Can Obsessive-Compulsive Disorder Increase the Risk of Alcohol Addiction?

Rachel was shocked by how quickly she descended into alcoholism, but she shouldn’t have been, as research shows that obsessive-compulsive disorder (OCD) and substance abuse frequently occur together. People who struggle with OCD are at least twice as likely to develop substance abuse problems as people who don’t struggle with OCD, and alcoholism is the most common. The relationship between substance abuse and OCD is still not well understood, but ideas about it can be grouped into two general theories.

The first is that substance abuse is a response to OCD, or, in other words, an unhealthy coping strategy. This is what is commonly referred to as “self-medicating.” Rachel was sure that her drinking was a form of self-medication: she’d attend classes buzzed because she felt like she could concentrate better if she wasn’t constantly performing rituals in her head. She felt like alcohol helped to calm her anxiety, and for the first time in her life she felt some relief from relentless anxiety and stress. With alcohol, if she felt the urge to perform a ritual, she could let it go. But the more she drank, the more classes she dropped, and the poorer she performed. Ultimately, what began as a coping strategy quickly turned into a major stumbling block.

The second theory suggests that OCD and addiction share a common cause, most likely a quirk in brain structure. That would mean people who are predisposed to obsessive compulsive disorder are also predisposed to substance abuse problems. This idea also resonated with Rachel, who believed her OCD, eating disorder, and alcoholism were all part of the same problem. In grade school and middle school, she used OCD rituals like flexing her stomach muscles while hitting them or coughing repetitively. But they unnerved her classmates, and by the time she got to high school, she had learned to channel that same anxiety into restrictive eating and excessive exercise. She was incredibly thin, and while this attracted concern and some cattiness at her all-girls school, she felt it was much more socially acceptable than repetitive coughing and hitting.

I had a complex web of rules and rituals that went with my eating disorder—it was definitely always about more than just food. Drinking complemented my eating disorder, and eventually replaced it. When I got sober, my bulimia returned. My OCD, my eating disorder, and my alcoholism were all tied together.

Whether one or both of these theories prove true, the correlation between OCD and substance abuse cannot be denied, and neither can the pain that it brings.

Overall, there’s a definite lack of research on the connection between OCD and addiction, as well as on co-occurring disorders in general. However, there are a few studies that shine light on the topic. In one major study, researchers found that, among people seeking treatment for obsessive-compulsive disorder, rates of substance abuse were higher than average. Over the course of their lifetimes, people with OCD were about twice as likely as people with no psychiatric condition to have a substance abuse problem. Interestingly, a large majority (70 percent) of participants with co-occurring OCD and substance abuse developed OCD symptoms first.

And it’s not just OCD. Many people who abuse substances also have other serious mental health challenges. In fact, SAMHSA reports that about half of individuals with a severe mental disorder experience substance abuse. It makes the need for dual diagnosis treatment all the more necessary.