- What is Obsessive-Compulsive Disorder (OCD)?
- Co-Occurring Conditions with OCD
- Signs of Obsessive-Compulsive Disorder
- Underlying Risk Factors
- Why Do People with OCD Abuse Substances?
- How Does Substance Abuse Affect Obsessive-Compulsive Disorder?
- Signs of Substance Abuse Disorder/Addiction
- OCD & Substance Abuse Stats
- Obsessive-Compulsive Disorder & Substance Abuse Treatment Options
- Key Therapies
- Key Sources
- Medical Disclaimer
Obsessive-compulsive disorder (OCD) is a well-known mental health condition. Frequently depicted in movies and on television, individuals with OCD are often portrayed as funny, quirky, or even somewhat fascinating. However, while the symptoms may seem lighthearted to others, the truth is that for individuals living with OCD, daily life can be isolating and full of anxiety.
Like most mental health conditions, OCD exists on a spectrum. Some people have milder symptoms and can cope easily with everyday life, whereas others with more intense symptoms can even find regular tasks to be challenging.
According to the National Institute of Mental Health, OCD affects roughly 1.2% of the U.S. population (roughly 1 in 40 adults, and 1 in 100 children). Of those, 25% are also said to struggle with substance abuse and/or addiction.
Due to the persistent thoughts and behaviors that accompany OCD, it is no surprise that many individuals turn to substances to cope. Also, many people with OCD have other co-occurring mental health conditions which make the situation more complex.
What is Obsessive-Compulsive Disorder (OCD)?
Obsessive-compulsive disorder (OCD) is a chronic mental health condition that is characterized by uncontrollable and recurring thoughts (known as obsessions) and/or behaviors (known as compulsions).
Also classed as an anxiety disorder, people with OCD engage in repetitive thoughts and behaviors that are fear-based and difficult to control. These can range from anxieties about the well-being of oneself and others, to a persistent need for order and repetition, to intrusive or disturbing thoughts about death or religion.
OCD typically begins in adolescence and often appears earlier in boys than in girls. However, due to its similarities to other mental health conditions, OCD can be difficult to diagnose, especially because people with this condition often have multiple co-occurring disorders.
According to the National Institute of Mental Health, diagnoses of OCD are based on the following characteristics:
- An inability to control thoughts or behaviors, even when the person realizes they are excessive.
- Spending at least 1 hour per day on uncontrollable thoughts or behaviors.
- Receiving no pleasure or satisfaction from performing the behaviors or rituals (although a brief reprieve may be felt, due to the anxiety caused by the thoughts).
- Experiencing significant problems in daily life due to these thoughts or behaviors.
Co-Occurring Conditions with OCD
Obsessive-compulsive disorder (OCD) often co-occurs with many other mental health conditions. These include:
OCD and Anxiety
Anxiety is a condition marked by excessive fear and worry. As OCD is also considered an anxiety disorder, many individuals are diagnosed with both conditions. For example, people with OCD can present with one or more of the following: generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobias, etc. While all these conditions are typified by excessive fear, they vary in terms of behavior, which means the symptoms of people with co-occurring anxiety and OCD will also vary.
OCD and Major Depressive Disorder (MDD)
Major depressive disorder (MDD) is characterized by persistent sadness or hopeless moods, decreased energy, and difficulties concentrating and sleeping for a period of 2 weeks or more. While the causes are not clear, evidence suggests that OCD and depression can occur together due to factors such as low serotonin levels, the stress of living with OCD symptoms, and the possibility that depressive symptoms are linked with obsessions and compulsions. Some research suggests that two-thirds of people with OCD will experience a major depressive episode in their lifetime.
Body Dysmorphic Disorder (BDD)
Body Dysmorphic Disorder (BDD) shares many similarities with OCD, which is why the two conditions often occur together. People with BDD and OCD both have obsessive and uncontrollable thoughts and behaviors. The primary difference is that BDD focuses primarily on the body (e.g., chronic mirror checking, seeking reassurance about their appearance), whereas OCD will focus on other behaviors (e.g., repetitive counting, avoiding contamination).
OCD and Eating Disorders
As some of the characteristics of eating disorders are similar to OCD, it is no surprise that these also occur together. Eating disorders involve obsessive thoughts about food and body image, as well as an intense fear of gaining weight. This can result in obsessive and compulsive food rituals, such as cutting food symmetrically, choosing foods by color, or hoarding certain items. Another trait these two disorders share is an anxiety-driven quest for perfection or to attain an imagined ideal.
