Both obsessive-compulsive disorder (OCD) and addiction, or a substance use disorder (SUD), are neuropsychiatric disorders that involve unwanted repetitive behaviors. Both OCD and addiction often result in negative effects on work and school or personal relationships and social activities.
In both disorders, the person tries to escape from unwanted emotional and physical distress by taking part in behaviors that eventually become unwanted and time-consuming. For OCD, it involves rituals. For a SUD, it involves the repeated use of a substance. In both cases, the relief is satisfying but temporary. The unwanted symptoms eventually return.
Since substances like alcohol and drugs are often used to try to subdue thoughts and feelings, people with OCD are at a higher risk for developing SUDs. And even though drug and alcohol use may hide OCD symptoms at first, using substances can make symptoms worse, interfere with treatment, and disrupt supportive relationships in the long run.
Why Is There a Link Between OCD and Addiction?
There are several theories about why addiction is more common in people with mental health conditions such as OCD. It may be the result of several factors such as:
- Self-medication: Some people use substances or behaviors to cope with their symptoms because they might give them temporary relief. Since OCD is an under-reported condition, it could be that some people with OCD self-medicate because they aren’t getting the support they need.
- Overlapping risk factors: Mental health and addiction risk factors are similar. They include:
- early stress and trauma
- changes in brain structure or chemistry
- genetic changes that can make some people more susceptible to both
- Substance side effects: Certain addictive substances can cause mental health symptoms or make them worse, either during use or when the substance wears off.
- Relationship between impulsiveness and compulsiveness: There are more specific theories that explain the link. One is that there may be a relationship between compulsiveness and impulsiveness. Impulsivity means that a person is less able to regulate his or her behavior and may “act” on impulse and follow spontaneous urges to try substances or behaviors that may become addictive. The authors of the study theorized that people with more severe OCD may have higher levels of impulsivity. This may explain why addiction rates are higher in this group.
Although the OCD symptoms of people who develop substance use disorders are comparable to people with OCD who don’t, research has shown that people who develop SUDs often:
- less educated
- have other types of mental illness as well as OCD
- had symptoms that started at an early age
Most people report that their OCD symptoms started well before they developed a SUD. It’s important to remember that people with OCD who go on to develop SUDs have a higher risk for suicide and hospitalization.
What is OCD?
OCD is a very disruptive disease that can take over a person’s life and prevent them from taking part in many of the most enjoyable parts of life. It’s an anxiety disorder, and a person with OCD has unreasonable fears and anxiety because of repeated thoughts. OCD features a pattern of unwanted thoughts and fears (obsessions) that cause the person to do repetitive behaviors (compulsions).
A person with OCD may try to ignore or stop their obsessions, but that just increases their discomfort and anxiety. After a while, they feel driven to perform compulsive acts to try to ease the stress. Performing these rituals gives them temporary relief, but the anxiety always returns. Despite the attempts that people with OCD have to get rid of bothersome thoughts or urges, they keep coming back. This then leads to more ritualistic behavior, and that’s the vicious cycle of OCD.
Some OCD Details:
- According to the Wexner Medical Center at Ohio State University, OCD affects around 2.2 million males and females in the U.S.
- OCD tends to have a hereditary feature since it affects family members more often.
- People with OCD may realize that their fears are irrational. Still, they can’t restrain their need to perform compulsive rituals to relieve their anxieties.
- Checking windows, hand washing, and cleaning their living room are just some of the ritualized habits that can take up so much time that they conflict with other daily activities.
The rituals and fears associated with obsessive-compulsive disorder are different from person to person. However, there are some trends and similarities. Some of the most common concerns among people with OCD are:
- The fear of getting sick from a bacteria or a virus
- An obsession with certain numbers that are considered “good” or “poor”
- Preferring religious subjects
- Fear of losing a family member from an illness or injury
- Photos of sexual acts that are intrusive
- Intrusive thoughts about hurting someone or yourself
Washing, grooming, counting, and organizing rituals are some of the most common activities seen in people with OCD. Such individuals with OCD are afraid that if they don’t follow their rituals, they or someone close to them will be hurt. Other people may be concerned that if they don’t perform certain rituals, they will hurt someone else.
Symptoms of OCD
Usually, obsessive-compulsive disorder includes both obsessions and compulsions. However, it’s also possible to have only obsession symptoms or only compulsion symptoms. Individuals may or may not realize that their obsessions and compulsions are excessive or unreasonable, but they do know that they take up a lot of time and intrude on their daily life.
