OCD and Addiction

Do You Have OCD?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted thoughts and repeated behaviors that you are compelled to perform. Common features of OCD are obsessive thoughts and behaviors that are so compulsive that they interfere with your daily life.

Although it’s not known how many people with OCD also have a substance use disorder (SUD), studies show that people with OCD have a higher rate of addiction than the population in general. Research puts it at about 30%, and alcohol is the most commonly abused substance.

Repetitive Behaviors

It’s normal to occasionally double-check to make sure you locked the door. It’s also normal to worry that you might have been exposed to germs or a virus. You might even have troublesome thoughts from time to time. However, if you have OCD, your brain gets stuck on a certain thought or urge like an old film that’s stuck on the same frame.

You might find you have to check the lock on the door 25 times to be certain that it’s really locked because you are terrified of burglars. You might need to wash your hands until they’re sore and raw because you are paralyzed at the thought of germs or dirt. These repetitive behaviors don’t give you any pleasure by doing them. Yet, they do give you some brief relief from the anxiety caused by your obsessive thoughts.

Obsessions

ocd and addiction

Typical Obsessive Thoughts

Obsessive thoughts are involuntary thoughts, images, or impulses that happen over and over in your mind. This isn’t something you’re trying to do, but you can’t stop. Regrettably, these obsessive thoughts are usually disturbing and distracting. They include:

Compulsions

Compulsions are behaviors or actions that you are compelled to act out over and over. They’re usually done in an effort to make the obsessions go away. A person obsessed with germs or contamination might develop compulsive cleaning rituals. But still, the relief never lasts and the obsessive thoughts tend to reappear even stronger. This then leads the compulsive behaviors to cause even more anxiety because they become so urgent and time-consuming. It’s an unending cycle of obsessive thoughts to compulsive behaviors and back to obsessive thoughts, etc.

Typical OCD Compulsions

Causes of OCD

Even though the causes aren’t known at this time, there are several theories about the causes of obsessive-compulsive disorder including:

Several factors may interact to spark the development of OCD. Primary, underlying causes might also be influenced by hormonal changes, personality traits, and troubling life events.

What is Substance Use Disorder?

Substance use disorder, also known as addiction, is a brain disease that is exposed by the urgent need to use a substance despite the negative consequences. An individual with an addiction will focus on using certain substances to the point where it takes over their life. And they will use more and more to reach the pleasure they felt initially. In this case, the relief from their anxious thoughts.

You may be able to avoid all the situations that trigger your obsessions and compulsions, but most people find that to be impossible. Unfortunately, many people try to self-medicate with drugs or alcohol. If you take this path to relieve your OCD symptoms, you will find yourself with a substance use disorder.

Your Addicted Brain

Individuals with SUD have distorted thinking, behavior, and body functions. Changes to certain neurotransmitters in the brain cause people to have strong cravings for the substance of abuse. Therefore, it becomes almost impossible to stop using it. Studies of the brain use imaging that shows changes in the brain areas that have to do with judgment, decision making, learning, memory, and behavior control.

Clearly, using drugs and alcohol can have a harmful effect on the way the brain functions. But the changes last long after the first effects of the drug, which is called intoxication. Intoxication is the extreme pleasure, heightened senses, and high caused by the substance. The symptoms of intoxication are different for each substance.

Eventually, people with addiction need more and more of the substance to experience the same effects they felt at first. This symptom of SUD is called tolerance. People who continue to build their tolerance are at higher risk for an overdose because they either use too much at one time or use too many times.

Substance Use Disorder Symptoms

Symptoms of SUD are usually grouped into 4 categories:

  1. Loss of control: The individual with SUD will have a strong craving or urge to use the substance. There will be attempts to quit or control substance use that will end in failure.
  2. Problems in social situations: Addictions can cause failure to complete tasks at work, school, or home. Work and leisure activities are cut back or given up entirely due to substance abuse.
  3. Risky use: Using substances in risky environments and continuing to do so despite known possible consequences.
  4. Effects of use: Tolerance with regular use and withdrawal symptoms when stopping.

Co-Occurring Disorders

People often have both a mental disorder and addiction. In fact, more than half the people with serious mental conditions also have a substance use disorder of some type. Sometimes, the mental illness is present before the addiction. On the other hand, the addiction might have worsened the mental illness. This condition is called a dual diagnosis. Either way, they need to be treated at the same time.