OCD and Bipolar Disorder
Bipolar disorder is marked by extremes in mood, energy, and behavior. This is characterized by a fluctuation between intense highs in energy and mood (known as mania) and intense lows (known as depression). While the exact link isn’t yet clear, research has shown strong connections between bipolar disorder and OCD. People with bipolar disorder and OCD also tend to present with additional conditions, such as panic disorder.
OCD and Attention-Deficit Hyperactivity Disorder (ADHD)
Attention-deficit hyperactivity disorder (ADHD) is a condition that is typified by impulsive behaviors, hyperactivity, and attention difficulties. However, it can be challenging to diagnose one or both conditions due to the similarities in symptoms. For example, teachers can mistake poor school performance and inattention for ADHD when in fact it is OCD (or sometimes both). One way to determine what is going on is to see how an individual’s OCD behaviors change in response to medications like Ritalin.
OCD and Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a condition that results after a person witnesses or experiences a traumatic event. Symptoms include hypervigilance (increased alertness), flashbacks, nightmares, panic attacks, and more. It is estimated that 30% of individuals with PTSD will develop OCD within a year of their diagnosis. Because PTSD and OCD are both anxiety-related disorders, it is no surprise that they often occur together.
Tic Disorder (Tourette’s)
Some people with OCD also have a tic disorder such as Tourette’s Syndrome. This is typified by sudden, repetitive movements like eye blinking or facial tics, grimaces, shoulder shrugging, or head or shoulder jerking. Some people also present with vocal tics like grunting, repetitive words, sniffing, or throat clearing. While the exact relationship between these two conditions is not fully understood, research shows that up to 60% of people with Tourette’s also have OCD.
Signs of Obsessive-Compulsive Disorder
Signs and symptoms of OCD are grouped into obsessions and compulsions:
- Fear of germs or contamination.
- Unwanted or intrusive thoughts about taboo subjects such as sex, religion, or violence.
- Fears of losing a loved one to injury or illness.
- Aggressive thoughts towards oneself or others.
- Needing to have things symmetrical or in perfect order.
- Fears of losing or misplacing something.
- Excessive cleaning and/or handwashing.
- Ordering and arranging things in a precise way.
- Repeatedly checking things (e.g., repetitively checking that the door is locked or that the oven is off).
- Compulsive counting and/or being obsessed with “good” and “bad” numbers.
- Excessive praying out of religious fear.
Underlying Risk Factors
While there is no exact cause of obsessive-compulsive disorder, there are several key risk factors. These include:
The connection is not entirely clear, but some brain imaging studies indicate that there are differences in the frontal cortex and subcortical structures of the brain in patients with OCD.
Like many mental health disorders, twin and family studies indicate that people with close relatives with OCD have a higher risk of developing the condition themselves. The risk is even higher if the close relative developed OCD as an adolescent.
Environmental factors such as childhood trauma and unstable, dysfunctional households are also contributing factors to OCD. However, more research is needed to fully understand these factors.
According to the National Institute of Mental Health, some children who have a streptococcal infection can also develop OCD or OCD symptoms. This is known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).
Why Do People with OCD Abuse Substances?
Many mental health conditions are accompanied by substance abuse and addiction. Below are some of the main reasons individuals with obsessive-compulsive disorder turn to substance abuse:
Individuals who struggle with mental health conditions such as OCD will often self-medicate using substances. Whether it’s alcohol, prescription medications, or street drugs, individuals with OCD may try to ease their intense anxiety by turning to substances. The problem with using substances to achieve relief is that it not only leads to addiction, but it can also exacerbate OCD symptoms, such as anxiety and depression —particularly when the drugs wear off.
Living with the symptoms of OCD can also cause someone to feel socially isolated. Many people with OCD are aware of their unusual behaviors and how they may not make sense to other people. This can cause them to feel alone and ashamed of their actions, preferring to isolate themselves rather than explain their behavior to others. These feelings, combined with seclusion, can lead them towards substance abuse.
Neurological factors also play a role in substance abuse and mood disorders. Neurotransmitters such as dopamine, serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) are thought to be connected to depression, addiction, and impulse control. As mentioned above, an imbalance in these neurochemicals (especially serotonin) is thought to be a contributing factor to the development of OCD and depression. Conversely, if an individual has a pre-existing imbalance in these neurotransmitters, they could be more prone to addiction and substance abuse.
How Does Substance Abuse Affect Obsessive-Compulsive Disorder?
Another factor when it comes to OCD and substance abuse is how they affect each other. Below, we explore some of the substances that are commonly abused by individuals with OCD, and describe what the effects are.