Obsessions are repeated, persistent and unwanted thoughts, urges, or images that are intrusive and cause stress or anxiety. Individuals try to ignore them or get rid of them by performing a compulsive behavior or ritual. Obsessions often intrude when the person is trying to think of or do other things. Obsessions frequently have themes.
Typical Obsession Themes include:
- Fear of dirt or contamination
- Feeling doubt and having a hard time tolerating uncertainty
- Needing things to be symmetrical and orderly
- Aggressive or horrifying thoughts about losing self-control and harming themself or others
- Unwanted thoughts including:
- sexual subjects
- religious issues
Obsession Signs and Symptoms Include:
- Fear of becoming contaminated by touching objects that have been touched by others
- Doubts that the door has been locked or the stove is turned off
- Severe stress when objects aren’t orderly or facing a particular way
- Thoughts about shouting obscenities or other inappropriate acts in public
- Unpleasant sexual images
- Avoiding situations that can trigger obsessions, like shaking hands
Compulsions are the repetitive behaviors that they feel compelled to perform. They’re meant to reduce anxiety and prevent something bad from happening. People might make up rituals to follow that help control their anxiety when having obsessive thoughts. Compulsions are excessive and usually aren’t realistically related to the problem that they’re supposed to solve. Compulsions also typically have themes.
Compulsion Themes include:
- Washing and cleaning
- Keeping to a strict routine
- Demanding reassurance
Compulsion Signs and Symptoms include:
- Washing hands until skin becomes raw
- Repeatedly checking doors to make sure they’re locked
- Repeatedly checking the stove to make sure it’s turned off
- Counting in certain patterns
- Silently repeating a word, phrase, or prayer
- Arranging canned goods to face in the same direction
OCD usually starts during the teen or young adult years, but it may start in childhood. Symptoms usually start gradually and vary in severity throughout life. Even the types of obsessions and compulsions that are experienced can change over time. Generally, symptoms get worse when the person is under greater stress. OCD is usually considered a lifelong disorder and can have mild to moderate symptoms or become so severe and time-consuming that it becomes disabling.
Treating OCD Symptoms
Many people with OCD turn to substances as a method of self-medication either to directly reduce the severity or to decrease the distress linked with the consequences of living with OCD including problems and difficulties at work or with relationships. In essence, substance use can be considered a coping strategy, even if it is a poor strategy, that allows the person to avoid the problem.
For an individual struggling with SUD, treatment needs to focus on substituting substance use with more adaptive coping strategies. These strategies will help the person become more comfortable dealing directly with symptoms and their related difficulties. Although this can cause even higher levels of anxiety at first, the long-term result is developing better methods for dealing with OCD symptoms.
Managing OCD and substance abuse as a co-occurring condition has many problems. But it also can provide a lot of benefits that can change a person’s life. But still, entering a treatment facility can be intimidating due to being in an unknown setting that is out of their control.
OCD can make it hard to concentrate in individual counseling or group counseling sessions because of the intrusive thoughts and time-consuming routines. The symptoms and needs of OCD can be integrated into a specialized dual diagnosis recovery program. A specialized program enables these individuals to complete their therapy programming.
According to the University of Michigan Depression Center, medication and behavioral therapy are the most common methods used to treat OCD and other anxiety disorders. Cognitive Behavioral Therapy (CBT) is one type of therapy that teaches the person how to identify and change harmful thoughts and habits.
Therapy sessions for OCD allow the person to be exposed to the object of fear without performing any anxiety-reduction rituals. The goal is to get rid of the unreasonable fear that accompanies specific situations or objects.
Certain antidepressant medications may be used in the treatment of OCD. Studies that have looked at OCD and SUD separately consistently indicate that adding medication to behavioral treatment is an effective choice that improves outcomes.
Treatment for these Co-Occurring Disorders
Historically, the method for treating OCD and a co-occurring SUD has been that the individual enters treatment for one disorder (whichever is most severe), then the symptoms of the other disorder interfere which results in the end of treatment. Often, the person bounces back and forth between unsuccessful attempts to treat each disorder separately. This becomes a huge obstacle for long-term recovery from either disorder.
Treating both disorders at the same time borrows the best of treatment from both worlds and combines them. This is what we do at Casco Bay Recovery. If you or a loved one is suffering from OCD and addiction, we have a specialized dual diagnosis treatment program that can be tailored to your needs. We can provide several levels of care and additional special programs for men, women, and young adults.
At Casco Bay, we understand that everyone is unique, and yet, we all have things in common. This is how we know that we can design a program specifically for you. Don’t let a treatable mental disorder propel you into a dangerous addiction. Contact us today.