OCD sufferers frequently use drugs or alcohol to subdue the intensity of their obsessions and the compulsions produced by the obsessions. They find that the calm and improved mood provides a very much-needed relief. However, the relief is only temporary and usually only ends up causing more severe symptoms of both conditions.

Treating a Dual Diagnosis

Unfortunately, it can be difficult to find treatment for someone who has a mental disorder and an SUD. Many treatment programs that treat mental disorders are not experienced at treating SUDs and programs that treat SUDs are commonly not prepared to treat mental illnesses. Because of this, people with dual diagnoses often go from one program to another. Or worse, they are refused by single-diagnosis treatment programs.

Substance abuse makes almost every phase of treatment more complicated for a person with a mental disorder. The standard of care for most medical professionals when treating comorbid OCD and addiction is to treat the SUD first and then the OCD. However, a recent study researched treating both SUD and OCD at the same time. The research reported positive results, which included a reduction in the severity of the OCD symptoms, longer time spent in treatment, and better abstinence rates as compared to the typical practice.

Treatment for OCD and Addiction

Studies of OCD discovered that the lifetime prevalence for co-occurring OCD and addiction is steadily in the 25% range. For people who meet the criteria for both conditions, it’s important to develop a thorough evaluation to be able to provide the most effective treatment.

Evaluation

It’s also important to remember that it’s common for people with both OCD and addiction to try to hide their symptoms. They do this partly due to embarrassment, shame, and/or denial of the severity of their symptoms. As a result of this, the evaluation process is often done by gathering information throughout several sessions. It’s not just a one-session conclusion.

Family Involvement

Once you identify co-occurring OCD and addiction, the next thing to consider in the evaluation is how the symptoms of each disorder have affected the family system. It is common for families to enable patients, usually intending to be supportive. Frequently there needs to be a recovery process for family members.

Exposure Response Prevention (ERP) for OCD

ERP is considered a behavior therapy because it focuses mainly on modifying the patient’s behavior. Patients with OCD are asked to confront or “expose” themselves to the images, thoughts, and/or situations that cause their anxiety and trigger their obsessions. The response prevention part in ERP refers to the patient making a conscious choice not to engage in compulsive behavior after the anxiety or obsessions have been triggered.

Twelve-Step Facilitation (TSF) for SUD

TSF for substance abuse patients combines professional treatment with the experiences of going to a mutual self-help group. This enhances the benefits and use of 12-step meetings such as Alcoholics Anonymous (AA). TSF is a structured approach to helping with early recovery from alcoholism and other drug abuse and addiction problems.

Clinicians might choose to use the AA manual or adjust treatment based on the principles of TSF. The goal is to highlight the value of less isolation and increased recovery-focused social interactions.

Cognitive Behavioral Therapy (CBT) for OCD and Addiction

CBT is an expansive treatment method that has been effectively used with both OCD and addiction patients. The point of CBT is to teach people to increase their awareness of their thought processes. Once they increase their awareness, they learn to respond differently to negative patterns of thinking and behavior.

For example, CBT might help a person be aware of the stressors, situations, and feelings that lead to substance use. The individual can then avoid them or make different choices when they happen. Likewise, CBT for OCD can teach the patient how to increase their awareness of when they are experiencing obsessions. The therapist can then help them learn different responses as opposed to compulsive behavior.

Medication-Assisted Treatment (MAT) for OCD and SUD

MAT is a combination of medication and behavioral therapies. Studies have looked at OCD and SUD separately and repeatedly indicate that the use of medication combined with behavioral treatment is a practical option that often improves the outcome. They include:

What Will You Do?

Did you recognize yourself or someone close to you? Although OCD is frequently a subject of humor to the public in general, at CNV Detox we know there’s nothing funny about it. And having to turn to drugs or alcohol to ease your symptoms is a very serious matter.

We are a dedicated group of professionals whose only job is to help you or your loved one. In fact, we specialize in dual diagnosis treatment. Contact us now. Get off the OCD-SUD cycle and let CNV get your life heading in the right direction.

References:

www.helpguide.org

www.psychiatry.org

www.iocfd.org/expert-opinions

www.betterhealth.vic.gov.au

www.treatmyocd.com

www.dartmouthedu/eap/library