Alcohol & OCD
It can be tempting to drink alcohol because it relaxes the body. As a nervous system depressant, alcohol can temporarily numb or calm the nerves of someone with anxiety and OCD. While an occasional drink isn’t harmful, using alcohol frequently and in large amounts can increase anxiety in the long term. The reason is that the body quickly builds up a tolerance to alcohol which can prompt someone to drink larger and larger amounts. Once alcohol is abused and taken in excess, the withdrawal will exacerbate anxiety, which can worsen someone’s OCD symptoms.
Stimulants & OCD
Individuals with anxiety will sometimes take prescription stimulants to help them study and stay focused. Adolescents are also sometimes prescribed stimulants to control their ADHD. However, the problem with stimulants is that they excite the nervous system, which causes adrenaline and other hormones to flood through the body. Stimulants excite the entire nervous system, resulting in increased heart rate, blood pressure, and body temperature, which then stimulates the production of adrenaline. This process can cause a person to feel even more anxious than before. Therefore, stimulants can have a detrimental effect on a person’s anxiety and OCD symptoms —even to the point of increasing them.
Cannabis & OCD
Cannabis is a complicated substance, because it can act as both a depressant and as a stimulant. Some individuals find that cannabis creates a relaxing effect in the body, which is why they turn to it for anxiety. However, while cannabis can provide temporary relief, one of the side effects is anxiety, especially if it’s taken in large doses or over a long period. High levels of THC in the body are linked to negative side effects such as anxiety, paranoia, increased heart rate, sweating, hallucinations, and more. These effects can worsen someone’s OCD symptoms.
Signs of Substance Abuse Disorder/Addiction
If you have OCD and you’re concerned about your alcohol or drug use, here are some key signs to watch out for, as they can be clear indications of addiction.
Occurs when your body is used to the drug and requires larger amounts to achieve the desired effects.
These symptoms present as physical and emotional discomfort, such as nausea, tremors, nervousness, cold sweats, or agitation when stopping drug use.
Occurs if your drug use has led you to feel guilty or sad, even though you are taking the substance to feel better.
This happens if you try to stop taking the drug but find yourself going back to it due to intense cravings or withdrawal symptoms.
OCD & Substance Abuse Stats
- Obsessive-compulsive disorder affects around 2.2 million adults in the U.S.
- 19 is the average age of onset of OCD in the U.S. 25% of people with OCD are typically diagnosed by age 14.
- According to the American Journal of Medical Genetics, in families with a history of OCD, there’s a 25% chance that another member will develop it in their lifetime.
- It is estimated that the lifetime occurrence of OCD in American adults is between 2.3% and 6%.
Stats by Co-Occurring Conditions
- Of the 2 million adults with OCD, roughly 25% to 40% also abuse substances.
- Less than 50% of people with OCD and substance use disorders seek treatment for their OCD.
- It is estimated that the lifetime co-occurrence of OCD and anxiety ranges from 31.9% to 34.6%.
- It is estimated that 30% to 50% of individuals with ADHD also have co-occurring conditions, such as anxiety and OCD.
- The estimates for co-occurring depression and OCD are as high as 45.9% to 68.4%.
- The lifetime prevalence rates of OCD and bipolar disorder vary widely and are estimated to be between 6% to 55%.
Obsessive-Compulsive Disorder & Substance Abuse Treatment Options
Treating obsessive-compulsive disorder and substance abuse is possible, but it usually involves multiple forms of therapy, especially as individuals usually also suffer from co-occurring conditions. This is best done using multiple levels of care that begin with detox and continue through to inpatient/residential, outpatient, and aftercare programs.
If you need to seek help, many of these programs are found in rehab facilities or drug treatment centers across the country.
Centers that offer dual diagnosis treatment are recommended, as they are set up to diagnose and treat concurrent mental health conditions and substance abuse. This kind of treatment is especially useful for people who have underlying issues such as OCD, bipolar disorder, anxiety, and depression. Dual diagnosis programs allow clinicians to safely address these conditions while an individual withdraws from alcohol or drugs. Dual diagnosis treatment programs can be found in both inpatient and outpatient clinics.
Other key treatments that are useful it comes to OCD and substance abuse are:
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) helps individuals change negative cycles of thought and behavior into more positive ones. When it comes to OCD, especially, CBT can help identify where a person’s obsessions and compulsive behaviors stem from. Clients receiving CBT for addiction and OCD learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, how to understand the behavior and motivation of others, and how to develop a greater sense of self-understanding and confidence.
CBT also teaches clients how to find solutions to triggers that might encourage drug use. CBT is known to be effective and long-lasting, as clients can continue utilizing these strategies once their therapy sessions have ended.
