OCD and Drug Addiction

Obsessive-compulsive disorder is a serious mental illness that often co-occurs with addiction or substance abuse. OCD is characterized by obsessive thoughts that are negative and persistent and by compulsive behaviors that are used to keep the thoughts at bay and to reduce stress, but that actually act as an unhealthy coping mechanism.

Addiction is dependence on drugs or alcohol, which causes use of substances to be out of control, to lead to tolerance, and to cause withdrawal symptoms. Someone with OCD may begin to abuse substances as a way to cope with the symptoms of the mental illness. This can easily lead to a substance use disorder, from mild to severe, or to actual addiction or dependence.

OCD and substance use often co-occur. It is likely that this happens because individuals with symptoms of OCD use drugs or alcohol as a way to cope and to try to suppress negative, obsessive thoughts.

• Prevalence of OCD in U.S. adults is between 1.6 and 2.3 percent.
• The prevalence of addiction in patients with OCD is hard to pinpoint but has been estimated between 10 and 40 percent.
• The prevalence is thought to be higher than what is reported because of the difficulties with diagnosis.
• The prevalence of OCD in people in treatment for substance use disorders is between 6 and 12 percent, about two to six times as high as in the general population.
• Fewer than half of people with OCD and a substance use disorder ever get treatment for OCD.
• People with both OCD and substance abuse are more impaired and are at a higher risk for suicide than those with OCD only.
• One study of hundreds of patients with OCD and substance use disorders found that 70 percent had developed OCD symptoms before substance abuse.

There are two main characteristic symptoms of OCD: obsessive thoughts and compulsive behaviors. The obsessive thoughts are negative and difficult to impossible to control. They may include things like a fear of germs or contamination, thoughts of loved ones being harmed, taboo or sexual thoughts, or fears of having forgotten to do something.

These thoughts are difficult to shake and cause a great deal of distress. They trigger obsessive behaviors that are equally difficult to control. Examples of compulsions include excessive hand washing, rearranging and ordering objects, repeatedly checking something, like a door lock, or tapping or touching objects in a certain patterns. The obsessions and compulsions vary by individual and are often related to each other, but do not have to be.

To be diagnosed with OCD a person has to have obsessions or compulsions, but most people experience both. A lot of people experience some degree of obsessive thoughts and ritualized, compulsive behaviors, but those with OCD spend a significant amount of time and energy on them. They cause a lot of distress and impairment in one or more areas of life.

Substance use disorders that may accompany OCD can worsen the symptoms of the condition, even though an individual is using in order to get relief. A person may be diagnosed with a mild, moderate, or severe substance use disorder, based on how well they meet the criteria: being unable to control use of the substance, experiencing social impairment, using substances in spite of risks and harm, and experiencing tolerance and withdrawal.

Diagnosing co-occurring disorders can be difficult because the two conditions affect each other. It is also important but often challenging to distinguish between true OCD and symptoms triggered by substance use. Because the two often occur together, it is important for patients with one of these conditions be screened for the other.

Diagnosing and managing these conditions is further complicated when an individual is high-functioning. This means they are able to manage their symptoms to the extent that they cause only mild impairment. Impairment is an important diagnostic criterion for both addiction and OCD, but it is not the only one. A person may be diagnosed in spite of high function if there are other indicators, such as compulsions taking up a lot of time or difficulty controlling substance use. High-function is not healthy and without diagnosis and treatment is likely to deteriorate and cause significant impairment.

Causes of OCD and substance use disorders cannot be exactly pinpointed, but there are likely contributing factors for both of them: family history and genetics, brain chemistry, structural abnormalities in the brain, and trauma and stress. That they have risk factors in common may help explain why OCD and addiction co-occur often.

These two conditions can also act as risk factors for each other. The symptoms of OCD are highly distressing, and it is not uncommon to use alcohol or drugs to try to cope with or minimize them. Likewise, using substances may contribute to OCD in someone who is predisposed to have obsessive thoughts or to engage in compulsive behaviors.

Withdrawal and Detox

Treating both OCD and addiction in someone diagnosed with each one is important, but often it is first necessary to go through detox. This is the time it takes for the drug or alcohol to leave the body. It triggers withdrawal symptoms, which may range from mild to severe depending on the severity of the addiction. Withdrawal has the potential to be dangerous, and even when not dangerous often leads to a relapse, so going through detox under supervision is recommended. Common symptoms experienced during withdrawal include:

• Pain and headaches.
• Abdominal discomfort, nausea, vomiting.
• Mood disturbances, including irritability, depression, anxiety, and anger.
• Confusion, disorientation, and difficulty focusing and thinking.
• Tremors and shaking.
• Excessive sweating.
• Insomnia or sleepiness.
• Appetite loss.

OCD may co-occur with any type of substance abuse. Some studies have determined that alcohol use disorder is more common in patients with OCD than drug use. Among drugs abused by people living with OCD, cannabis and cocaine are most common. Stimulants like cocaine likely exacerbate symptoms of OCD, while cannabis and alcohol may seem to soothe symptoms in the short-term.

In addition to substance use disorders, people with OCD may have other mental illnesses. Ninety percent of people diagnosed with OCD also have the criteria for at least a substance use disorder or one other mental illness. The most common mental illnesses that co-occur with OCD are depression, generalized anxiety disorder, social anxiety, specific phobias, panic disorder, and post-traumatic stress disorder.

Treatment of any co-occurring disorders, like OCD and substance use disorders, should include comprehensive care for all conditions. Research clearly shows that there are better outcomes when each condition is treated as a primary condition and when all are treated at the same time. In one study that specifically looked at patients with OCD and a substance use disorder, those who were given treatment for both issues at the same time stayed longer in treatment, had lower relapse rates, and had fewer and less severe OCD symptoms as compared to those who were only treated for substance abuse.

The strategies for treating OCD and substance use may be separate, but they also overlap. Both conditions can benefit from therapy and counseling, including behavioral therapies, family and relational therapies, trauma-focused therapies, and group therapy and support. Medications may also be a part of treatment. Patients with OCD may benefit from antidepressants, while depending on the substance of abuse, medication-assisted treatment may help manage addiction and prevent relapse.

One particular type of therapy that is often used to treat OCD with significant effectiveness is exposure and response prevention, or ERP. Based on cognitive behavioral therapy, ERP uses exposure to a patient’s fears or obsessive thoughts to help them learn to manage and cope with them in healthy ways. This may also help with substance abuse if the patient typically uses drugs or alcohol as a coping strategy.

When a patient with co-occurring OCD and addiction is accurately diagnosed with both and with potentially other conditions, it is possible to successfully treat and manage them. With quality inpatient drug rehab for both conditions at the same time and a treatment plan that is tailored for an individual’s needs, the prognosis is good. Most patients who are committed to ongoing, and in fact lifelong, treatment are able to learn to successfully manage symptoms and avoid or minimize relapses.