the National Institute on Drug Abuse, drug addiction is a type of substance abuse disorder in which the individual cannot control use of a psychoactive substance, such as heroin, benzodiazepines, or cocaine, among others.4 Specifically, addiction implies that the individual has developed physical or psychological dependence on the drug being used to function normally. It also means that the individual cannot stop using the substance, even in light of the negative effects of using the substance, such as health issues, social or relationship problems, risk-taking behaviors, or an inability to keep up with responsibilities.

Addiction develops when a person has been using a substance over a long period of time and comes to rely on the way that substance makes them feel. This can be based on actual physical changes the substance causes in the brain, or reinforcing thoughts of comfort or a sense of control or serenity that the person has when using the substance. Whether it is physical or psychological, this can result in a self-medicating response to other mental health conditions that the person is dealing with. This is where drug addiction and OCD can begin to co-occur.

Interaction between OCD and Addiction

Sometimes, substance use in addiction can be a compulsive behavior – something that the individual can’t control or stop doing. In fact, an article from the Society for the Study of Addiction demonstrates that the brain struggling with addiction displays similar behaviors to the brain that is exhibiting compulsive behaviors – that is, both addiction and compulsion have to do with an inability to control impulses or inhibitions.5 In fact, the Brain and Behavior Research Foundation goes so far to say that addiction is, in itself, a compulsive behavior.6

Even more specifically, substance abuse may be one of the compulsive behaviors initiated in response to the obsessive thoughts of OCD. Using substances like alcohol or heroin can sometimes result in clouding the obsessive thoughts or blunting the anxiety that arises from them. If this occurs, addiction can develop extremely quickly as a result.

One study reported that 12% of people in a clinical population with OCD had a lifetime history of alcoholism. In a test where 50 patients with a diagnosis of alcohol dependence or abuse were screened it was found that 6% had OCD – 3 times the lifetime prevalence of OCD in the general population.7 However, many people with OCD recognize that they have a problem, and are ashamed of it and the fact that they are using substances to feel better, therefore they are very good at keeping both the disorder and addiction a secret from others.

Because of this, drug addiction and OCD can have a negative, spiraling relationship when they occur together, which can mean special care is required in treatment.

Addressing OCD and Addiction Together

On the positive side, the similarities between OCD and addiction to drugs or alcohol mean that many therapies undertaken to treat one or the other can actually treat both. As described by Mayo Clinic, treatments for OCD include Cognitive Behavioral Therapy, which is also used in treatment for addiction.8

This type of therapy helps the person learn to recognize the situations in which symptoms of the disorder arise, enabling the individual to develop responses to those situations that help to control the compulsive behaviors. Because this works for both OCD and addiction, it is a great therapy to use in treating someone who is dealing with both conditions.

A challenge in treating the two together is that medication is often used to treat OCD; however, many of the medications used, such as benzodiazepines that help to control anxiety, are also addictive substances. If drug addiction is present in the individual struggling with OCD, using these medications can make the situation worse.

Effective Treatment for Addiction and OCD

When seeking treatment for an individual who struggles with both OCD and drug addiction, it is important to find a program or rehab center that is experienced in the risks and challenges that arise with treatment of both disorders. Research-based treatment centers that have experience in treating co-occurring disorders have access to treatment therapies that can manage both conditions, making sure that the addiction is not overlooked in the OCD treatment, and vice versa.

By seeking out a reputable, professional treatment program, the individual is much more likely to gain control over both conditions. This makes it possible to get back on track and achieve recovery, creating a daily life that is productive and hopeful for years to come.