Dialectical-Behavior Therapy (DBT)
Another highly effective modality is dialectical-behavior therapy (DBT), a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients better regulate their moods, impulsiveness, and how to develop healthy coping skills. This kind of therapy is useful for people who have co-occurring conditions, especially those who have OCD, depression, and bipolar symptoms. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
Eye Movement Desensitization and Reprocessing (EMDR)
Since a history of trauma can cause or exacerbate OCD, treatments such as EMDR that focus on trauma are also effective. Consisting of 8 phases, EMDR is led by a therapist who guides an individual through a series of rapid eye movements to help redirect negative or traumatic memories. This redirection helps the person form new connections or associations so that the memory is less emotionally distressing over time. This therapy is therefore useful for individuals with mood disorders, as it helps them overcome the emotional suffering associated with traumatic events.
Seeking Safety is an evidence-based counseling model that helps individuals attain safety from trauma and/or substance abuse. The sessions can be delivered in individual or group settings, and consist of different topics such as setting boundaries, coping with triggers, self-nurturing, and taking back personal power.
Seeking Safety has been successfully implemented across vulnerable populations, including the homeless, victims of domestic violence, military personnel, and more. It has also proven to be effective for all types of addictions, making it a useful therapy for individuals with trauma and substance abuse issues.
Transcranial Magnetic Stimulation (TMS)
The Food and Drug Administration (FDA) recently approved TMS as a form of therapy for OCD. While research outcomes are still in their infancy, TMS may be useful for this condition, as it utilizes a repetitive magnetic pulse to calm the parts of the brain that cause obsessions and compulsions. In some cases, treatment can take up to 30 sessions for 6 weeks.
Medications can also be a useful treatment modality for obsessive-compulsive disorder and substance abuse. Medications that have shown to be effective for the treatment of OCD include:
Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs) are often used to help reduce OCD symptoms. Common SRIs and SSRIs include Zoloft, Prozac, and Paxil.
Mood stabilizers may be required for individuals with OCD and bipolar disorder. These medications can help treat addiction, impulsive behavior, and rapid changes in mood. Common mood stabilizers include Lithobid, Depakote, Lamictal, and Tegretol.
Anxiolytics (Anti-Anxiety Drugs)
Many individuals with substance abuse disorder and OCD also have intense anxiety; therefore, anti-anxiety (anxiolytics) medications such as benzodiazepines are also sometimes prescribed. Common anxiolytics include Ativan, Klonopin, Xanax, and Valium.
Alternative or Holistic Therapies
Holistic therapies are also effective at treating addiction and anxiety. The purpose of holistic therapies is to treat the whole person, and not just the symptoms. These approaches can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies include:
- Relaxation techniques
- Nutritional therapy
- Animal-assisted therapy (e.g., emotional support dogs)
- Adventure therapy (e.g., hiking or rock climbing)
- Mindfulness and meditation
- Art therapy and music therapy
- Yoga, Tai-Chi
- Equine-assisted (horse) therapy
Alongside these treatments, there are other ways to enhance your recovery by making personal lifestyle adjustments, like the ones below:
This can stimulate endorphins which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises such as walking, running, swimming, cycling, or yoga.
This can help calm anxious or racing thoughts and reduce impulsive behavior, which is useful when recovering from OCD and addiction.
The right diet can help repair the damage incurred from sustained drug use and lead to improved immunity, cognitive function, and energy.
Learning to avoid triggers, like certain people, situations, or circumstances, can help prevent OCD symptoms and a desire to take drugs.
While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.
If you or a loved one are struggling with obsessive-compulsive disorder and substance abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Anxiety & Depression Association of America. Obsessive-Compulsive Disorder (OCD). ADAA. https://adaa.org/understanding-anxiety/co-occurring-disorders/obsessive-compulsive-disorder.
Beyond OCD. (n.d.) Disorders That May Co-exist with OCD. Beyond OCD.org. https://beyondocd.org/ocd-facts/related-conditions.
Lesser, B. (2021). The Connection Between Obsessive Compulsive Disorder and Addiction. Dual Diagnosis.org. https://dualdiagnosis.org/ocd-addiction.
National Institute of Mental Health. (n.d.) Obsessive-Compulsive Disorder: When Unwanted Thoughts or Repetitive Behaviors Take Over. NIH. https://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/20-mh-4676-ocd_150041.pdf
Smith, C. (2021). Alcohol and Obsessive-Compulsive Disorder. Alcohol Rehab Guide. https://www.alcoholrehabguide.org/resources/dual-diagnosis/alcohol-obsessive-compulsive-disorder.
Substance Abuse and Mental Health Services Administration. (2016). Obsessive-Compulsive Disorder and Substance Use Disorders. https://store.samhsa.gov/product/Advisory-Obsessive-Compulsive-Disorder-and-Substance-Use-Disorders/SMA16-4977.
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